Psychotic and affective symptoms of early-onset bipolar disorder: an observational study of patients in first manic episode

Objective: Presence of psychotic symptoms seems to be a commonplace in early-onset bipolar disorder (BD). However, few studies have examined their occurrence in adolescent-onset BD. We sought to investigate the frequency of affective and psychotic symptoms observed during the first manic episode in adolescents. Methods: Forty-nine adolescents with bipolar I disorder (DSM-IV criteria) were admitted to a psychiatric hospital during their first acute manic episode. Assessment for current psychiatric diagnosis was performed by direct clinical interview and the DSM-IV version of the Diagnostic Interview for Children and Adolescents (DICA). Results: Teenage inpatients with BD consistently exhibited typical manic features, such as euphoria, grandiosity, and psychomotor agitation. In addition, disorganization and psychotic symptoms were present in 82 and 55% of the total sample, respectively. There was no significant difference in symptoms between early- and late-adolescent subgroups. Remarkably, most patients (76%) reported previous depressive episode(s); of these, 47% had prominent psychotic features in the prior depressive period. Conclusion: These findings suggest that disorganization and psychotic symptoms during the first manic episode are salient features in adolescent-onset BD, and that psychotic depression frequently may precede psychotic mania. Nevertheless, differential diagnosis with schizophrenia should be routinely ruled out in cases of early-onset first psychotic episode.

Psychotic and affective symptoms of early-onset bipolar disorder: an observational study of patients in first manic episode.

OBJECTIVE: Presence of psychotic symptoms seems to be a commonplace in early-onset bipolar disorder (BD). However, few studies have examined their occurrence in adolescent-onset BD. We sought to investigate the frequency of affective and psychotic symptoms observed during the first manic episode in adolescents. METHODS: Forty-nine adolescents with bipolar I disorder (DSM-IV criteria) were admitted to a psychiatric hospital during their first acute manic episode. Assessment for current psychiatric diagnosis was performed by direct clinical interview and the DSM-IV version of the Diagnostic Interview for Children and Adolescents (DICA). RESULTS: Teenage inpatients with BD consistently exhibited typical manic features, such as euphoria, grandiosity, and psychomotor agitation. In addition, disorganization and psychotic symptoms were present in 82 and 55% of the total sample, respectively. There was no significant difference in symptoms between early- and late-adolescent subgroups. Remarkably, most patients (76%) reported previous depressive episode(s); of these, 47% had prominent psychotic features in the prior depressive period. CONCLUSION: These findings suggest that disorganization and psychotic symptoms during the first manic episode are salient features in adolescent-onset BD, and that psychotic depression frequently may precede psychotic mania. Nevertheless, differential diagnosis with schizophrenia should be routinely ruled out in cases of early-onset first psychotic episode.

Predictive potential role of glutathione S-transferases polymorphisms in response to chemotherapy and breast cancer prognosis.

The aim of this study was to evaluate the role of GSTM1 null/present, GSTT1 null/present, and GSTP1 polymorphisms in the clinical response to chemotherapy and treatment outcome of breast cancer. The GSTM1, GSTT1, and GSTP1 IIe105Val polymorphism genotypes were analyzed using polymerase chain reaction coupled with restriction fragment length polymorphism. Conditional logistic regression analysis revealed that breast cancer patients carrying the GG genotype of GSTP1 IIe105Val showed a significantly better response to chemotherapy compared to those expressing the AA genotype [odds ratio = 2.66, 95% confidence interval (CI) = 1.24-5.91, P = 0.007]. The Cox proportional hazards model indicated that the GG genotype of GSTP1 IIe105Val in breast cancer patients was correlated with a lower risk of death from all causes than those with AA genotype. The adjusted hazard ratio (95%CI) for the GG genotype of GSTP1 IIe105Val was 0.44 (0.18-0.99; P = 0.03). In conclusion, the results of our study indicated that the GG genotype of GSTP1 IIe105Val was significantly associated with better response to chemotherapy and longer overall survival, compared to the wide-type genotype.

Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 1: planning sequence.

The success of craniomaxillofacial (CMF) surgery depends not only on the surgical techniques, but also on an accurate surgical plan. The adoption of computer-aided surgical simulation (CASS) has created a paradigm shift in surgical planning. However, planning an orthognathic operation using CASS differs fundamentally from planning using traditional methods. With this in mind, the Surgical Planning Laboratory of Houston Methodist Research Institute has developed a CASS protocol designed specifically for orthognathic surgery. The purpose of this article is to present an algorithm using virtual tools for planning a double-jaw orthognathic operation. This paper will serve as an operation manual for surgeons wanting to incorporate CASS into their clinical practice.

Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 2: three-dimensional cephalometry.

Three-dimensional (3D) cephalometry is not as simple as just adding a 'third' dimension to a traditional two-dimensional cephalometric analysis. There are more complex issues in 3D analysis. These include how reference frames are created, how size, position, orientation and shape are measured, and how symmetry is assessed. The main purpose of this article is to present the geometric principles of 3D cephalometry. In addition, the Gateno-Xia cephalometric analysis is presented; this is the first 3D cephalometric analysis to observe these principles.

Adjuvant chemotherapy may improve survival of patients with luminal A breast cancer and positive lymph nodes.

