Family caregiving in bipolar disorder: caregiver consequences, caregiver coping styles, and caregiver distress.

AIMS: This study investigated the consequences caregivers of outpatients with bipolar disorder are confronted with, the distress they experience and their coping styles. METHODS: Caregivers (n = 115) were asked to complete the Involvement Evaluation Questionnaire (IEQ) to measure caregivers' consequences, the Utrecht Coping List (UCL) to measure caregivers' coping styles, and the 12-item General Health Questionnaire (GHQ-12) to measure caregiver distress. Scale (sub)scores were calculated and relationships between the results were explored. RESULTS: Caregiver consequences were found to be limited, although approximately 30% reported distress. Male caregivers used a more avoiding coping style and undertook activities to provide diversion. Female caregivers used a less active approach and sought less social support. Correlations were found between the IEQ overall score and its subscales 'tension' and 'worrying' and the UCL subscales 'palliative reaction pattern' and 'passive reaction pattern'. Distress appears to occur more often in caregivers who report more consequences, tend to use a more avoiding coping style, and have a more passive reaction pattern. CONCLUSIONS: Clinicians should assess symptoms of caregiver distress. When caregiver distress is noticed, efforts should be undertaken to support the caregiver and teach them skills to cope effectively with the consequences they experience in order to stay well.

Self-reported care needs of outpatients with a bipolar disorder in the Netherlands.

The care needs of patients with a bipolar disorder have not been studied to date. In the present research, the care needs, care received and unmet care needs for a population of outpatients with a bipolar disorder in the Netherlands are described. The participants (n = 157) completed the Need for Care Questionnaire and a questionnaire addressing various demographic and clinical characteristics. The results show the care needs to mainly involve the domains of psychological help, psychiatric help and social functioning. Unmet needs are frequently reported for all domains and found to be particularly frequent for needs on social functioning. Some significant associations between source of income, number of hospitalizations and involvement of community psychiatric nurses, on the one hand, and reported care needs, on the other hand, are identified and discussed. Incorporation of needs assessment into the treatment process is recommended in the form of structured questionnaires which can also then be used to guide and evaluate the treatment process. Future research should focus on the identification of the specific risk factors for particular care needs and thereby work to minimize the occurrence of such risk factors and promote early intervention efforts to reduce the burden on patients and their relatives.

[Lamotrigine in the treatment of bipolar disorder, a review]. / Lamotrigine bij de behandeling van bipolaire stoornissen. Een overzicht.

BACKGROUND: Lamotrigine is being prescribed increasingly for the treatment of bipolar disorder. In this article we review the current literature on the subject. AIM: To review the literature in order to assess the present position of lamotrigine in the treatment of bipolar disorder. METHOD: We reviewed the literature from 1985 to 2005 by means of PubMed and we also consulted the bibliographic references for the articles we found. In addition, we studied a review article by Goldsmith e. a. (2003). RESULTS: Although a considerable amount of research has been done, evidence for the efficacy of lamotrigine is limited. Lamotrigine was not effective in the treatment of acute mania. In only one of three studies was lamotrigine effective in the treatment of acute depression. In two extensive maintenance studies lamotrigine was found to be effective in preventing new depression episodes; however, the latter studies have such serious methodological weaknesses that the results provide only very limited evidence that lamotrigine is beneficial. CONCLUSION: In the guideline for the treatment of bipolar depression published by the NVVP (the Dutch Psychiatric Association; 2001), lamotrigine was mentioned as a possible treatment option for bipolar disorder and rapid cycling. In view of the results of randomised controlled trials (RCTS) that have been published so far, there is at present no reason to alter the status of lamotrigine.

[Psychotherapeutic treatment options for bipolar disorders. A review of randomized controlled studies]. / Psychotherapeutische behandelmogelijkheden voor bipolaire stoornissen. Een overzicht van gerandomiseerde en gecontroleerde onderzoeken.

BACKGROUND: Until recently research into the efficacy of treatment of bipolar disorders focused mainly on the pharmacological treatment. Over the last few years more and more research has concentrated on the psychological treatments for bipolar disorders. aim To review published, controlled and randomised studies dealing with the efficacy of forms of psychotherapeutic treatment for bipolar disorders. METHOD: By searching Medline and Embase using the search terms, 'psychotherapy', 'cognitive (behavioural) therapy', 'family therapy' and 'psychoeducation' we found eight relevant reports of randomised, controlled trials, which described the interventions that were undertaken and recorded the relapse rates. RESULTS: The following forms of treatment were investigated: Relapse-Prevention Plan, Cognitive Behavioural Therapy, Interpersonal and Social Rhythm Therapy, Family-Focused Treatment and Group Psychoeducation. These forms of treatment were used in addition to standard pharmacological treatment. The addition of psychotherapeutic treatment was found to reduce lower the relapse rate, to lead to less hospitalisation and to improve functioning. CONCLUSION: The authors recommend that patients with bipolar disorders be offered psychotherapeutic treatment because it is likely to lower the risk of relapse.

