A randomized controlled trial of cognitive behavioral group therapy for bipolar disorder.

BACKGROUND: This study evaluated the effectiveness of adjunctive cognitive behavioral group therapy (CBGT) to prevent recurrence of episodes in euthymic patients with bipolar disorder. METHODS: A randomized controlled single-blind trial was conducted with 50 patients with bipolar disorder types I and II followed up for at least 12 months in an outpatient service and whose disease was in remission. An experimental CBGT manual was developed and added to treatment as usual (TAU), and results were compared with TAU alone. RESULTS: Intention-to-treat analysis showed that there was no difference between groups in terms of time until any relapse (Wilcoxon = 0.667; p = 0.414). When considering type of relapse, there was still no difference in either depressive (Wilcoxon = 3.328; p = 0.068) or manic episodes (Wilcoxon = 1.498; p = 0.221). Although occurrence of episodes also did not differ between groups (χ(2) = 0.28; p = 0.59), median time to relapse was longer for patients treated with CBGT compared to TAU (Mann-Whitney = -2.554; p = 0.011). CONCLUSIONS: Time to recurrence and number of episodes were not different in the group of patients treated with CBGT. However, median time to relapse was shorter in the TAU group. Studies with larger samples may help to clarify whether our CBGT approach prevents new episodes of bipolar disorder. Our findings also indicated that CBGT is feasible in euthymic patients with bipolar disorder and should be investigated in future studies. To our knowledge, this is the first publication of a controlled trial of CBGT for euthymic patients with bipolar disorder.

Anthropology, knowledge-flows and global health.

Global health programmes are damaged by blockages in the upward flow of information from localities and regional centres about realities of professional practice and about patients' lives and conditions of treatment. Power differentials between local actors and national or international decision-makers present further obstacles to effective action. Anthropological research and action, in its most effective current forms, make important contributions to these issues. This research often continues over the long term, intensively. It can be multi-sited, studying actors at local, national and international levels simultaneously. It studies the relative knowledge and power of impoverished patients and global decision-makers, all within a single frame. By doing so, anthropological research is capable of providing new and important insights on the diverse meanings of patient decision-making, informed consent, non-compliance, public health reporting, the building of political coalitions for health and many other issues.

Medicine betrayed: hemophilia patients and HIV in the US.

The contamination of blood products by HIV in the early 1980s resulted in thousands of deaths among people with hemophilia in the United States and elsewhere. In the US, industry, government, physicians, and advocacy groups were implicated in this tragedy. In response to pleas from members of the US hemophilia community, the Institute of Medicine (IOM) of the National Academy of Science convened a public hearing to identify the institutional determinants of the HIV/AIDS epidemic among US hemophilia patients. The resulting IOM Report (1995) established a narrative of the crisis and indicated necessary improvements to the management of the US blood supply. The Report, however, failed to address the hemophilia community's demands for accountability and retribution. In this paper we explore the moral and social dimensions of this tragedy through narrative analysis of the original testimonies of hemophilia sufferers, interviews with some patients and their families, and a re-examination of the text of the IOM Report itself. We examine the process by which this crisis was addressed--through the discourses of science and law--and how it was ultimately framed as a failure of management and oversight rather than a moral failure of the for-profit health-care system. Thus, while the Report and its aftermath demonstrate powerfully how testimonials of suffering can influence public policy, by not addressing what is at stake for the victims--failure to protect patients in an era of increasingly commodified health care--it led to an exculpatory solution that obfuscated the moral dimensions of suffering.

Suicide in contemporary China: a review of China's distinctive suicide demographics in their sociocultural context.

Suicide is a complex phenomenon--arguably a social and a moral deed--occurring within associated psychological, biological, and cultural contexts. We present data on suicide rates in China for 1988, 1990, and 1992 and provide an analysis of their social context. These figures, from the Chinese Public Health Annuals, have never before been publicly reported. These and other recent data indicate that suicide rates in China, although reportedly low in the past, are by global standards alarmingly high among certain demographic groups. They also reveal distinctive epidemiological patterns of suicide in China that contrast with the patterns characteristic of Western societies-for example, higher rates in rural than in urban areas and, among some demographic groups, higher among women than among men. As in the West, however, suicide among the elderly is a major problem in China. The sociocultural context of these data is examined as a means toward understanding their distinctive patterning.

The place of culture in DSM-IV.

This paper critically reviews the process and outcome of an effort to enhance the cultural validity of DSM-IV and outlines recommendations to improve future diagnostic systems. An ordered presentation of the antecedents and the main phases of this developmental effort is followed by a content analysis of what was proposed and what was actually incorporated, and a conceptual analysis of underlying biases and their implications. The cultural effort for DSM-IV, spearheaded by a scholarly independent NIMH workgroup, resulted in significant innovations including an introductory cultural statement, cultural considerations for the use of diagnostic categories and criteria, a glossary of culture-bound syndromes and idioms of distress, and an outline for a cultural formulation. However, proposals that challenged universalistic nosological assumptions and argued for the contextualization of illness, diagnosis, and care were minimally incorporated and marginally placed. Although a step forward has been taken to introduce cultural elements in DSM-IV much remains to be done. Further culturally informed research is needed to ensure that future diagnostic systems incorporate a genuinely comprehensive framework, responsive to the complexity of health problems in increasingly multicultural societies.

The transformation of everyday social experience: what a mental and social health perspective reveals about Chinese communities under global and local change.

Chinese communities in East Asia are undergoing great economic and social change. The result includes material prosperity but also worsening mental and social health indices. Epidemiological studies clarify the magnitude of these problems and the particular vulnerability of women and the elderly. Ethnographic studies indicate that moral experience is also changing, and that with it subjectivity is being altered in ways that are of concern. And yet it is not clear, in historical perspective, how to assess these changes when they are compared to the extraordinarily difficult experiences of the Chinese over most of the Century.

The social course of schizophrenia: local and societal factors.

In this paper, we propose a model of social course of schizophrenia based on cross-cultural research on the influence of family, wider social network, work, political economy, and legal and mental health care institutions on the experience of illness. We posit the way these ordinary arrangements of daily living organize the course of schizophrenia in part through cultural processes that affect the body-self in suffering and in part through social processes that establish an intersubjective matrix for the experience of illness. We believe this model can be generalized to other chronic illness such as depression, diabetes, asthma, osteoarthritis, chronic pain syndrome, chronic fatigue syndrome, and even heart disease and cancer. We develop the implications of this anthropological approach for research and practice.

Immediate loading of a single hydroxyapatite-coated threaded root form implant: a clinical report.

The successful results of endosseous root form implants in the treatment of partially and completely edentulous patients has been made possible by the application of standardized surgical and prosthetic protocols. Different techniques have been published in the literature with the purpose of reducing implant prosthetic rehabilitation times. This clinical case report describes a new surgical concept and a technique to fabricate screw-retained provisional crowns for immediate loading of free-standing single tooth implants. Further clinical and histologic studies are necessary in order to promote routine clinical application of this technique.