The identification of mixed features during a major depressive episode is important due to the worse course and treatment issues associated with this condition. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition mixed features specifier criteria are controversial, because it includes typical manic symptoms, whereas it excludes overlapping excitatory symptoms that are frequently reported in mixed depression. Psychomotor agitation, mood lability, and aggressiveness are the new proposed criteria based on the results of the Bipolar Disorders: Improving Diagnosis, Guidance and Education-II-Mix study. Several clinical and course indicators of bipolarity were found to be associated with the presence of mixed characteristics, mainly overlapping excitatory symptoms, during a major depressive episode.
Cel pracyLeki przeciwpadaczkowe (LPP), które są powszechnie stosowane w zapobieganiu nawrotom i leczeniu ostrych faz choroby afektywnej dwubiegunowej (ChAD) oraz zaburzeń schizoafektywnych (schizoaffective disorder, SAD), często wiążą się z działaniami niepożądanymi w czasie ciąży oraz z poważnymi wadami wrodzonymi (major congenital malformations, MCM). Celem niniejszej pracy było podsumowanie dostępnych badań oceniających skutki stosowania leków przeciwpadaczkowych u ciężarnych kobiet z ChAD i /lub SAD.MetodaPrzeszukano cztery bazy danych od początku do 18 stycznia 2019 roku. Do przeglądu włączono recenzowane badania obserwacyjne dotyczące stosowania LPP u ciężarnych kobiet z ChAD lub SAD. Wykluczono badania nieprzedstawiające danych dotyczących ChAD lub SAD, nie określające stosowanych LPP lub nie oceniające wyników ciąży lub poważnych wad wrodzonychWynikiŁączna ilość znalezionych badań wyniosła 2861. Po usunięciu zdublowanych badań i zastosowaniu kryteriów włączenia/wykluczenia do przeglądu włączono 9 badań obserwacyjnych oceniających pacjentki z ChAD i SAD. Badano następujące LPP: lamotrygina (LTG), kwas walproinowy (VPA), karbamazepina (CBZ), okskarbazepina (OXC), topiramat (TPR) i gabapentyna (GBP). Kwas walproinowy i karbamazepina były lekami przeciwpadaczkowymi, których stosowanie najczęściej wiązało się z poważnymi wadami wrodzonymi. Lamotrygina wykazywała najlepszy profil bezpieczeństwa. U leczonych i nieleczonych kobiet z ChAD obserwowano wyższe wskaźniki powikłań w czasie ciąży w porównaniu ze zdrowymi ciężarnymi.WnioskiStosowanie leków przeciwpadaczkowych w ciąży może mieć niekorzystne skutki oraz prowadzić do poważnych wad wrodzonych u dzieci kobiet z ChAD lub SAD, przy czym wyższe ryzyko występuje przy stosowaniu wyższych dawek. U tego typu pacjentek można rozważyć podawanie lamotryginy, biorąc pod uwagę niski poziom działań niepożądanych. W czasie ciąży należy unikać stosowania kwasu walproinowego i karbamazepiny.
Background: Patients with schizoaffective disorder (SAD) suffer from cognitive impairment, which negatively influences their functionality. Cognitive remediation (CR) interventions have been shown to be effective in patients with schizophrenia (SZ) and bipolar disorder (BD), but evidence in SAD is limited so far. The aim of this study is to systematically review the published data on CR interventions, either in neurocognition or social cognition, in patients with SAD.Methods: We conducted a comprehensive, computerized literature search using terms related to CR interventions in psychotic and affective disorders, and particularly in SAD. Pubmed, Embase, and Web of Knowledge databases were used up to February 28th, 2018 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search returned 2672 articles of which four were finally selected meeting the inclusion criteria.Results: Cognitive Enhancement Therapy, computerized Cognitive Remediation Therapy and Cognitive Training showed positive results in subsamples of patients with SAD regarding neurocognition and functioning in comparable terms to patients with schizophrenia as well as in a greater extent in quality of life. Benefits in social cognition were also described when Social Cognition Interaction Training was considered in patients with SAD.Conclusions: CR interventions seem to improve neurocognition and social cognition in patients with SAD as well as functioning and quality of life. However, further randomized controlled trials on CR interventions with an optimized design focusing on selected sample of patients with SAD are imperative.
This review examines the association between the perinatal period and thoughts and behaviours of neonaticide, infanticide, and filicide, highlighting mothers' risk factors. A literature search was conducted on PubMed, PsycINFO, and ScienceDirect, with 2,957 articles screened and 13 determined as eligible for inclusion. Inclusion criteria were: 1) studies on neonaticide, infanticide and filicide; 2) studies conducted on women; 3) studies with perinatal population; 4) original, peer-reviewed studies; 5) studies written in English or Italian language. Single-case reports and qualitative studies were excluded, as were those studies written in any other language, and any studies for which the full-text version could not be obtained (i.e. conference abstracts). Two reviewers independently reviewed titles and abstracts, reviewed relevant articles' full text, and extracted the data. Several individuals and socio-environmental risk factors were identified for neonaticide, infanticide, and filicide during the perinatal period, highlighting the importance of paying particular attention to the mother's well-being in this critical phase. Women who committed neonaticide, infanticide, or filicide faced a variety of challenges in their lives. Such life events might prompt mental health professionals to address the possibility of harmful acts in their patients.
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