How to make online mood-monitoring in bipolar patients a success? A qualitative exploration of requirements.

BACKGROUND: The Life-Chart Method (LCM) is an effective self-management treatment option in bipolar disorder (BD). There is insufficient knowledge about the consumers' needs and desires for an e-monitoring solution. The first step towards a new mood monitoring application is an extended inventory among consumers and professionals. METHODS: The aim of the current study was: to identify opinions about online mood monitoring of patients with BD and professionals and to identify preferences on design, technical features and options facilitating optimal use and implementation of online mood monitoring. This study used a qualitative design with focus-groups. Participants were recruited among patients and care providers. Three focus-groups were held with eight consumers and five professionals. RESULTS: The focus-group meetings reveal a shared consciousness of the importance of using the Life-Chart Method for online mood monitoring. There is a need for personalization, adjustability, a strict privacy concept, an adjustable graphic report, and a link to early intervention strategies in the design. Due to the fact that this is a qualitative study with a relative small number of participants, so it remains unclear whether the results are fully generalizable. We can't rule out a selection bias. CONCLUSIONS: This study demonstrates the importance of involving stakeholders in identifying a smartphone-based mood charting applications' requirements. Personalization, adjustability, privacy, an adjustable graphic report, and a direct link to early intervention strategies are necessary requirements for a successful design. The results of this value specification are included in the follow-up of this project.

[A protocol for light therapy in bipolar disorder]. / Protocol voor lichttherapie bij bipolaire stoornis.

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.

Study protocol of a multicenter randomized controlled trial of mindfulness-based cognitive therapy and treatment as usual in bipolar disorder.

BACKGROUND: Despite multiple pharmacological interventions, many people with bipolar disorder (BD) experience substantial residual mood symptoms, even in the absence of severe mood episodes, which have a negative impact on the course of illness and quality of life. Limited data are available on how to optimize treatment for BD, especially for those who suffer from persistent and residual depressive symptoms. Preliminary evidence suggests Mindfulness-Based Cognitive Therapy (MBCT) as a psychological treatment option for BD. This study aims to investigate whether adding MBCT to treatment as usual (TAU) will result in symptomatic and functional improvements in adults with BD compared to TAU alone. METHODS/DESIGN: This study is a prospective, evaluator blinded, multicenter, randomized controlled trial of MBCT + TAU and TAU alone in 160 adults with bipolar type I and type II. Assessments will be conducted at baseline (T0), mid-treatment (Tmid), and at 3 (T1), 6 (T2), 9 (T3), 12 (T4), and 15 (T5) months follow-up. Primary outcome is post-treatment severity of depressive symptoms (Inventory of Depressive Symptomatology- Clinician administered). Secondary outcomes are severity of (hypo) manic symptoms, anxiety, relapse rates, overall functioning, positive mental health, and cost-effectiveness. As possible mediators will be assessed rumination of negative affect, dampening and rumination of positive affect, mindfulness skills, and self-compassion. DISCUSSION: This study will provide valuable insight into the (cost-)effectiveness of MBCT on clinician- and self-rated symptoms of BD, relapse rates, positive mental health, and overall functioning. TRIAL REGISTRATION: NCT03507647 . Registered 25th of April 2018.

Show yourself, a short film to show professionals at an admission ward your 'euthymic being' during an admission for mania.

BACKGROUND: The progress and recovery of a patient with mania during hospitalization is differently seen by professionals working at an admission ward and by relatives of the patient. Professionals often indicate that the situation of the patient is improving while relatives estimate the improvement to be minimal in relation to the recovery of the patient. OBJECTIVE(S): To develop an intervention to give professionals at an admission ward an impression of the patient in a euthymic mood state to provide professionals with information to plan and conduct individualized patient centred care. METHODS: Professionals, patients, and relatives were individually interviewed about the preferable content and use of a film in which patients' shows their 'euthymic being'. Content analysis was performed. RESULTS: An outline for the content and use of the film was developed. CONCLUSIONS: The intervention holds promise for clinical practice, but further development and testing is necessary.

