Restricting evidence syntheses of interventions to English-language publications is a viable methodological shortcut for most medical topics: a systematic review.

OBJECTIVES: To assess the impact of restricting systematic reviews of conventional or alternative medical treatments or diagnostic tests to English-language publications. STUDY DESIGN AND SETTING: We systematically searched MEDLINE (Ovid), the Science Citation Index Expanded (Web of Science), and Current Contents Connect (Web of Science) up to April 24, 2020. Eligible methods studies assessed the impact of restricting systematic reviews to English-language publications on effect estimates and conclusions. Two reviewers independently screened the literature; one investigator performed the data extraction, a second investigator checked for completeness and accuracy. We synthesized the findings narratively. RESULTS: Eight methods studies (10 publications) met the inclusion criteria; none addressed language restrictions in diagnostic test accuracy reviews. The included studies analyzed nine to 147 meta-analyses and/or systematic reviews. The proportions of non-English-language publications ranged from 2% to 100%. Based on five methods studies, restricting literature searches or inclusion criteria to English-language publications led to a change in statistical significance in 23/259 meta-analyses (9%). Most commonly, the statistical significance was lost, but had no impact on the conclusions of systematic reviews. CONCLUSION: Restricting systematic reviews to English-language publications appears to have little impact on the effect estimates and conclusions of systematic reviews.

Excluding non-English publications from evidence-syntheses did not change conclusions: a meta-epidemiological study.

OBJECTIVES: We aimed to assess whether limiting the inclusion criteria solely to English-language publications affected the overall conclusions of evidence syntheses. STUDY DESIGN AND SETTING: Our analyses used a dataset of a previous methods study that included 59 randomly selected Cochrane intervention reviews with no language restrictions. First, we ascertained the publication language of all 2,026 included publications. Next, we excluded studies based on the following criteria: (1) publication solely in non-English language, or (2) main publication (in case of multiple publications of the same study) in non-English language. We then re-calculated meta-analyses for outcomes that were presented in the main summary of findings tables of the Cochrane reports. If the direction of the effect estimate or the statistical significance changed, authors of the respective Cochrane reviews were consulted to assess whether the new evidence base would have changed their conclusions. The primary outcome of our analyses examined the proportion of conclusions that would change with the exclusion of non-English publications. We set the threshold for the approach as noninferior if the upper limit of the 95% confidence interval of the proportion of changed conclusions did not cross a margin of 10%. RESULTS: Across all 59 Cochrane reviews, 29 (49%) included 80 non-English publications. For 16 (27%) of these Cochrane reviews, the exclusion of non-English publications resulted in the exclusion of at least one study. In the remaining 13 Cochrane reviews, the non-English publications were not the only or main publication of the study or they did not contribute to the main summary of the findings table, so their exclusion did not result in an exclusion of the study. Overall, the exclusion of non-English publications led to the exclusion of 31 studies contributing to 40 outcomes. For 38 of the 40 outcomes, the exclusion of non-English studies did not markedly alter the size or direction of effect estimates or statistical significance. In two outcomes, the statistical significance changed, but authors would have still drawn the same conclusion, albeit with less certainty. Thus, the proportion of changed conclusions in our sample was 0.0% (95% CI 0.0-0.6), which indicated the noninferiority of the approach. However, the majority of excluded studies were small. CONCLUSION: Exclusion of non-English publications from systematic reviews on clinical interventions had a minimal effect on overall conclusions and could be a viable methodological shortcut, especially for rapid reviews.

