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81.
Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation 总被引:2,自引:0,他引:2
Viguera AC Whitfield T Baldessarini RJ Newport DJ Stowe Z Reminick A Zurick A Cohen LS 《The American journal of psychiatry》2007,164(12):1817-24; quiz 1923
OBJECTIVE: This study estimated the risk of recurrence of mood episodes among women with a history of bipolar disorder who continued or discontinued treatment with mood stabilizers during pregnancy. METHOD: In a prospective observational clinical cohort study, the authors determined recurrence risk and survival-analysis-based time to recurrence of a new episode in 89 pregnant women with DSM-IV bipolar disorder. Eligible subjects were euthymic at conception and continued mood stabilizer treatment or discontinued treatment proximate to conception. RESULTS: The overall risk of at least one recurrence in pregnancy was 71%. Among women who discontinued versus continued mood stabilizer treatment, recurrence risk was twofold greater, median time to first recurrence was more than fourfold shorter, and the proportion of weeks ill during pregnancy was five times greater. Median recurrence latency was 11 times shorter after abrupt/rapid versus gradual discontinuation of mood stabilizer. Most recurrences were depressive or mixed (74%), and 47% occurred during the first trimester. Predictors of recurrence included bipolar II disorder diagnosis, earlier onset, more recurrences/year, recent illness, use of antidepressants, and use of anticonvulsants versus lithium. CONCLUSIONS: Discontinuation of mood stabilizer, particularly abruptly, during pregnancy carries a high risk for new morbidity in women with bipolar disorder, especially for early depressive and dysphoric states. However, this risk is reduced markedly by continued mood stabilizer treatment. Treatment planning for pregnant women with bipolar disorder should consider not only the relative risks of fetal exposure to mood stabilizers but also the high risk of recurrence and morbidity associated with stopping maintenance mood stabilizer treatment. 相似文献
82.
Viguera AC Newport DJ Ritchie J Stowe Z Whitfield T Mogielnicki J Baldessarini RJ Zurick A Cohen LS 《The American journal of psychiatry》2007,164(2):342-345
OBJECTIVE: Current practice guidelines discourage use of lithium during breast-feeding, despite limited data. This study aimed to quantify lithium exposure in nursing infants. METHOD: In 10 mother-infant pairs, the authors obtained assays of lithium in maternal serum, breast milk, and infant serum and indices of infant renal and thyroid function. RESULTS: Maternal serum, breast milk, and infant serum daily trough concentrations of lithium averaged 0.76, 0.35, and 0.16 meq/liter, respectively, each lithium level lower than the preceding level by approximately one-half. No serious adverse events were observed, and elevations of thyroid-stimulating hormone, blood urea nitrogen, and creatinine were few, minor, and transient. CONCLUSIONS: Serum lithium levels in nursing infants were low and well tolerated. No significant adverse clinical or behavioral effects in the infants were noted. These findings encourage reassessment of recommendations against lithium during breast-feeding and underscore the importance of close clinical monitoring of nursing infants. 相似文献
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Jeffrey J. Sable Kristin L. Knopf Marie R. Kyle Lauren T Schully Megan M. Brooks Kelly H. Parry Ivy A. Thompson Elise B. Suna Rachel Stowe Laura A. Flink Rebecca E. Diamond 《Psychophysiology》2013,50(3):308-313
Previous ERP studies have provided mixed information about ADHD, especially in adults and when conscious attention to stimuli is not required. We used the auditory N1 to assess automatic attention in adults with and without ADHD. While participants watched a silent video, trains of 5 tones (400‐ms onset‐to‐onset time) were presented with intertrain intervals (ITIs) of 1 or 5 s. The P1, N1, P2, and N2 were analyzed. Compared to controls, participants with ADHD had relatively little N1 attenuation after the 5‐s ITI, which was driven by uniformly small N1s to all tones. However, after the 1‐s ITI, the ADHD group had relatively large N2s to all 5 tones in the train. The reduced N1 in adults with ADHD indicated reduced automatic attention to salient sound stimuli, which may be due to reduced function of brain‐stem arousal mechanisms. However, the increased N2 in these participants suggests they had developed certain compensatory mechanisms. 相似文献
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Nancy L Monson Sara J Ireland Ann J Ligocki Ding Chen William H Rounds Min Li Ryan M Huebinger C Munro Cullum Benjamin M Greenberg Ann M Stowe Rong Zhang 《Journal of cerebral blood flow and metabolism》2014,34(1):30-33
Alzheimer''s disease (AD) is a progressive, neurodegenerative disease that may involve inflammatory responses in the central nervous system (CNS). Our objective was to determine whether patients with amnestic mild cognitive impairment (aMCI), a preclinical stage of AD, have inflammatory characteristics similar to patients with multiple sclerosis (MS), a known CNS inflammatory disease. The frequency of lymphocytes and levels of pro-inflammatory cytokines in the cerebrospinal fluid of aMCI patients was comparable to MS patients or patients at high risk to develop MS. Thus, brain inflammation occurs early at the preclinical stage of AD and may have an important role in pathology. 相似文献
90.
Claire L. Tomlinson PhD Rebecca Stowe PhD Smitaa Patel MSc Caroline Rick PhD Richard Gray MSc Carl E. Clarke MD 《Movement disorders》2010,25(15):2649-2653
Interpretation of clinical trials comparing different drug regimens for Parkinson's disease (PD) is complicated by the different dose intensities used: higher doses of levodopa and, possibly, other drugs produce better symptomatic control but more late complications. To address this problem, conversion factors have been calculated for antiparkinsonian drugs that yield a total daily levodopa equivalent dose (LED). LED estimates vary, so we undertook a systematic review of studies reporting LEDs to provide standardized formulae. Electronic database and hand searching of references identified 56 primary reports of LED estimates. Data were extracted and the mean and modal LEDs calculated. This yielded a standardized LED for each drug, providing a useful tool to express dose intensity of different antiparkinsonian drug regimens on a single scale. Using these conversion formulae to report LEDs would improve the consistency of reporting and assist the interpretation of clinical trials comparing different PD medications. © 2010 Movement Disorder Society 相似文献