High educational performance is a distinctive feature of bipolar disorder: a study on cognition in bipolar disorder, schizophrenia patients, relatives and controls.

BACKGROUND: Schizophrenia is associated with lower intelligence and poor educational performance relative to the general population. This is, to a lesser degree, also found in first-degree relatives of schizophrenia patients. It is unclear whether bipolar disorder I (BD-I) patients and their relatives have similar lower intellectual and educational performance as that observed in schizophrenia. METHOD: This cross-sectional study investigated intelligence and educational performance in two outpatient samples [494 BD-I patients, 952 schizophrenia spectrum (SCZ) patients], 2231 relatives of BD-I and SCZ patients, 1104 healthy controls and 100 control siblings. Mixed-effects and regression models were used to compare groups on intelligence and educational performance. RESULTS: BD-I patients were more likely to have completed the highest level of education (odds ratio 1.88, 95% confidence interval 1.66-2.70) despite having a lower IQ compared to controls (ß = -9.09, S.E. = 1.27, p < 0.001). In contrast, SCZ patients showed both a lower IQ (ß = -15.31, S.E. = 0.86, p < 0.001) and lower educational levels compared to controls. Siblings of both patient groups had significantly lower IQ than control siblings, but did not differ on educational performance. IQ scores did not differ between BD-I parents and SCZ parents, but BD-I parents had completed higher educational levels. CONCLUSIONS: Although BD-I patients had a lower IQ than controls, they were more likely to have completed the highest level of education. This contrasts with SCZ patients, who showed both intellectual and educational deficits compared to healthy controls. Since relatives of BD-I patients did not demonstrate superior educational performance, our data suggest that high educational performance may be a distinctive feature of bipolar disorder patients.

[Development of (hypo)mania during discontinuation of venlafaxine in two patients with bipolar disorder]. / Een (hypo)manie tijdens de afbouw van venlafaxine bij twee patiënten met een bipolaire stoornis.

The scientific literature frequently warns that patients with bipolar disorder risk developing a (hypo)mania on starting a course of antidepressants. In this case report, however, two patients with bipolar disorder developed a (hypo)mania while their dosage of venlafaxine was being gradually tapered off. We discuss a pharmacodynamic explanation for the induction of (hypo)mania during discontinuation of venlafaxine. We also discuss alternative explanations, such as a venlafaxine withdrawal syndrome; induction of rapid cycling; difficulties in distinguishing an agitated depression and a dysphoric mania and the naturalistic course of a bipolar disorder.

Major aphthous-like ulcers in two patients infected with human immunodeficiency virus.

Two patients infected with human immunodeficiency virus (HIV) presented with persistent, large, and painful oral ulcers. Results of cultures and examination of a biopsy specimen were negative for infection and malignancy. Major aphthous-like ulcers should be considered in the differential diagnosis of oral ulcers in the HIV-infected patient.

Orbital myositis, vitiligo, and giant cell myocarditis.

Giant cell myocarditis is a rare idiopathic inflammatory heart disease characterized histologically by multinucleated giant cells, and clinically by rapid progressive heart failure, arrhythmias, or sudden death, often within hours to days of initial symptoms. There are two previously reported cases of giant cell myocarditis with idiopathic orbital myositis. We report a similar case in a patient who also had vitiligo, a diagnostic endomyocardial biopsy, and survival because of a cardiac transplant. Giant cell myocarditis should be monitored for in the course of inflammatory orbital myopathy because of its life-threatening fulminant course.

Rothmund-Thomson syndrome associated with annular pancreas and duodenal stenosis: a case report.

The Rothmund-Thomson syndrome is a rare autosomal recessive condition. It is primarily a clinical diagnosis with manifestations that include poikiloderma, short stature, sparse hair, juvenile cataracts, small hands and feet, bone defects, photosensitivity, hypogonadism, defective dentition, onychodystrophy, and hyperkeratosis. There is only one published case of associated gastrointestinal abnormalities. We report a patient with Rothmund-Thomson syndrome with annular pancreas and duodenal stenosis.