Nivel de resiliencia y autoconcepto en los cuidadores de personas en situación de discapacidad / No disponible

La investigación tuvo como propósito determinar los niveles de resiliencia y autoconcepto en 80 cuidadores de personas en situación de discapacidad en en Maracaibo (Venezuela), mediante un estudio de tipo y nivel descriptivo, estudio de campo y diseño no experimental. La técnica de recolección de datos fue el instrumento de resiliencia de Colina y Esqueda (2002) y la Escala de Autoconcepto de Tennessee (tennessee self concept scale-tsds) de Fitts (1965), adaptada por Garanto (1984). Los resultados mostraron que la variable resiliencia reflejó nivel medio alto en cuidadores. La variable autoconcepto se encontró en un nivel medio. Al analizar las dimensiones de autoconcepto, las dimensiones Identidad y Conducta se situaron en nivel medio, en la dimensión Autosatisfacción los resultados mostraron nivel bajo, indicando que existe insatisfacción en su estado de salud mental actual. En cuanto a la relación de grupos de edad, fliación y tipo de discapacidad con las variables resiliencia y autoconcepto, no se apreció relación signifcativa según la prueba no paramétrica H de Kruskal Wallis (AU)

The research aimed to determine the levels of resilience and self-concept in 80 caregivers of people with disabilities (Maracaibo, Venezuela), in a field study of descriptive type and non-experimental design. The technique of data collection was the instrument of resilience of Colina and Esqueda (2002) and the Tennessee self-concept scale-tsds of Fitts (1965), adapted by Garanto (1984). The results showed that the resilience variable reflected medium high level in caregivers. As for the variable self-concept, it remained at an average level. When analyzing the dimensions of self-concept, the Identity and Conduct dimensions were found in the middle level; however in the dimension self satisfaction the results showed low level, indicating that there is dissatisfaction in their present state of mental health. As for the relation of age groups, affiliation and type of disability with the variables resilience and self-concept, there was a significant relation according to the non-parametric test of Kruskal Wallis (AU)

Preliminary assessment of intrahemispheric QEEG measures in bipolar mood disorders.

OBJECTIVE: This study assessed the quantitative electroenchephalographic (QEEG) absolute power and coherence differences between a group of patients with bipolar I mood disorder (BMD I) and a group of patients with schizophrenia. We also examined the correlation between QEEG measures and family history of BMD. METHOD: Using the National Institutes of Mental Health (NIMH) Global Rating Scale, we rated 18 adult inpatients with a DSM-III-R diagnosis of BMD I for the severity of the current episode. We also collected data on the family history of the illness. This group was then matched for age, sex, and handedness with an equal number of inpatients with a DSM-III-R diagnosis of schizophrenia. QEEG absolute power and coherence was calculated for the alpha bandwidth (8.0 to 12.0 Hz), assessed at 18 pairs of electrodes in both hemispheres during resting, eyes-closed condition in all the patients. RESULTS: The patients with schizophrenia showed significantly higher coherence (P = 0.047) at 6 pairs of electrodes on the right side. The group with BMD showed significantly higher power (P = 0.042) at 2 pairs of electrodes on the right side. Correlational analysis showed that QEEG measures were significantly correlated (P = 0.01) with positive family history of BMD. CONCLUSION: These findings suggest that the patients with BMD are more disorganized in the right anterior hemisphere and that there is a significant positive correlation between the QEEG measures and the presence of family history of BMD. Further studies in a larger sample are required to confirm these preliminary findings.

Physician satisfaction with review boards: the provincial psychiatric hospital perspective.

OBJECTIVES: To assess the level of satisfaction of physicians in provincial psychiatric hospitals with Review Boards (RBs) regarding Civil Commitment Certificates (CCCs), Certificates of Incompetence (COIs), and Treatment Orders (TOs). METHOD: A total of 200 survey questionnaires were distributed to physicians in provincial psychiatric hospitals. Ninety surveys (completed by 25 females, 45 males, and 20 unknown gender) were returned, representing a 45% return rate. Because of their assignments (for example, outpatient department), not all physicians were involved with RBs, and the return rate is likely to have been influenced by this factor. RESULTS: Physician satisfaction rates of 58.2% for CCCs, 66.7% for COIs, and 70.0% for TOs were obtained. Stepwise multiple regression analysis showed that the level of physician satisfaction with RBs for CCCs was predicted best (44.7% of variance) by physician level of comfort with certification and years of institutional affiliation. Qualitative physician responses revealed 3 major themes: patient-related issues, physician-related issues, and RB structure- and process-related issues. CONCLUSIONS: Strategies that increase physician comfort level with RBs and changes in the medicolegal structure and process are discussed. A similar survey of patients and RB members is recommended.

