Medium and long-term efficacy of psychoeducational family intervention for bipolar I disorder: Results from a real-world, multicentric study.

OBJECTIVES: This study aims to explore the long-term efficacy of a psychoeducational family intervention (PFI) in bipolar I disorder at one and five years post-intervention in terms of improvement of: (1) patients' symptoms and global functioning and (2) relatives' objective and subjective burden and coping strategies. METHODS: This is a multicentre, real-world, controlled, outpatient trial. Recruited patients and key-relatives were consecutively allocated to the experimental intervention or treatment as usual. Patients were assessed at baseline, and after one and five years. RESULTS: One hundred and thirty-seventh number families have been recruited; 70 have been allocated to the experimental intervention, and 67 have been allocated to the control group. We observed an increasing positive effect of the PFI on patients' clinical status, global functioning and objective and subjective burden after one year. We also found a reduction in the levels of relatives' objective and subjective burden and a significant improvement in the levels of perceived professional support and of coping strategies. The efficacy of PFI on patients' clinical status was maintained at five years from the end of the intervention, in terms of relapses, hospitalizations and suicide attempts. CONCLUSIONS: The study showed that the provision of PFI in real-world settings is associated with a significant improvement of patients' and relatives' mental health and psychosocial functioning in the long term. We found that the clinical efficacy of the intervention, in terms of reduction of patients' relapses, hospitalization and suicide attempts, persists after 5 years. It is advisable that PFI is provided to patients with BD I in routine practice.

[Sliding-clip robotic nephropexy]. / Sliding-clip robotic nephropexy.

BACKGROUND: Nephroptosis is a clinical condition characterized by an abnormal caudal movement of the kidney that descends more than 2 vertebral bodies (or more than 5 cm) during a position change from supine to upright. In the last decade, the availability of laparoscopic surgery has led to a revival of interest in nephroptosis and nephropexy. We describe our technique for transperitoneal laparoscopic robotic-assisted nephropexy. METHODS: The surgery was performed on a 78-year-old woman with a BMI of 18 and ASA 2. The diagnosis of nephroptosis was preoperatively confirmed by excretory urography in the supine and upright positions. The patient was placed in Trendelemburg position on the left side. The laparoscopic surgery was performed, through a transperitoneal approach, using the daVinci system: the ptosic kidney was fixed using two separated stiches of non-absorbable prolene 2.0 between the superior surface of the kidney and the quadratus lumborum muscle. The sutures were fixed using Hem-o-lok clips. RESULTS: Intra- or post-operative complications have not occurred. The effectiveness of treatment was demonstrated by an intravenous urography 60 days after. CONCLUSIONS: Robotic-assisted nephropexy is a safe and effective procedure that leads to both clinical and aesthetic excellent results, comparable to the ones obtained with the laparoscopic approach for the treatment of symptomatic renal ptosis. The robotic-assisted nephropexy appears to be easier, with the particular advantages of the intracorporeal suturing and a better intraoperative view; the sliding-clips method allows reducing the organ trauma to the minimum.