ABSTRACT
One of the big challenges in treating individuals with bipolar disorder (BD) is nonadherence to medication. This is the principal factor associated with a worse prognosis or outcome of the disease. This study aimed to explore and analyze the individual perceptions that people with BD have about the positive and negative aspects when taking medication. A descriptive and interpretative study was carried out using the qualitative research paradigm with the use of the analytical technique of discourse analysis, extracting the data through the completion of focus groups. Participants' speech was digitally audio-recorded in digital format. In order to complete the codification of the participants' speech content, we relied on the qualitative data analysis (using the QRS NVivo 10 computer software). Thirty-six participants diagnosed with bipolar disorder took part in our study. In the participants' speech concerning the main barriers to pharmacological treatment, three key topics were identified. Perceived facilitators were summarized in four factors. The main facilitators regarding the use of pharmacological treatment in individuals with BD were the ones related with the perceived need for treatment in the acute phase, the recognition of the illness, the shared clinical decision, and the causal biological attribution in the chronic phase. In terms of perceived barriers, social control was identified in both phases, adverse effects in the acute phase, and the absence of effective treatment in the chronic state.
Subject(s)
Bipolar Disorder , Bipolar Disorder/drug therapy , Focus Groups , Humans , Medication Adherence , Qualitative ResearchABSTRACT
BACKGROUND: Management of schizophrenia is sub-optimal in many patients. Targeting negative symptoms, among the most debilitating aspects of schizophrenia, together with positive symptoms, can result in significant functional benefits and dramatically improve quality of life for patients and their carers. Cariprazine, a partial agonist of the dopamine receptors D2/D3 has demonstrated effectiveness across symptom domains in clinical trials, particularly on negative symptoms. OBJECTIVE: To obtain a broader insight from clinicians with specific experience with cariprazine, on how it affects patient populations outside the clinical trial setting. METHODS: The panel addressed a series of psychopharmacologic topics not comprehensively addressed by the evidence-based literature, including characteristics of patients treated, dosing and switching strategies, duration of therapy, role of concomitant medications and tolerability as well as recommendations on how to individualize cariprazine treatment for patients with schizophrenia. RESULTS: Patients recommended for cariprazine treatment are those with first episodes of psychosis, predominant negative symptoms (maintenance/acute phase) and significant side effects (metabolic side effects, hyperprolactinemia, sedation) with other antipsychotics. When the long-term treatment of a lifetime illness is adequately weighted, cariprazine becomes one of the first-line medications, not only for patients with predominant negative symptoms but also for those with relatively severe positive symptoms, especially if they are at the first episodes and if a specific medication is added for symptoms such as agitation or insomnia. For instance, patients with agitation may also benefit from the combination of cariprazine and a benzodiazepine or another sedating agent. Cariprazine may be prescribed as add-on to medications such as clozapine, when that medication alone is ineffective for negative symptoms, and sometimes the first may be discontinued or its dose lowered, after a period of stability, leaving the patient on a better tolerated antipsychotic regimen. CONCLUSIONS: Based on real-world clinical experience, the panel considered that cariprazine, with its distinct advantages including pharmacokinetics/pharmacodynamics, good efficacy and tolerability, represents a drug of choice in the long-term management of schizophrenia not only for patients with predominant negative symptoms but also for those with positive symptoms.
ABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Ureteral Obstruction/diagnostic imaging , Sarcoma/diagnosis , Uterine Neoplasms/diagnostic imaging , Uterine Neoplasms/pathology , Ultrasonography , Tomography, Emission-Computed , Retroperitoneal Neoplasms/diagnosisABSTRACT
No disponible
Subject(s)
Humans , Male , Adolescent , Urachal Cyst/diagnostic imaging , Pain/etiology , Urachus/diagnostic imaging , Tomography, X-Ray Computed , Scrotum/diagnostic imagingABSTRACT
BACKGROUND: There is an increased risk of premature death in people with severe mental illness (SMI). Respiratory disorders and cardiovascular disease are leading causes of increased mortality rates in these patients, and tobacco consumption remains the most preventable risk factor involved. Developing new tools to motivate patients towards cessation of smoking is a high priority. Information on the motivational value of giving the lung age and prevention opportunities is unknown in this high-risk population. METHODS/DESIGN: This article describes in detail a protocol developed to evaluate an intensive motivational tool, based on the individual risks of pulmonary damage and prevention opportunities. It is designed as a randomized, 12-month, follow-up, multicenter study. A minimum of 204 smokers will be included, aged 40 years and older, all of whom are patients diagnosed with either schizophrenia or bipolar disorder (BD). Chronic obstructive pulmonary disease (COPD) will be evaluated using spirometry, and the diagnosis will then be validated by a pneumologist and the lung age estimated. Based on this value, a motivational message about prevention will be issued for the intervention group, which will be reinforced by individualized text messages over a period of 3 months. The efficacy of the method and the pulmonary damage variables will be evaluated: smoking cessation at the end of follow-up will be confirmed by cooximetry, and the COPD diagnosis and the severity of the staging for disease will be assessed. DISCUSSION: In the context of community care, screening and early detection of lung damage could potentially be used, together with mobile technology, in order to produce a prevention message, which may provide patients with SMI with a better chance of quitting smoking. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03583203 . Registered on 11 July 2018. Trial status: recruitment.
Subject(s)
Bipolar Disorder/psychology , Pulmonary Disease, Chronic Obstructive/therapy , Schizophrenia , Schizophrenic Psychology , Smoking Cessation/methods , Smoking Prevention/methods , Smoking/psychology , Bipolar Disorder/diagnosis , Health Behavior , Health Knowledge, Attitudes, Practice , Humans , Lung/physiopathology , Motivation , Multicenter Studies as Topic , Patient Education as Topic , Prospective Studies , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/psychology , Randomized Controlled Trials as Topic , Schizophrenia/diagnosis , Severity of Illness Index , Smoking/adverse effects , Spain , Text Messaging , Time Factors , Treatment OutcomeABSTRACT
Tobacco consumption is the main preventable factor of mortality in smokers with bipolar disorder (BD), and any possible solutions are often blocked by prejudices over desire, and the possibilities and risks for these patients in giving up tobacco consumption. Adults with BD were recruited at 8 Mental Health Centres. Smokers were evaluated before and after a brief intervention based on the 3 A's and classified into a 'Stage of Change' (SOC) and their 'Readiness to Change' (RTC). A multiple linear regression was used to analyze the progression in their RTC and the independent effect of different variables (pharmacological treatment, history of psychotic symptoms, current anxiety symptoms, willingness, self-perceived capacity to quit smoking and subjective perception of cognitive functioning). Of 212 stable patients diagnosed with BD, current smokers (n=101; 47.6%) were included in the intervention phase, and 80.2% completed it. At baseline, 75.2% were considering the idea of giving up smoking and, after the brief intervention, 30.9% of the patients progressed in their SOC. A significant increase in the level of RTC was observed (53.3 vs 59.3, P=0.019). Perception of cognitive performance (ß=-0.35;P=0.002), the degree of willing to quit (ß=0.32;P=0.008), self-perceived capacity to quit tobacco smoking (ß=-0.30;P=0.012), the patient's age (ß=-0.72;P=0.004), the age of onset of smoking (ß=0.48;P=0.022) and years as a smoker (ß=0.48;P=0.025) were all factors that significantly influenced the chances of improving after the short intervention. Smokers with BD consider the idea of quitting and a brief intervention developed in the every day mental health care setting improves the level of readiness. The neurocognitive dysfunction associated with BD may limit patients' readiness to quit smoking.
