The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders

Objectives:  Via an international panel of experts, this paper attempts to document, review, interpret, and propose operational definitions used to describe the course of bipolar disorders for worldwide use, and to disseminate consensus opinion, supported by the existing literature, in order to better predict course and treatment outcomes.
Methods:  Under the auspices of the International Society for Bipolar Disorders, a task force was convened to examine, report, discuss, and integrate findings from the scientific literature related to observational and clinical trial studies in order to reach consensus and propose terminology describing course and outcome in bipolar disorders.
Results:  Consensus opinion was reached regarding the definition of nine terms (response, remission, recovery, relapse, recurrence, subsyndromal states, predominant polarity, switch, and functional outcome) commonly used to describe course and outcomes in bipolar disorders. Further studies are needed to validate the proposed definitions.
Conclusion:  Determination and dissemination of a consensus nomenclature serve as the first step toward producing a validated and standardized system to define course and outcome in bipolar disorders in order to identify predictors of outcome and effects of treatment. The task force acknowledges that there is limited validity to the proposed terms, as for the most part they represent a consensus opinion. These definitions need to be validated in existing databases and in future studies, and the primary goals of the task force are to stimulate research on the validity of proposed concepts and further standardize the technical nomenclature.     

Symptomatic Hypocalcemia in Primary Hyperaldosteronism: A Case Report

The metabolic alterations caused by hyperaldosteronism are being increasingly recognized and have generated considerable interest among the medical fraternity. Hyperaldosteronism is suspected to have a pivotal role in the patho-physiology of congestive cardiac failure where it has been studied extensively. But its effects on calcium metabolism, parathyroid metabolism and renal handling of calcium are less well described. Recent experimental models have shed light into the roles played by previously unknown mechanisms in causing these metabolic alterations. We hereby report a case of primary hyperaldosteronism due to adrenal adenoma (Conn''s syndrome) who presented with a myriad of clinical features including symptomatic hypocalcemia, significant weight loss along with uncontrolled hypertension for a prolonged period before eventually detected to have primary hyperaldosteronism. Surgical removal of the causative tumor resulted in prompt disappearance of all the symptoms and signs and regain of lost weight.     

Factors affecting the therapeutic response of enalapril in treatment of post transplant erythrocytosis

Summary: Enalapril was used for post transplant erythrocytosis (PTE) in 19 stable male hypertensive renal allograft recipients. Post transplant erythrocytosis was defined as haematocrit (Hct) >0.45 for 3 consecutive months. Dosage of enalapril was adjusted according to the blood pressure of individual patients and varied from 2.5 mg to 20 mg per day in divided doses. Patients'serum creatinine level, blood pressure and haematocrit were monitored. Therapeutic response was expressed as percentage drop in Hct (Δ%Hct). Factors affecting Δ%Hct was then determined. After 32 weeks of treatment, haematocrit fell from 0.495 ± 0.021 to 0.396 ± 0.053, which represented a 19.9% drop (paired Student's t-test, P > 0.001). With multiple regression analysis, reciprocal of plasma creatinine (RCr) prior to enalapril therapy (B = 3.40 ± 0.72, P > 0.0005), dose of enalapril adjusted with bodyweight (B = - 0.058 ± 0.020, P > 0.02, and pre-treatment haematocrit level (B = - 1.90 ± 0.71, P > 0.02) were found to be independent factors affecting Δ%Hct. We concluded that the dosage of enalapril, renal allograft function and severity of erythrocytosis were the major factors affecting the therapeutic response of PTE by enalapril treatment.     

Spontaneous superior sagittal sinus thrombosis secondary to type II heparin-induced thrombocytopenia presenting as an acute subarachnoid hemorrhage.

Cerebral sinus thrombosis is a rare cause of spontaneous subarachnoid hemorrhage. The development of cerebral sinus thrombosis as a complication of heparin-induced thrombocytopenia is even rarer. In this paper, we present a 59-year-old patient admitted to our service with cerebral sinus thrombosis secondary to type II heparin-induced thrombocytopenia. We also review the literature in regard to the incidence, pathophysiology and management of this rare clinicopathological entity.     

电子束计算机体层成像用于诊断冠状动脉疾病

背景 :电子束计算机体层成像 (ＥＢＣＴ)是检查冠状动脉钙化的一项新的、非创伤性的方法 ,作为一项冠状动脉疾病 (ＣＡＤ)的诊断性检查 ,它日益被提倡。在其临床用途被证实之前 ,必须更好的确定ＥＢＣＴ的总体准确性。目的 :评估ＥＢＣＴ诊断阻塞性ＣＡＤ的准确性。数据来源 :1979年 1月～ 2 0 0 0年 2月 2 9日期间检索了采用ＭＥＤＬＩＮＥ和ＣｕｒｒｅｎｔＣｏｎｔｅｎｔ数据库、图书及专家评议的英语文献。数据的选择 :纳入研究者要求 :①将ＥＢＣＴ作为诊断性检查 ;②所报道的病例应有真阳性、假阳性、真阴性、假阴性结果的绝对数 ;③冠…     

Reliability and cultural applicability of the Greek version of the International Personality Disorders Examination.

Background  

The International Personality Disorders Examination (IPDE) constitutes the proposal of the WHO for the reliable diagnosis of personality disorders (PD). The IPDE assesses pathological personality and is compatible both with DSM-IV and ICD-10 diagnosis. However it is important to test the reliability and cultural applicability of different IPDE translations.     

Nursing Care of the Pregnant Woman with Diabetes Mellitus

A review of pregnancy and diabetes and a discussion of nursing in relation to pregnancy, mental health, and diabetes are presented. The various complications of a chronic disease complicated by pregnancy are discussed, including emotional tensions, family life, sexual changes, and financial responsibilities. The authors propose collaboration of team members with a clinical nurse specialist as central to care continuity, education to help the diabetic woman fulfill the medical plan of therapy, counseling to assist her in adjusting to pregnancy, and nonseparation of pregnancy and diabetes for purposes of nursing and medical care.