Treatment Of Mixed States Research Articles

Treatment of mixed states using intravenous sodium valproate: Efficacy and tolerability

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease of unknown cause occurring in adults and affecting approximately 5 million people worldwide. The American Thoracic Society 2015 guidelines provide recommendations for the treatment of patients with IPF, including supportive care measures such as oxygen therapy, pulmonary rehabilitation, gastric acid therapy, sleep apnea, vaccinations, lung transplant evaluation, and pulmonary hypertension assessment. A smart-phrase was developed that outlines the supportive care measures for the IPF patient, which was then implemented into a new patient clinic note in the electronic medical record. Documentation of the measures improved significantly after implementation of the smart-phrase.

Mixed States in Bipolar Disorder: Etiology, Pathogenesis and Treatment.

Many bipolar disorder patients exhibit mixed affective states, which portend a generally more severe illness course and treatment resistance. In the previous renditions of Diagnostic and Statistical Manual mixed states were narrowly defined in the context of bipolar I disorder, but with the advent of DSM-5 the term “mixed episode” was dropped and replaced by “mixed features” specifier which could be broadly applied to manic, hypomanic and depressive episodes in both the bipolar spectrum and major depressive disorders. This paradigm shift reflected their significance in the prognosis and overall management of mood disorders, so that the clinicians should thoroughly familiarize themselves with the contemporary notions surrounding these conditions. The purpose of this manuscript is to bring to light the current conceptualizations regarding the etiology, pathogenesis and treatment of mixed states. To achieve this goal, in June 2016 an extensive literature search was undertaken using the PubMed database. Some exploratory terms utilized included “mixed states”, “mixed episodes”, “switching”, “rapid cycling” cross referenced with “bipolar disorder”. Focusing on the most relevant and up to date studies, it was revealed that mixed states result from genetic susceptibility in the circadian and dopamine neurotransmission apparatuses and disturbance in the intricate catecholamine-acetylcholine neurotransmission balance which leads to mood fluctuations. The management of mixed states is challenging with atypical antipsychotics, newer anticonvulsants and electroconvulsive therapy emerging as the foremost treatment options. In conclusion, while progress has been made in the neurobiological understanding of mixed states, the currently available therapeutic modalities have only shown limited effectiveness.

Consider second-generation antipsychotics for the management of mixed states in bipolar disorder

The diagnosis and treatment of mixed states in bipolar disorder can be challenging. The mainstay of treatment is antipsychotic therapy (± a mood stabilizer), with second-generation antipsychotics emerging as the treatment of choice. When medication fails or cannot be used, electroconvulsive therapy may be effective.

Second Line Treatment? Utility of Lithium´s Use in Bipolar Mixed States. a Clinical Case Report.

1. Introduction Mixed states have had growing importance since Kraeplin. They have long contributed to the concept of bipolar disorder. They are frequent, occurring in 1/3 of all bipolar episodes. Many severe psychotic mixed states are still misdiagnosed and mistreated as schizophrenia. Because they have such complex presentations, they represent a challenge to diagnosis and treatment. 2. Objectives/ Aims The authors' aims are to report a mixed episode; to describe its fast improvement only when lithium was introduced and to compare this result with the evidence in current guidelines. 3. Methods A patient clinical file was analyzed. Literature research was performed. Relevant chosen papers were selected. 4. Results Women. 33. Actress. Gradual depressive simptoms, after broke up with her boyfriend the month before. She became suspicious, showing persecutory ideias. She was thin, unable to sleep, her house was disorganized. On admisson she was agitated, her eyes sad, her face almost inexpressive, her speech disconected. She showed great instability: she seemed depressive, then loughed inexpectedly, suddendly became coprolalic. She was diagnosed borderline personality before. She has positive psychiatric family history (mother, psychotic depression). After valproate, bupropion and olanzapine her humor and judgment improved but she kept an unstable behaviour. Lithium´s introdution enabled a fast, sharp recovery and organized behaviour. 5. Conclusions Despite the prevalence of mixed states, research into the eficacy of treatments is limited. Current guidelines lack specific treatment recommendations and are sometimes inaccurate. Further studies are needed to complete our knowledge´s gap in the treatment of mixed states.

