How does work work for people with bipolar affective disorder?

Despite modern treatments, bipolar disorder remains a chronic, relapsing disorder that leads to long-term psychosocial disability. A review of the literature suggests that while employment rates amongst individuals with bipolar disorder may improve over time, and are relatively better compared to some other chronic mental disorders, employment prospects do not match the high scholastic achievements seen amongst this group of people before the onset of their illness. For those with bipolar disorder, clinical recovery does not necessarily mean functional recovery, and the usual early age of onset may further reduce an individual's preparedness for employment. Two brief vignettes are used to discuss how occupational therapists can help their clients maintain their sense of hope in vocational recovery, gain better self-awareness and work with clients at various stages of recovery rather than waiting for full functional recovery. Further research is required to help identify specific factors that contribute to the success of employment integration amongst people with bipolar disorder.     

Left Main Coronary Angioplasty: Assessment of a "Risk Score" to Predict Acute and Long-Term Outcome

Due to the recent emergence of adjunctive techniques such as cardiopulmonary bypass support, left main angioplasty may become more routinely applied in the near future. In order to choose the best possible therapy, a precise risk assessment will be desirable. Twenty-two left main angioplasties were thus reviewed and patients were divided in two groups according to a risk score adapted from a previously published jeopardy score. Group I included patients with a risk score ≤ 6 and group II patients with a risk score > 6. A cutoff criterion of six points was chosen because it represents the maximal amount of myocardium put at jeopardy from a single coronary stenosis. The success rate of the procedure was 77% and was similar in both groups. Of the 12 patients in group I, two patients underwent in-hospital bypass surgery and one of them died. Among the ten patients of group II, one sustained a myocardial infarction, three underwent acute surgery, and one patient died postoperatively. After a mean follow-up of 41 months, the total mortality rate was 17% in group I and 30% in group II. The long-term event-free survival rate was 75% in group I and 10% in group II (P = 0.004). The risk score was found to be a potentially important predictor of sustained success (long-term success: 4.4 ± 2.9 vs no long-term success: 8.3 ± 3.4; P = 0.01), although sophisticated statistical analysis was limited by the small number of patients. Thus, in patients with a low risk score, angioplasty seems to be an appropriate treatment while it appears that surgery should remain the standard therapy for patients with a calculated high risk score. However, the clinical significance of this new risk score remains to be determined with more elaborate statistical analysis applied to a larger number of patients.