RESUMO
BACKGROUND: In the literature there is increasing interest in the chronobiology of affective disorders and in the most important chronotherapies for treating these disorders. AIM: To discuss the background to and the main features of the most important therapies for affective disorders. METHOD: Using PubMed, we performed a concise review of the literature on the use of chronotherapeutics in affective disorders and we also studied the standard textbooks on the subject. RESULTS: Light therapy is the type of chronotherapy that has been studied most. Chronotherapies show interesting and promising results in open label studies, but so far there have been no randomized double-blind placebo controlled trials. CONCLUSION: Chronotherapeutics provides a neurobiological model and a series of promising, possibly effective non-pharmacological therapies, particularly for affective disorders. Light therapy deserves to be included in the multidisciplinary treatment guidelines relating to affective disorders. However, more, better and longer trials are needed in order to evaluate the various types of chronotherapies.
Assuntos
Cronoterapia/métodos , Transtornos do Humor/terapia , Fototerapia/métodos , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: Sexual problems arise frequently among psychiatric patients, either as a symptom of psychiatric disorders or as a side effect of psychotropic medication. However, it is questionable whether in daily practice psychiatrists and trainee psychiatrists give enough attention to patients' sexual problems. GOAL: To investigate how much attention psychiatrists and trainees give to patients' sexual problems and to discover what factors influence the amount of attention they give. METHODS: All psychiatrists and trainees working at two academic psychiatric centres and three mental health institutes in the province of North Holland were asked to complete an online questionnaire about the discussion of sexual problems. RESULTS: 164 psychiatrists and trainee psychiatrists completed the questionnaire (response rate 44%). About 50% of the respondents stated that they spent less than five minutes per week discussing sexual problems with their patients. When prescribing antidepressants and antipsychotics, psychiatrists and trainees often failed to inform patients about sexual side effects (33% in the case of antidepressants and 50% for antipsychotics). CONCLUSIONS: The investigation reveals that psychiatrists and trainees give little attention to sexuality problems of patients. The main reason for this seems to be feelings of shame and incompetence. Lack of time was not identified as a significant factor. We believe that the situation will improve considerably if psychiatrists and trainees involved in training programmes and supervisory activities give more attention to sexual problems.