A closer look at inpatient suicide.

BACKGROUND: We examined the risk factors for suicide among inpatients in an Ontario provincial psychiatric hospital. METHODS: Forty-four inpatients who had committed suicide during their hospital stay from 1969 to 1995 were compared with a group of inpatient controls matched for sex, age and date of admission. The diagnosis for each patient was reviewed by the authors. RESULTS: Suicide victims were more likely to have had a mood disorder, family history of psychiatric problems, mention of suicide risk in chart notes and a previous suicide attempt. Two findings necessitated further scrutiny: The most common diagnosis among inpatients who committed suicide in this study was a mood disorder and not schizophrenia as previously reported. A large proportion of patients (24) had experienced a rapidly fluctuating clinical course prior to the time of suicide. CONCLUSIONS: The implications of these findings, including the possible role of antidepressants in the induction of cycling prior to suicide, are discussed.

A review of continuation and maintenance electroconvulsive therapy.

BACKGROUND: Many patients with major psychiatric disorders who are severely ill, medication-resistant, or medication-intolerant respond more reliably and quickly to a course of electroconvulsive therapy (ECT). The management of such patients after successful treatment with ECT is of significant importance given the high rate of relapse and recurrence of these disorders. The unmet clinical need to maintain the mental health of these seriously ill patients at an optimal level has revived the interest in ECT as an alternative prophylactic treatment. METHOD: We review the historical background of ECT and the literature that supports its use as a prophylactic treatment in various disorders and special populations. A clinical summary outlining its efficacy, acceptability, risks, cost-effectiveness, and medicolegal aspects is followed by a guide for prescribing ECT for prophylactic reasons. RESULTS: Continuation and maintenance ECT (C/MECT) has been found to be efficacious, safe, well tolerated, and cost-effective. Its greatest impact has been in reducing relapse, recurrence, and rehospitalization, particularly in the management of recurrent mood disorders in the elderly. The elderly are usually refractory or intolerant to pharmacotherapy but have a good response to ECT during the index episode. Parkinson's disease (PD), schizophrenia, and obsessive-compulsive disorder (OCD), as well as affective disorders coexisting with dementia, neurological disorder, or mental retardation, have also been reported to respond to C/MECT. The outcome depends greatly on rate of compliance. Cognitive risk of C/MECT need to be further studied because the literature to date consists mostly of case reports and anecdotal evidence. Controlled studies with well-defined outcome measurements are needed. CONCLUSIONS: When planning a rational approach to the care of patients with major psychiatric disorders, clinicians should carefully consider ECT along with other alternatives.

Treatment of bipolar depression: a survey of Canadian psychiatrists.

OBJECTIVE: This study was conducted to examine how Canadian psychiatrists manage bipolar depression. METHOD: A questionnaire specific to the treatment of bipolar depression was mailed to 1639 active members of the Canadian Psychiatric Association. RESULTS: Seven hundred and sixty-six completed questionnaires were returned (46.7%). Most psychiatrists indicated that a combination of psychotherapy and somatic therapy was their preferred approach. For bipolar disorder, depressed, lithium carbonate and selective serotonin reuptake inhibitors (SSRIs) were the preferred treatment strategies. For substitution, tricyclic antidepressants (TCAs) were the favoured choice. Lithium carbonate was the preferred choice for augmentation and, addition. CONCLUSION: These findings indicate that a combination of psychotherapy and somatic therapy is the preferred treatment approach for bipolar depression. Lithium carbonate and SSRIs are the favoured somatic therapies.

A nongenetic basis of cycle frequency in bipolar disorder: study of a monozygotic twin pair.

The authors describe a pair of monozygotic twins with bipolar disorder but with a different course of the illness including age of onset, sequence of episodes, and cycle length. Based on these findings, the clinical course of bipolar illness does not appear to be genetically determined.