Present status of eyelid phototherapy. Clinical efficacy and transmittance of ultraviolet and visible radiation through human eyelids.

BACKGROUND: Phototherapy for the eyelid has not previously been recognized as a safe and effective treatment of photoresponsive dermatoses of the eyelid, such as atopic dermatitis, vitiligo, psoriasis, lymphomatoid papulosis, and parapsoriasis. OBJECTIVE: The purpose of this study was to demonstrate the efficacy and safety of this treatment. METHODS: Two cases are presented to demonstrate clinical efficacy. In addition, a retrospective eye evaluation of seven patients receiving a combined total of greater than 1300 eyelid phototherapy treatments was performed. To determine whether potentially harmful UV radiation is significantly transmitted through eyelid skin, an in vitro study was conducted to measure the percentage transmittance of ultraviolet-visible radiation through five excised eyelids. RESULTS: In the two cases presented, remarkable improvement occurred without adverse side effects, suggesting that it is possible to deliver incremental UV dosages to eyelid skin to achieve clearing of skin disease. Retrospective analysis of patients' records revealed no ocular disease from the phototherapy. In vitro eyelid examination produced data that indicated negligible quantities of UV radiation were transmitted through eyelid skin compared with the visible spectrum, in which up to 77% of the radiation was transmitted through the tissue. CONCLUSION: The combined clinical experience and transmittance data suggest that eyelid phototherapy is a safe and effective treatment in selected patients.

Demographic and clinical data associated with acute necrotizing ulcerative gingivitis in a dental school population (ANUG-demographic and clinical data).

This study was undertaken to determine the prevalence of demographic and clinical factors of patients diagnosed as having ANUG as determined by the presence of painful, bleeding, necrotic and ulcerated interproximal gingival papillae. Results showed that ANUG patients were evenly divided between males and females relative to the general clinic population. 58% of the patients with ANUG were under 25 years of age as compared to 31% under 25 in the general clinic population. Overall, the ANUG group accounted for 1.4% of the under 34 age group in the general clinic population. 76% of the ANUG group had a high school education or less with 67% having less than $5,000 annual income. Only 20% presented with elevated temperature. Only 6% of the patients with ANUG were non-smokers as compared to 63% in a matched control group. Of great significance was the fact that only 1 patient with ANUG was black as compared to a 41% black population in the clinic population.

Leukocyte function in the etiology of acute necrotizing ulcerative gingivitis.

Patients with the diagnosis of acute necrotizing ulcerative gingivitis (ANUG) and their controls, matched for age, sex, race and general plaque accumulation, donated blood for differential white blood cell counts and for assay of several leukocyte functions. The leukocyte function assays included polymorphonuclear leukocyte (PMN) responsiveness to chemotaxis and phagocytosis, and lymphocyte responsiveness to stimulation by nonspecific mitogens. The differential leukocyte counts were within the normal range for all subjects tested, and there was no difference between ANUG patients and controls. The ANUG patients did, however, display significantly depressed PMN responsiveness in both chemotaxis and phagocytosis, compared to the controls. There was also reduced DNA synthesis by ANUG patients' lymphocytes upon stimulation by a nonspecific mitogen (Con A). The data presented in this report suggest that depression of some host defense mechanisms, particularly PMN chemotaxis and phagocytosis, may be important in the pathogenesis of ANUG.

A comparison of the effectiveness of variable diameter vs. unwaxed floss.

A clinical study was undertaken to compare the effect of a variable diameter dental floss with a conventional unwaxed dental floss in the removal of plaque and the reduction of gingival inflammation in 15 patients who had little or no previous experience with dental floss. Each patient, on a random basis, was instructed in the use of one type of floss in the maxillary arch and the other type of floss in the mandibular arch. Initially and after using the floss for 14 days, plaque and gingivitis were scored using the Plaque and Gingival Index. No significant differences were found in the mean reduction of the Plaque Index or Gingival Index when comparing the effectiveness of a variable diameter dental floss to a conventional unwaxed floss in patients with minimal oral hygiene instruction.