RESUMEN
OBJECTIVE: To investigate the effect of lithium, anticonvulsants and antipsychotics on brain structure in bipolar disorder (BD). METHOD: A cross-sectional structural brain magnetic resonance imaging study of 74 remitted patients with BD, aged 18-65, who were receiving long-term prophylactic treatment with lithium or anticonvulsants or antipsychotics. Global and regional grey matter, white matter, and cerebrospinal fluid volumes were compared between treatment groups. RESULTS: Grey matter in the subgenual anterior cingulate gyrus on the right (extending into the hypothalamus) and in the postcentral gyrus, the hippocampus/amygdale complex and the insula on the left was greater in BD patients on lithium treatment compared to all other treatment groups. CONCLUSION: Lithium treatment in BD has a significant effect on brain structure particularly in limbic/paralimbic regions associated with emotional processing.
Asunto(s)
Anticonvulsivantes/farmacología , Antimaníacos/farmacología , Trastorno Bipolar/tratamiento farmacológico , Encéfalo/efectos de los fármacos , Litio/farmacología , Adolescente , Adulto , Anciano , Anticonvulsivantes/uso terapéutico , Antimaníacos/uso terapéutico , Encéfalo/patología , Mapeo Encefálico/métodos , Estudios Transversales , Femenino , Humanos , Litio/uso terapéutico , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: Gender is known to modulate the clinical course and severity of bipolar disorder (BD). Although cognitive abnormalities are an established feature of BD, there is limited information regarding whether gender also influences the pattern and severity of cognitive impairment. METHOD: We evaluated the performance of 86 remitted patients with BD, type 1, (BD-I) (36 male and 50 female) and 46 healthy participants (21 male and 25 female) on tasks of general intellectual ability, memory encoding, recognition and retrieval, response inhibition and executive function (abstraction and perseveration). The impact of illness severity in patients was assessed using the global assessment of functioning (GAF). RESULTS: We found a gender effect and an interaction between diagnosis and gender on immediate memory, implicating encoding and retrieval processes, both showing male BD-I patients being disadvantaged compared with female patients and healthy controls. Immediate memory correlated with GAF scores and this association was statistically significant for male BD-I patients. CONCLUSIONS: Our findings suggest that gender differences in BD-I are associated with memory function, particularly processes relating to encoding and retrieval, and may contribute to poor functional outcome particularly in men.
Asunto(s)
Trastorno Bipolar/psicología , Trastornos del Conocimiento/psicología , Memoria a Corto Plazo , Adulto , Trastorno Bipolar/diagnóstico , Trastornos del Conocimiento/diagnóstico , Formación de Concepto , Femenino , Humanos , Inhibición Psicológica , Inteligencia , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica , Factores Sexuales , Escalas de WechslerRESUMEN
Abdominal tuberculosis can be difficult to diagnose. In order to minimize diagnostic delay, an audit study showed that the Mantoux test and/or culture of ascitic fluid did not reveal tuberculosis immediately. Laparoscopy/laparotomy with Ziel-Nielson staining and culture of tissue biopsy always confirmed the diagnosis. It is suggested that biopsy should be the first line in investigating patients suspected of having abdominal tuberculosis.
