Evidence Based Treatments for Bipolar Disorder in Children and Adolescents

Limited research has been devoted to developing and testing psychosocial treatments for bipolar disorder (BPD) in children and adolescents, a chronic and impairing mental illness that has received increased attention in recent years. Existing treatments are intended as adjuncts to medication, and share a family-based psychoeducation approach. Components of four treatments are discussed: family-focused treatment (FFT), the RAINBOW Program, multi-family psychoeducation groups (MFPG), and individual family psychoeducation (IFP). Evidence supporting each approach is detailed. Selected components of MFPG are described. A flowchart provides suggestions for sequencing interventions to maximize effectiveness. To illustrate the use of evidence-based treatment for children with BPD, a case example is provided.

Parental Refusal of Medical Treatment for a Newborn

Theoretical Medicine and Bioethics - When there is a conflict between parents and the physician over appropriate care due to an infant whose decision prevails? What standard, if any, should guide...     

Relationships between personal beliefs and treatment acceptability, and preferences for behavioral treatments

Background

The literature on preferences for behavioral interventions is limited in terms of understanding treatment-related factors that underlie treatment choice. The objectives of this study were to examine the direct relationships between personal beliefs about clinical condition, perception of treatment acceptability, and preferences for behavioral interventions for insomnia.

Methods

The data set used in this study was obtained from 431 persons with insomnia who participated in a partially randomized clinical trial and expressed preferences for treatment options. The data were collected at baseline. Logistic regression was used to examine the relationships between personal beliefs and treatment acceptability, and preferences. The relationships between personal beliefs and perception of treatment acceptability were explored with correlational analysis.

Results

Perception of treatment acceptability was associated with preferences. Persons viewing the option as convenient tended to choose that option for managing insomnia. Personal beliefs were not related to preferences. However, beliefs about sleep promoting behaviors were correlated with perceived treatment effectiveness.

Conclusions

Perception of treatment acceptability underlies expressed preferences for behavioral interventions. Personal beliefs about insomnia are not directly associated with preferences. Importance is highlighted for providing information about treatment options and exploring perception of each option's acceptability during the process of treatment selection.     

The Sequential Combination of Pharmacotherapy and Psychotherapy in Mood Disorders

The aim of this review was to consider the literature concerned with a sequential use of pharmacotherapy and psychotherapy in mood disorders. Review of the clinical trials where treatment components were used in a sequential order were identified by using MEDLINE, a manual search of the literature and the Index Medicus. In unipolar recurrent depression, the sequential use of pharmacotherapy and psychotherapy was found to improve relapse rate. In bipolar disorder, the use of psychotherapeutic strategies in patients who were already assuming mood stabilizers was also found to yield clinical benefits. The sequential model has the potential for improving the logic and timing of interventions. A conceptual shift in current assessment methods (staging) is needed.     

老年非小细胞肺癌治疗中存在的问题

肺癌已成为危害人类健康和导致死亡的最主要疾病,其中一半以上发生在老年人,且大部分为确诊时已为晚期,针对这些患者的诊断和治疗还存在很多误区,因多病并发所致的诊断延误、因恐惧所致的逃避、以及因对药物的过度依赖而对患者心理因素的忽视等,致使部分老年肺癌患者不能及时得到合理的治疗,值得引起临床医师的重视。     

盆腔炎性疾病的诊断和治疗

盆腔炎性疾病（pelvic inflammatory disease,PID）是指女性上生殖道的一组感染性疾病,由于临床不典型和致病微生物的多样性,导致目前临床上PID的诊断和治疗有一定的难度。本文介绍PID发病机制、高危因素、后遗症和并发症等方面的研究进展,推荐其诊断和治疗的最新规范。     

盆腔脓肿的诊断与治疗

盆腔脓肿是一个严重影响妇女健康的疾病,100多年来,盆腔脓肿的诊断和治疗观念不断更新。B超、CT、MRI、镓,锢标记的白细胞扫描等技术诊断的应用提高了诊断的准确率。B超、CT引导下的穿刺以及广谱抗生素的运用,使得盆腔脓肿的治愈率不断提高。     

论疾病之病痛与病损

文章认为,疾病可分为“病损”（疾病对机体的损害）和“病痛”（患者感受到的不适感）两个方面,此二者可一致亦可背离,故治疗必须分别对待。特别指出“病痛”于康复过程的重要意义,提出了合理祛除“病痛”的要点。分析也揭示了中西医之间的优缺点,于正确诊治疾病和认识中西医之关系,促进医学健康发展具有一定意义。     

辩证看待老年人的药物应用

老年人的用药具有特殊性和复杂性,每位医师在做出,临床决策时,应具有人文精神和辩证的思维方式,使哲学思维与科学思维密切结合,应用这种方式,重点探讨了老年人的个体化用药、注重整体、顺势而治、侧重治未病与自然疗法,从而为老年人提供人性化的最优化治疗,降低药源性损害。     

风湿性心脏病瓣膜置换术后抗凝治疗中“度”的把握

风湿性心脏瓣膜病在世界范围内发病率极高,瓣膜置换术是目前治疗该病的主要方法,根据不同的病情及需要可置换机械瓣或生物瓣,我国患者更常选择机械瓣置换,术后生物瓣置换需抗凝3个月～6个月,而机械辩置换者需终身抗凝,故抗凝治疗非常关键。本文从辨证思维的角度分析如何在瓣膜置换术后把握好抗凝治疗。