[Follow-up study of 3 years group therapy with lithium treatment]. / Une étude suivie de 3 ans de thérapies de groupe additives au traitement au lithium.

Group psycho-education for bipolar patients has been shown to increase patient self-esteem and to cut down on the number of re-admissions. For the purposes of this study, a comparison was made between a 10-sessions group programme, without additional written information (26 patients) and a highly structured 5-sessions group programme which did include written information (15 patients). Measurements were done before and after group therapy over a 3-year follow-up period. In the 10-sessions programme there was evidence of improved patient self-esteem; patients in both programmes reported that they had benefitted from them and that subsequently they had fewer psychosocial problems. In the 3-year follow-up period, there was a significant decrease in the non-compliance (from 54 and 47 percent to 31 and 33 respectively) and hospitalization ratio in both programme groups. The ratio of hospitalizations in the first and second programmes was: 0.33 and 0.25 a year previously; 0.25 and 0.26 respectively whilst taking lithium; and 0.08 and 0.09 at the end of the group education of 3-year follow-up period.

[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.

Bipolar illness, lithium prophylaxis, and pregnancy.

In advising bipolar patients wishing to become pregnant, Weinstein's guidelines were extended to seven stages: contraceptive measures; genetic counseling; discontinuing lithium in the first trimester or prescribing alternatives; ultrasound scanning for congenital anomalies, low lithium levels during pregnancy; discontinuing lithium at the end of pregnancy; starting immediately after birth, no breast feeding, observation of the neonate in the neonatal ward; and close observation of the patient in the follow-up year. Of the 15 bipolar patients, 11 gave birth to healthy children (five of them twice). Most patients knew nothing about the inheritance of bipolar illness. Four made no further attempt to become pregnant: two in view of a serious possibility of inheritance, the other two after a severe relapse. Three patients chose an alternative to lithium medication (carbamazepine and haloperidol). Postpartum, 27% of the patients who used medication relapsed and 60% of the patients who used none relapsed.

Psychoeducation of partners of bipolar-manic patients.

The partners of 14 bipolar-manic patients attending psychoeducation sessions were compared with 12 controls. After the sessions and 6 months later they showed more knowledge of the disease, medication and social strategies. Patient compliance did not change over the next year. The risk of this procedure is the initially increased level of anxiety of the patients.

Group therapy in addition to lithium therapy in patients with bipolar disorders.

In patients with a bipolar disorder and well regulated lithium prophylaxis many psychological and social problems still remain. These can lead to non-compliance and relapse, which often increases the problems especially in the patient's direct environment. After group therapy, the self-confidence of 20 patients appeared to have improved compared with 14 control patients on the waiting-list for group therapy. The most important discovery for most of the patients was that their condition is not unique. They also gained the insight that they were potentially able to solve some of their problems themselves.

Distal amyotrophy of predominantly the upper limbs with pyramidal features in a large kinship.

An autosomal dominant disease characterised by amyotrophy of predominantly distal upper limb muscles and mild pyramidal features is described. There are sensory changes in older patients, whilst in others the disease presents itself as a disorder of motor neurons. Owing to variations in the clinical picture, it may be difficult to distinguish this disease in individual patients from distal spinal muscular atrophy, or from pure pyramidal syndromes. There is an overlap in clinical signs between this disease and peroneal muscular atrophy with pyramidal features. Whether or not the latter two conditions are genetically distinct, is a matter of doubt.