ABSTRACT
BACKGROUND: There is no national protocol for the use of light therapy in bipolar depression.
AIM: The chronotherapy collaboration group of the Foundation for Bipolar Disorders intended to write a protocol for light therapy in bipolar depressive episodes.
METHOD: Narrative review of several systematic reviews, two clinician's guides and deliberation with the sub-commission Guidelines of the Dutch Ophthalmologic Society.
RESULTS: The following indication was established: depressive episode, with or without seasonal features, in bipolar I or II disorder, including subsyndromal (depressive) seasonal complaints. The list of relative contra-indications (pre-existent retinal illnesses, systemic illnesses with effect on the retina and use of photosensitive medication) was shortened. In this case the medical professional discusses the possibility of an ophthalmologic consultation with the patient. Use of a mood stabilizer/antimanic medication in order to prevent mania or a mixed episode is only necessary in a depressive episode in bipolar I, but not in bipolar II disorder. Standard treatment is 10.000 lux white light during 30 minutes in the morning.
CONCLUSION: There is sufficient evidence to propose light therapy in a bipolar depressive episode with or without seasonal features.
Subject(s)
Bipolar Disorder , Phototherapy , Bipolar Disorder/therapy , Humans , Psychotropic Drugs/therapeutic use , Review Literature as TopicABSTRACT
BACKGROUND: Research into the nature and extent of cognitive dysfunction in patients suffering from bipolar disorder has increased greatly over the last 10 years because the dysfunction is known to persist even if the mood symptoms are in remission and can influence a patient's psychosocial functioning. AIM: To provide an overview of 1) the nature and extent of cognitive dysfunction in bipolar patients; 2) clinically relevant factors such as illness characteristics, comorbidity and psychotropic/psychoactive drugs and 3) the consequences of cognitive dysfunction. METHOD: We searched the literature in PubMed using the following search terms: bipolar disorder, neuropsychological, cognitive functioning, cognition, functional outcome, determinants, psychotropic/psychoactive drugs. RESULTS: Attentional deficits, memory lapses and aberrant executive functioning occur in both manic and depressive episodes, and may persist even in absence of mood symptoms. The precise cause of cognitive dysfunction is unknown. Persistent cognitive dysfunction frequently interferes with daily functioning. CONCLUSION: Since the treatment of bipolar patients is nowadays directed towards complete recovery rather than symptomatic remission, it is important to take into account the possibility that these patients are also suffering from cognitive dysfunction.
Subject(s)
Bipolar Disorder/epidemiology , Cognition Disorders/epidemiology , Executive Function/physiology , Bipolar Disorder/psychology , Cognition Disorders/psychology , Comorbidity , Depressive Disorder, Major/epidemiology , Depressive Disorder, Major/psychology , Humans , Neuropsychological Tests , NeuropsychologySubject(s)
Cognitive Behavioral Therapy , Gynecologic Surgical Procedures , Vulvitis/surgery , Women's Health , Clinical Competence , Cognitive Behavioral Therapy/methods , Decision Making , Female , Gynecologic Surgical Procedures/methods , Humans , Pain/etiology , Pain Management , Patient Participation , Professional-Patient Relations , Vulvitis/prevention & control , Vulvitis/psychologyABSTRACT
OBJECTIVE: To determine the additional value of mediastinoscopy/tomy in the pre-surgical staging of non-small-cell lung carcinoma. DESIGN: Retrospective. METHODS: Patients who underwent mediastinoscopy/tomy for staging of non-small-cell lung carcinoma from 1994 to 2000 at Groningen University Hospital, the Netherlands, were evaluated. Starting with data on history, physical examination, data imaging tests and bronchoscopy, the additional value of the mediastinoscopy was then evaluated using a logistic regression model. Not only was the additional value of a limited, routinely performed mediastinoscopy (whereby only lymph nodes at the site of the primary tumour are biopsied) examined, but also that of the comprehensive standard mediastinoscopy (conforming to the minimal requirements regarding number and localization of biopsied lymph nodes, i.e. lymph-node stations 2L, 2R, 4R, 4L, 7). The outcome against which all the test results were measured was the result of final pathological tumour staging. RESULTS: A total of 176 evaluable patients were included. History, physical examination and bronchoscopy played a small but significant role in predicting the percentage of patients in which resection was possible, 58% (95% CI: 50-67). Age was an important predictor. The subsequent addition of the limited and routinely performed mediastinoscopy to the model increased the correct prediction to 69% (95% CI: 61-77), while adding the standard mediastinoscopy to the model showed a significantly higher correct prediction of 81% (95% CI: 75-88). CONCLUSION: The standard mediastinoscopy involving a minimum of five different lymph node stations was of greater diagnostic value than limited mediastinoscopy.