El consumo de tabaco es el principal factor prevenible de mortalidad en pacientes con trastorno bipolar (TB), y las posibles soluciones se encuentran bloqueadas por prejuicios acerca del deseo, posibilidades y riesgos al dejar el consumo de tabaco en estos pacientes. En 8 Centros de Salud Mental se reclutaron consecutivamente pacientes con TB. Los fumadores fueron evaluados antes y después de una intervención breve basada en las 3 As y clasificados según los "estadios de cambio" (EC) y su "disposición para el cambio" (DC). Mediante una regresión lineal múltiple se analizó la evolución del DC y su efecto sobre otras variables independientes (tratamiento farmacológico, historias de síntomas psicóticos, presencia de síntomas de ansiedad, deseo de abandono, capacidad auto-percibida y la percepción subjetiva de funcionamiento cognitivo). Se incluyeron 212 pacientes con TB estabilizados, los fumadores activos (n=101; 47.6%) pasaron a la fase de intervención, y un 80.2% la completaron. Basalmente, 75.2% consideraban la idea de dejar de fumar, después de la intervención breve, el 30.9% de los pacientes progresó en su EC. Se observó un incremento significativo del nivel de DC (53.3 vs 59.3, P=0.019). La autopercepción del rendimiento cognitivo (ß=-0.35;P=0.002), el deseo de abandono (ß=0.32;P=0.008), la autopercepción de la capacidad para dejar de fumar (ß=-0.30;P=0.012), la edad del paciente (ß=-0.72;P=0.004), la edad de inicio del tabaquismo (ß=0.48;P=0.022) y los años fumando (ß=0.48;P=0.025) fueron los factores que influyeron significativamente en la posibilidad de cambio tras la intervención breve. Los fumadores con TB consideran la idea de dejar de fumar y una intervención breve desarrollada en el marco de la atención a la salud mental diaria, mejoraría el nivel de preparación. La disfunción neurocognitiva asociada con el TB podría limitar la disposición de los pacientes a dejar de fumar.
Subject(s)
Bipolar Disorder/complications , Smoking Cessation/methods , Tobacco Smoking/psychology , Tobacco Smoking/therapy , Adult , Counseling/methods , Female , Humans , Linear Models , Male , Middle Aged , Motivation , SpainABSTRACT
El consumo de tabaco es el principal factor prevenible de mortalidad en pacientes con trastorno bipolar (TB), y las posibles soluciones se encuentran bloqueadas por prejuicios acerca del deseo, posibilidades y riesgos al dejar el consumo de tabaco en estos pacientes. En 8 Centros de Salud Mental se reclutaron consecutivamente pacientes con TB. Los fumadores fueron evaluados antes y después de una intervención breve basada en las 3 As y clasificados según los "estadios de cambio" (EC) y su "disposición para el cambio" (DC). Mediante una regresión lineal múltiple se analizó la evolución del DC y su efecto sobre otras variables independientes (tratamiento farmacológico, historias de síntomas psicóticos, presencia de síntomas de ansiedad, deseo de abandono, capacidad auto-percibida y la percepción subjetiva de funcionamiento cognitivo). Se incluyeron 212 pacientes con TB estabilizados, los fumadores activos (n = 101; 47.6%) pasaron a la fase de intervención, y un 80.2% la completaron. Basalmente, 75.2% consideraban la idea de dejar de fumar, después de la intervención breve, el 30.9% de los pacientes progresó en su EC. Se observó un incremento significativo del nivel de DC (53.3 vs 59.3, P = 0.019). La autopercepción del rendimiento cognitivo (β = -0.35;P = 0.002), el deseo de abandono (β = 0.32;P = 0.008), la autopercepción de la capacidad para dejar de fumar (β = -0.30;P = 0.012), la edad del paciente (β = -0.72;P = 0.004), la edad de inicio del tabaquismo (β = 0.48;P = 0.022) y los años fumando (β = 0.48;P = 0.025) fueron los factores que influyeron significativamente en la posibilidad de cambio tras la intervención breve. Los fumadores con TB consideran la idea de dejar de fumar y una intervención breve desarrollada en el marco de la atención a la salud mental diaria, mejoraría el nivel de preparación. La disfunción neurocognitiva asociada con el TB podría limitar la disposición de los pacientes a dejar de fumar