[Bipolar disorder and pregnancy; experiences from the practice]. / Bipolaire stoornis en zwangerschap: ervaringen uit de praktijk.

Patients with bipolar disorder who become pregnant may develop an episode during their pregnancy, but an episode is much more likely to occur during the postpartum period. Three case histories show the kinds of problems that can arise. Risk factors are mentioned and advice is given about the best ways of preventing such problems.

[Borderline or bipolar disorder after all?]. / Borderline of misschien toch bipolair?

In two women aged 35 and 21 years, the initial diagnosis 'borderline personality disorder' was changed to 'bipolar disorder'. These disorders are separate entities with different therapy, but may resemble each other very much. It may be necessary to use heteroanamnesis and family anamnesis and to follow the patient for some time in order to establish whether there are mood disorders.

[Consequences of a bipolar disorder and use of mood stabilizers for its management during pregnancy]. / Consequenties van een bipolaire stoornis en gebruik van stemmingsstabilisatoren voor het beleid rond zwangerschap.

UNLABELLED: For patients with a bipolar disorder who are pregnant or consider pregnancy, the following issues are of importance: Genetic counselling: genetic vulnerability is virtually certainly the basis of the occurrence of a bipolar disorder. MEDICATION: discontinuation of the medication may lead to recurrence; continuation may cause intoxications in the woman and her child and congenital anomalies in the child. Alternatives to mood stabilizers can be applied; electroconvulsive therapy is a possibility as is medication with antidepressants, antipsychotics and benzodiazepines during acute episodes of mood disorder. Precautions for mother and child if mood-stabilizing treatment is continued: use sustained-release preparations, regularly check blood levels and thyroid function, administer vitamin K if necessary, perform ultrasonoscopy/examination of amniotic fluid, have the child delivered in hospital. Management of the newborn child: observation, determination of blood levels, regular checks of thyroid function, if necessary administration of vitamin K.

[Rapid cycling in bipolar disorders]. / 'Rapid cycling' bij bipolaire stoornissen.

Two patients, a woman aged 32 and a man aged 27 years, were suffering from rapid cycling bipolar disorder (i.e. a course with four or more episodes a year). Hypothyroidism and the use of antidepressants may be involved in the development of such a disease course. Treatment with carbamazepine was successful in both patients. Patients suffering from rapid cycling bipolar disorder should be treated with lithium or carbamazepine, or a combination of these. Antidepressants should only be used with great caution.

Multidimensional ordering of psychopathology. A factor-analytic study using the Comprehensive Psychopathological Rating Scale.

The aim of the study was to search for a multidimensional order in the psychopathology of the functional mental disorders in general. A heterogeneous group of 192 patients was investigated by means of a semistructured interview based on the Comprehensive Psychopathological Rating Scale. Principal component factor analysis revealed 5 clinically meaningful dimensions interpretable as representing dysregulation of emotion and motivation, perceptual and behavioural disintegration and dysregulation of autonomic functions.

The interrater reliability of a Dutch version of the Comprehensive Psychopathological Rating Scale.

To apply the Comprehensive Psychopathological Rating Scale (CPRS) in the Netherlands we translated the English version into Dutch and examined its interrater reliability. Three patient groups were investigated. Kappa coefficients were generally comparable with those reported in a study of the German version of the CPRS and in a Dutch study measuring the present state by means of the Present State Examination.

Therapeutic drug monitoring of amitriptyline: impact of age, smoking and contraceptives on drug and metabolite levels in bulimic women.

Concentrations of amitriptyline (AT), nortriptyline (NT) and E-10-hydroxynortriptyline (E-10-OH-NT) were measured in 18 women with bulimia receiving 100 mg AT/day for at least 6 wk. After onset of treatment between days 36 and 57 there is a decrease in AT and an increase in E-10-OH-NT concentrations, probably due to an autoinductive effect on hydroxylation. The estimated mean (+/- SD; range; n) elimination half-life time of AT was 14.0 (+/- 7.8 h; 7.5-38.5 h; 14). On day 36, AT concentrations in females using oral contraceptives (OC) were higher than in non-users of OC, which indicates inhibition of AT metabolism by OC. In all smokers the E-10-OH-NT concentrations on day 36 were lower than in non-smokers. Our findings suggest induction of N-demethylation and glucuronidation by smoke components.