Practical considerations in the pharmacological treatment of bipolar disorder / 四川精神卫生

Bipolar disorder is one of the most common mood disorders characterized by an early age of onset and high prevalence rate， and patients tent to have poor prognosis due to high misdiagnosis rate and incomplete diagnosis rate. At present， existing pharmacological treatment for bipolar disorder remains highly variable. Therefore， this paper presents a review of indications of the medications， clinical therapeutic effect and adverse drug reactions， thus providing references for the pharmaceutical treatment of bipolar disorder.

Anticonvulsivantes y su efecto en el metabolismo de la vitamina D: revisión del tema, a propósito de un caso / Anticonvulsants and their effect on the metabolism of vitamin D: literature review with case report

La epilepsia es una enfermedad neurológica frecuente que afecta a cerca de 50.000 millones de personas en el mundo. En Chile, la prevalencia estimada es de 10.8 a 17 por 1.000 habitantes. La primera opción para su tratamiento son los fármacos antiepilépticos (FAE) los cuales logran un aceptable control de enfermedad en la mayoría de los casos, sin embargo, tienen la potencialidad de desencadenar una serie de efectos adversos destacando entre ellos el desarrollo de hipocalcemia (HC) secundaria a hipovitaminosis D (HD), alteración que por lo general es leve y asintomática. Presentamos el caso de una mujer perimenopausica con antecedente de epilepsia en tratamiento con anticonvulsivante que desarrolla hipocalcemia severa. Además revisamos los mecanismos descritos a través de los cuales los FAE afectan el metabolismo de esta vitamina.

Epilepsy is a common neurological disease that affects about 50,000 million people in the world. The estimated prevalence is 10.8 to 17 per 1.000 inhabitants in Chile. The first option for its treatment are antiepileptic drugs (AEDs) which achieve an acceptable control of the disease in most cases, however, they have the potential to trigger a series of adverse effects (AE) highlighting among them the development of hypocalcemia (HC) secondary to hypovitaminosis D (HD), an alteration that is generally mild and asymptomatic. We present the case of a perimenopausal woman with a history of epilepsy under treatment with an anticonvulsant who develops severe hypocalcemia. We also review the mechanisms described through which AEDs affect the metabolism of this vitamin.

La Epilepsia en la mujer embarazada / Epilepsy in the pregnant woman

Introduction: epilepsy is defined as the presence of recurring unprovoked crisis, and whose treatment is typically an antiepileptic drug regimen taken daily for a long time. About 1 in 200 pregnant women develop epilepsy (0.5%). Women with epilepsy have a higher risk of poor outcomes of pregnancy, although most of their children will be normal. In pregnancy, the main risks for the mother and child are the result of poor control of their epilepsy and an elevated risk of major congenital malformations after to antiepileptic treatment. Treatment should be given to control crisis during pregnancy, despite its teratogenic potential, since the effects of epilepsy crisis are much more harmful to both mother and fetus. The treatment has to be administered as monotherapy, with minimal and effective doses able to control the crisis. In addition to the antiepileptic treatment, it is essential for the pregnant woman to be treated with folic acid at prophylactic doses of 0.4 mg daily and vitamin K with dose of 20 mg daily for the last month of pregnancy in order to prevent neural tube defects and maternal and fetal bleeding. It should also be given to the newborn immediately with a dosage of 1mg IM. The objective of this study was to determine treatment regimens that can be used to control epilepsy in pregnant women, and other measures to be taken in order to minimize the risks to the mother and fetus.

Intake rate of folic acid among pregnant women consulting the Japan Drug Information Institute in Pregnancy / 医薬品情報学

<b>Objective: </b>In 2000, the Ministry of Health and Welfare issued an advisory that recommended intake of 0.4mg of folic acid in dietary supplements to reduce the risk of development of neural tube defects.  Since subsequent reports of questionnaire surveys by various investigators showed a low in the intake rate, we surveyed and evaluated the folic acid intake rate among the pregnant women consulting the Japan Drug Information Institute in Pregnancy.<br><b>Methods: </b>We evaluated differences in folic acid intake rate according to the consulting women’s background factors. i.e., age, pregnancy planning, pregnancy history, and taking of anticonvulsant drugs in the 1053 women capable of participating in the survey among the 1061 pregnant women who requested a consultation with the Japan Drug Information Institute in Pregnancy between April 2006 and August 2008.<br><b>Results: </b>According to the result of our survey, the intake rate of folic acid was 29% of the 1053 pregnant women.  The only 3 women of the 42 pregnant women taking anticonvulsant drugs took folic acid before they got pregnant.<br><b>Conclusion: </b>Even now, 8 years after the Ministry of Health and Welfare advisory, the folic acid intake rate is low.  Drawing upon successful measures promoting intake in the U.S. and Canada,we play a vital role in delivering this critical health information to pregnant women.