Split Hospitalizations: a Model for Mood Disorders.

Depression is a major burden for society. While most mood disorders are treated on an outpatient basis, specific indications warrant hospitalization. Besides progresses in pharmacology, psychotherapy, or interventional procedures, we suggest that the hospital setting could also be used as a tool to address specific aspects of the mood disorder problem. Hospitalizations may present some iatrogenic effects and participate to the chronicization of some inpatients. In this paper, we propose a split hospitalization model for the treatment of mood disorders, where the stay in the hospital is split by a period of return to home, to test their ability to find own solutions to their mood difficulties. This split model could offset some of the negative effects inherent in long-term or repeated hospitalization, and chronicization. This model, where patients are treated as actors of their recovery supports the self-efficacy dimension by deconstructing a self-fulfilling prophecy based on the idea that the main function of the hospital is to serve as an asylum where the patient seeks protection against own self-destructive tendencies. This article outlines how the system was set up, described the expected therapeutic prospects, and presents a critical discussion of the main issues at stake.

Shape of Thyroid Cartilage Influences Outcome of Montgomery Medialization Thyroplasty: A Gender Issue.

OBJECTIVE: This study aimed to determine whether the shape of the thyroid cartilage and gender influence voice outcomes after a Montgomery thyroplasty implant system (MTIS). METHODS: A retrospective cohort study was performed on 20 consecutive patients who underwent MTIS. Voice outcome variables were the relative decrease in Voice Handicap Index (%) and the absolute increase in maximum phonation time (MPT) (in seconds). Material variables were the angle between the thyroid cartilage laminae (α-angle), the size of the prosthesis, and a combination of both (the α-ratio). Continuous variables were analyzed using medians and were compared between groups using the Mann-Whitney U test. Factors associated with the outcome variables were assessed by multivariable linear regression. A Pearson coefficient was calculated between material variables. RESULTS: The absolute increase in MPT between the pre- and postoperative period was significantly different between men and women, with a median absolute increase of 11.0 seconds for men and of 1.3 seconds for women (P < 0.001). A strong inverse correlation between the α-ratio and the absolute increase in MPT is observed in all patients, with a Pearson correlation coefficient R = -0.769 (P < 0.001). No factors were significantly associated with the relative Voice Handicap Index decrease in univariable or multivariable analyses. A better Pearson coefficient between the α-angle and the prosthesis size was found for females (0.8 vs 0.71). CONCLUSION: The MTIS is a good thyroplasty modality for male patients, but inadequate design of MTIS female implants leads to poor MPT outcomes. This represents a gender issue that needs to be further studied and eventually tackled.