Asunto(s)
Conducta del Adolescente , Salud Mental , Adolescente , Conducta del Adolescente/psicología , Humanos , Red SocialRESUMEN
OBJECTIVES: There is evidence from recent controlled clinical studies that replacement therapy of hypothyroidism with T4 in combination with a small amount of T3 may improve the well-being of the patients. As the issue is still the subject of controversial discussion, our study was assigned to confirm the superiority of a physiological combination of thyroid hormones (absorbed molar ratio 14 : 1) over T4 alone with regard to mood states and cognitive functioning. DESIGN AND PATIENTS: After a run-in period with the T4 study medication for 4 weeks, a controlled, randomized, double-blind, two-period (each 12 weeks), cross-over study without washout between the treatment periods was performed in 23 hypothyroid patients (three males, 20 females, age 23-69 years, 21 subjects after surgery/radioiodine, two with autoimmune thyroiditis) to compare the effects of the previous individual T4 dose (100-175 micro g) with a treatment in which 5% of the respective T4 dose was substituted by T3. MEASUREMENTS: Standard hormonal characteristics and standardized psychological tests to quantify mood and cognitive performance were measured after the run-in period and at the end of each treatment period. In 12 subjects, the concentration-time profiles of fT3 and fT4 were compared after the last administration of the respective study medication. TSH, fT3 and fT4 were measured with immunological assays. CLINICAL RESULTS: Replacement therapy with T4 and T4/T3 was not different in all steady-state hormonal, metabolic and cardiovascular characteristics except for TSH, which was more suppressed after T4/T3. The efficacy of replacement therapy with the T4/T3 combination was not different from the T4 monotherapy with regard to all psychological test scores describing mood and cognitive functioning of the patients. Mood was even significantly impaired by the T4/T3 combination in eight subjects, with TSH < 0.02 mU/l, compared to patients with normal TSH (Beck Depression Inventory: 8.25 +/- 5.01 vs. 4.07 +/- 5.60, P = 0.026). PHARMACOKINETIC RESULTS: The area under the concentration-time curve (AUC(0-8h)) of fT3 was significantly higher after T4/T3 compared to the T4 monotherapy (42.8 +/- 9.03 pmol x h/l vs. 36.3 +/- 8.50 pmol x h/l, P < 0.05) and was significantly correlated to serum TSH (r(s) = -0.609, P < 0.05). After T4/T3, patients with a history of Graves' disease or autoimmune thyroiditis had significantly higher serum trough levels of fT3 whereas the fT4 concentrations were significantly lower in patients with a nonautoimmune background. CONCLUSION: Replacement therapy of hypothyroidism with T4 plus T3 does not improve mood and cognitive performance compared to the standard T4 monotherapy. There is even a higher risk of signs of subclinical hyperthyroidism associated with impaired well-being of the patients, which is clearly caused by significant fluctuations in the steady-state fT3 serum concentrations.
Asunto(s)
Hipotiroidismo/tratamiento farmacológico , Tiroxina/uso terapéutico , Triyodotironina/uso terapéutico , Adulto , Afecto/efectos de los fármacos , Anciano , Disponibilidad Biológica , Cognición/efectos de los fármacos , Estudios Cruzados , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Hipotiroidismo/sangre , Hipotiroidismo/psicología , Masculino , Persona de Mediana Edad , Estadísticas no Paramétricas , Tirotropina/sangre , Tiroxina/efectos adversos , Tiroxina/sangre , Insuficiencia del Tratamiento , Triyodotironina/efectos adversos , Triyodotironina/sangreAsunto(s)
Trastorno Bipolar/diagnóstico , Trastornos del Conocimiento/diagnóstico , Evaluación en Enfermería/métodos , Diagnóstico de Enfermería/métodos , Adolescente , Adulto , Trastorno Bipolar/enfermería , Trastornos del Conocimiento/enfermería , Femenino , Hospitales Psiquiátricos , Humanos , MasculinoAsunto(s)
Evaluación en Enfermería/métodos , Diagnóstico de Enfermería/métodos , Trastornos Somatomorfos/diagnóstico , Actividades Cotidianas , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Teóricos , Enfermería Psiquiátrica , Trastornos Somatomorfos/etiologíaAsunto(s)
Carcinoma/tratamiento farmacológico , Ensayos de Selección de Medicamentos Antitumorales/métodos , Neoplasias de la Boca/tratamiento farmacológico , Planificación de Atención al Paciente , Ensayos de Selección de Medicamentos Antitumorales/instrumentación , Humanos , Células Tumorales CultivadasRESUMEN
To summarize, based on a sample of six subjects who were depressed, 12 nursing diagnoses were identified. Five of the 12 diagnoses occurred in more than one subject. Criteria for making a diagnosis were specified, and the diagnoses and their defining characteristics were examined for principles of classification.
Asunto(s)
Trastorno Depresivo/diagnóstico , Evaluación en Enfermería , Proceso de Enfermería , Enfermería Psiquiátrica , Adulto , Anciano , Trastorno Depresivo/clasificación , Femenino , Humanos , Persona de Mediana Edad , Evaluación en Enfermería/métodos , Proceso de Enfermería/métodosRESUMEN
The authors describe a short-term inpatient program for adolescents that uses a variety of group sessions to help them deal with their immediate problems and, when necessary, prepare them for outpatient treatment. No attempt at complete ego reconstruction is made. The program includes family therapy and sessions on practical living skills, such as job hunting, productive use of leisure time, transportation, food planning, and renting and leasing. Assertiveness techniques are taught in small groups, and their use is encouraged on the unit, where staff attempt to create an acceptable social environment and provide a model for group decision-making.