The study examined the clinicopathological characteristics and treatment options in patients with luminal A breast cancer. This retrospective cohort included 1580 patients with luminal A breast cancer treated between January 2005 and June 2007. Patients were divided into four subgroups according to lymph node status. Prognostic factors and 5-year overall survival (OS) and disease-free survival (DFS) of patients were analyzed. The median duration of follow-up was 67 months. Multivariate Cox-regression analysis revealed that patients in the LN2 and LN3 subgroups had a higher risk of recurrence and death than patients in the LN0 subgroup (LN2: HR = 2.2 for DFS and HR = 2.1 for OS; LN3: HR = 4.7 for DFS and HR = 4.7 for OS). In the LN2 subgroup, there was a trend towards reduced risk of recurrence and death for patients receiving adjuvant chemotherapy plus endocrine therapy, although this difference did not reach statistical significance. In the LN0 and LN1 subgroups, there was a trend towards an increased risk of death in patients receiving chemotherapy. Although lymph node status remains one of the most important independent prognostic predictors for luminal A breast cancer, in patients with 0-3 positive lymph nodes endocrine therapy can be considered sufficient. However, patients with ≥4 positive lymph nodes, and especially in those with ≥ 10, should receive chemotherapy.

Clinical evaluation with self-sequential longitudinal reference intervals: pregnancy outcome and neonatal thyroid stimulating hormone level associated with maternal thyroid diseases.

OBJECTIVE: We attempted to evaluate maternal thyroid function in a new self-sequential longitudinal reference interval (SLRI) which we established recently. By this method, we analysed the correlation between pregnancy outcome, neonatal thyroid stimulating hormone (TSH) level and maternal thyroid diseases. METHODS: A total of 1744 pregnant women participated in the study and 1747 babies were born from those women (three bore twins). The levels of TSH, free thyroxine (FT4) and thyroid peroxidase antibodies (TPO-Ab) of mothers were quantified by electrochemistry immunoassay (ECL). The levels of neonatal blood TSH were detected by time-resolved fluorescence immunoassay (TRFIA). All data were collected and statistically analysed by SPSS 13.0 software. RESULTS: With our new SLRI method, we found that 0.11%-3.84% pregnant women would get thyroid diseases. Subclinical hypothyroidism was the most common maternal thyroid disorder. Being positive for thyroid peroxidase antibodies was a significant risk factor of subclinical hypothyroidism during pregnancy. The median, P2.5-P97.5, and interquartile range (IQR) of neonatal TSH (N-TSH) of 1747 babies were 2.72 mIU/L, 0.10-8.01 mIU/L and 2.62 mIU/L, respectively; 28.6% of pregnant women with thyroid diseases developed pregnancy complications. The prevalence was significantly higher than in the normal thyroid function group (p < 0.001). The levels of N-TSH were low correlated with maternal TSH levels (p < 0.05), but there were no significant correlations between N-TSH and maternal FT4 and maternal TPO-Ab (p > 0.05). CONCLUSIONS: Thyroid disorders, especially subclinical hypothyroidism, are common in pregnant women. These disorders are associated with pregnancy and fetal outcome. Routine maternal thyroid function screening is important and should be recommended.

Vertigem postural fóbica: aspectos clínicos e evolutivos / Phobic postural vertigo: clinical aspects and course of illness

A vertigem postural fóbica (VPF), o segundo diagnóstico mais freqüente em ambulatório de distúrbios vestibulares, é síndrome somatoforme caracterizada por desequilíbrio subjetivo e ataques breves de vertigem em situações específicas. Em período de 18 meses, a VPF foi observada em 41 pacientes, de 251 atendidos. Vinte e seis apresentavam VPF primária; em 65 por cento havia distúrbios de ansiedade ou depressão, e 15 pacientes tiveram diagnóstico de VPF secundária. O exame neurológico e a avaliação complementar foram normais na maioria dos casos. Observou-se resposta favorável ao tratamento (antidepressivos, benzodiazepínicos, psicoterapia e/ou orientações) em 62 por cento dos pacientes, sem diferença entre os grupos de VPF primária e VPF secundária. Apesar da alta prevalência, a VPF é subdiagnosticada. Entretanto, seu reconhecimento é importante para o tratamento adequado, evitando recorrência e incapacitação.

[Phobic postural vertigo: clinical aspects and course of illness]. / Vertigem postural fóbica: aspectos clínicos e evolutivos.

Phobic postural vertigo (PPV) is the second most common diagnosis on a dizziness unit. It is a somatoform syndrome characterized as a chronic and incapacitating condition with subjective imbalance and short attacks of dizziness. During a period of 18 months, PPV was observed in 41 patients among 251 of a dizziness unit. Twenty-six had primary PPV, among whom 65% had depressive or anxiety disorders, and 15 patients were diagnosed at secondary PPV. Normal neurological examination and diagnostic tests were observed in most cases. A favorable response to treatment (antidepressants, benzodiazepines, psychotherapy and/or orientation) was observed in 62% of all patients, without difference between both groups -- primary and secondary PPV. Despite the high prevalence, PPV is misdiagnosed. Therefore one must attempt to recognize it, since its appropriate treatment prevents recurrence and incapacitation.