The phenomenon of rapid cycling in bipolar mood disorders: a review.

OBJECTIVE: To review the various pharmacological and nonpharmacological factors associated with the induction of rapid cycling in bipolar mood disorder, and to introduce the idea that parturition may also have a role. Factors known to contribute to bipolar mood disorder rapid cycling include antidepressant agents, female gender and middle age. Currently, there is evidence that hypothyroidism may also play a role. METHOD: A critical review of the literature was undertaken. CONCLUSION: Caution should be exercised in the use of antidepressants in patients with bipolar mood disorders.

A comparison of comorbid patterns in treatment-resistant unipolar and bipolar depression.

OBJECTIVE: To examine the occurrence of concomitant psychiatric disorders in patients with treatment-resistant unipolar and bipolar depression. METHOD: Forty-nine patients participated as subjects. Twenty-four (49%) had unipolar depression and 25 (51%) had bipolar depression using DSM-III-R criteria. Structured clinical interviews were conducted with all patients. Chart reviews and interviews with family members were also carried out. Information relating to both current and lifetime diagnoses was obtained. RESULTS: Of the entire sample, 75.5% were found to have at least one other Axis I diagnosis and 46.9% had at least two additional Axis I diagnoses. The unipolar group had significantly more current comorbid diagnoses. When type of diagnoses was examined, unipolar patients had significantly more anxiety diagnoses at the time of the index episode, and over their entire lifetime. Bipolar patients had significantly more lifetime substance abuse diagnoses. CONCLUSIONS: Axis I comorbidity appears to be differentially associated with treatment resistance in unipolar and bipolar depression.

Comorbidity of obsessive compulsive disorder in bipolar disorder.

The comorbidity of OCD and bipolar disorder has not been systematically examined. Therefore, we determined the frequency of patients meeting DSM-III criteria for OCD syndrome in a sample of 149 inpatients with DSM-III major affective disorder who had received a clinically reviewed structured diagnostic interview. The frequency of OCD syndrome was not significantly different between subjects with major depression (35.2%, n = 105) and bipolar disorder (35.1%, n = 37). This suggests that OCD is equally common in bipolar as in unipolar patients.

Effect of pregnancy on three patients with bipolar disorder.

Case histories of three bipolar II disorder patients who had periods of sustained euthymia during all their pregnancies are described. The clinical and research implications of these observations are discussed.

Development and validation of a scale for rating mood states of psychiatric inpatients.

OBJECTIVE: The authors assessed reliability and validity of a scale developed for use with inpatients on a mood disorders unit. The scale is used to rate a patient's mood along a quantitative continuum from -5, depressive stupor, through 0, euthymic, to 5, full mania. The scale lists behaviors that constitute criteria for each rating point. Mixed states and idiosyncratic behavior can also be assessed. METHODS: Assessment of the scale's reliability and validity was based on data for 53 psychiatric inpatients. The scale's reliability was assessed by comparing nurses' ratings. Validity was assessed by comparing nurses' ratings with patients' self-ratings using previously validated self-report instruments as well as a patient self-report version of the scale. RESULTS: Interrater reliability for the instrument was high (r = .84). Estimates of validity obtained using patient self-report measures ranged from .54 to .85. CONCLUSIONS: The psychometric properties of the scale are comparable to and in some cases are superior to those reported for instruments that include more items and that take longer to complete.

Hyperthyroidism after treatment with lithium.

The association between treatment with lithium and hypothyroidism is well documented. Reports of hyperthyroidism are rare and it is less well known among patients treated with lithium. It may be overlooked simply because the clinician will be watching for hypothyroidism, the reverse phenomenon. This paper describes the cases of four patients who have been on long term lithium treatment, all of whom developed Graves' disease, or an atypical form of hyperthyroidism. Some suggestions are offered to account for the mechanism underlying this unusual association. Although hyperthyroidism may be rare among patients receiving lithium, astute clinical observation and appropriate laboratory tests are called for to detect the early stages of such thyroid dysfunction and to provide appropriate intervention.