Tobacco consumption is the main preventable factor of mortality in smokers with bipolar disorder (BD), and any possible solutions are often blocked by prejudices over desire, and the possibilities and risks for these patients in giving up tobacco consumption. Adults with BD were recruited at 8 Mental Health Centres. Smokers were evaluated before and after a brief intervention based on the 3 A's and classified into a 'Stage of Change' (SOC) and their 'Readiness to Change' (RTC). A multiple linear regression was used to analyze the progression in their RTC and the independent effect of different variables (pharmacological treatment, history of psychotic symptoms, current anxiety symptoms, willingness, self-perceived capacity to quit smoking and subjective perception of cognitive functioning). Of 212 stable patients diagnosed with BD, current smokers (n = 101; 47.6%) were included in the intervention phase, and 80.2% completed it. At baseline, 75.2% were considering the idea of giving up smoking and, after the brief intervention, 30.9% of the patients progressed in their SOC. A significant increase in the level of RTC was observed (53.3 vs 59.3, P = 0.019). Perception of cognitive performance (β = - 0.35;P = 0.002), the degree of willing to quit (β = 0.32;P = 0.008), selfperceived capacity to quit tobacco smoking (β = -0.30; P = 0.012), the patient's age (β = -0.72; P= 0.004), the age of onset of smoking (β = 0.48;P = 0.022) and years as a smoker (β = 0.48;P = 0.025) were all factors that significantly influenced the chances of improving after the short intervention. Smokers with BD consider the idea of quitting and a brief intervention developed in the every day mental health care setting improves the level of readiness. The neurocognitive dysfunction associated with BD may limit patients' readiness to quit smoking
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Bipolar Disorder/complications , Smoking Cessation/methods , Tobacco Smoking/psychology , Tobacco Smoking/therapy , Counseling/methods , Linear Models , Motivation , SpainABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Renal Veins/abnormalities , Urinary Bladder Neoplasms/surgery , Incidental Findings , Vascular Malformations/diagnosis , Tomography, X-Ray ComputedABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Urogenital Abnormalities/diagnosis , Back Pain/etiology , Ureter/abnormalities , Seminal Vesicles/abnormalitiesABSTRACT
50 year old male with history of renal colic presenting to the emergency room with left colic pain. On ultrasound horseshoe kidneys were visualized without hydronephrosis or stones. CT scan: horseshoe kidney with inferior isthmus, no signs of nephrolithiasis or urolithiasis. There are multiple associated vascular anomalies (there are at least five right renal arteries and two left, double venous return is seen in both hemi-kidneys).
Subject(s)
Kidney/abnormalities , Kidney/diagnostic imaging , Renal Artery/abnormalities , Renal Artery/diagnostic imaging , Tomography, X-Ray Computed , Humans , Male , Middle AgedABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Kidney/abnormalities , Renal Colic/etiology , Urogenital Abnormalities/diagnosisABSTRACT
No disponible
Subject(s)
Humans , Male , Urogenital Abnormalities/diagnosis , Urinary Tract/abnormalities , Choristoma/diagnosis , Low Back Pain/etiologyABSTRACT
OBJECTIVE: To describe the case of a patient with gross hematuria. The pathological study revealed a subepithelial hematoma of the renal pelvis (Antopol-Goldman lesion). METHODS/RESULTS: An 86 year-old woman presented with gross hematuria through the right ureteral orifice. A filling defect is visualized in the right renal pelvis on CT and right nephroureterectomy was carried out after the diagnosis of suspicious upper urinary tract tumor. The pathological study revealed the presence of a subepithelial hematoma without evidence of malignancy. CONCLUSION: Antopol-Goldman lesion is a benign condition that one must have in mind in the work up of patients with hematuria and filling defects in the urinary tract who present a predisposing factor for pyelic hematoma.