Clinical, Evolutionary and Therapeutic Characteristics of Mixed States

Introduction Mixed states are very common although largely under identified. They pose a real problem for clinical characterization. Their features, in particular evolutionary, warrant special attention Objectives The goal of the study was 1) Describe the epidemiological characteristics of patients with mixed state 2) To study the evolutionary and prognostic clinical aspects of mixed states 3) To evaluate our clinical practice in the treatment of mixed states and to compare it with international recommendations Materials and Methods We achieved a retrospective descriptive cross-sectional study on 77 cases of patients with bipolar disorder. Our study was conducted between September 2004 and September 2013. Results The prevalence of patients with a mixed access among admissions for bipolar disorder during the study period was 32.35%. The average age of our patients was 38.08 years, ranging from 16 to 68 years. The sex ratio was 1.26. A history of suicide attempts (TS) was found in 30 cases (39%). A substance abuse occurs in 42cas (54.5%). The average age of onset of the disease in our patients was 26 years. The average number of hospitalizations was 5.44 hospitalizations. The average total duration in days of hospitalization was 73.73 days. Conclusion Recognition of these mixed states and the use of appropriate treatment are needed to improve the prognosis and quality of life of patients

Mood stabilizers in the treatment of bipolar disorder mixed states

Mixed states represent a frequent issue in the context of bipolar disorders (up to 40% of acute phases). They are complex and serious clinical pictures, which pose diagnostic challenges but also require specific treatment interventions. The purpose of this article is to provide an overview of the current literature on the pharmacotherapy of bipolar mixed-states, focusing on mood stabilizers. Literature was identified by searches in MEDLINE (Medical Literature Analysis and Retrieval System Online), using PubMed search engine. Studies are chosen if they contained the keywords: "mixed mania or mixed state(s) or mixed episode(s) treatment or therapy". There was a small number of double-blind, placebo-controlled studies focused on the treatment of mixed states. The majority of available data derives from sub-group analysis made on studies that primarily include manic patients. Nevertheless, current evidences underline that, among mood-stabilizers, valproate, olanzapine and aripiprazole could be considered first-line drugs. Lithium has less evidences about its efficacy in the treatment of mixed states, but it could be a valid choice in combined therapies. There is a need of further researches on the treatment of mixed states. Less restrictive diagnostic criteria could allow to select big sized samples in order to obtain more specific and meaningful data about the efficacy of drug treatments.

Electroconvulsive therapy in the treatment of mixed states in bipolar disorder

Introduction. Mixed bipolar states are not infrequent and may be extremely difficult to treat. Lithium, anticonvulsants including valproate and carbamazepine, and antipsychotics such as olanzapine, ziprasidone, and aripiprazole have been reported to be at least partially effective in controlled clinical trials, but many patients do not respond to pharmacological approaches. Electroconvulsive therapy has been tested to be efficacious for the treatment of both manic and depressive episodes, but much less evidence is available with regards to mixed states. The aim of the review was to report the available evidence for the use of electroconvulsive therapy in mixed bipolar states.Methods. A systematic review of the literature on treatment of mixed states, focused on electroconvulsive therapy, was made, beginning in August 1992 and ending in March 2007. The key words were “electroconvulsive therapy” and “mixed bipolar”.Results. Only three studies met the required quality criteria and were included. This literature suggests that ECT is an effective, safe, and probably underutilized treatment of mixed states. Recent technical developments have made ECT more friendly, tolerable, and safe. Potential alternatives, such as vagus nerve stimulation, deep brain stimulation, or transcranial stimulation, are still far to be proved as effective as ECT.

Affektive Mischzustände bei Bipolaren Störungen: ein Überblick

Affective mixed states in bipolar disorders are a current matter of scientific debate and represent a complex clinical picture with coexisting manic and depressive symptoms. Treatment of mixed states is regarded as an important challenge. As diagnostic uncertainties complicate systematic clinical evaluations of this patient group, generally accepted clinical treatment guidelines are lacking yet. In this review the significance as well as the problems and risks of new treatment options are discussed.