Lamotrigine and lithium in primary care psychiatric consultation: adoption and adverse effects.

Background: The Collaborative Care Model of psychiatric consultation in primary care has improved outcomes for unipolar depression, but bipolar depressions are challenging for providers and consultants. Although lamotrigine and lithium are both first line medications for bipolar depression, their use in primary care has been declining over the last decade.

Objective: Our project aimed to quantify the frequency of and adoption of recommendations for lamotrigine and lithium, and their adverse effects, in a Collaborative Care program.

Psychiatric consultation in the collaborative care model: The "bipolar sieve" effect.

Around the world, psychiatrists are in exceptionally short supply. The majority of mental health treatment is delivered in primary care. In the United States, the Collaborative Care Model (CCM) addresses the shortfall of psychiatrists by providing indirect consultation in primary care.

Delayed union in internal fixation of pediatric both-bone forearm fractures.

The aim of this study was to retrospectively determine the risk factors for delayed union in 117 consecutive pediatric both-bone forearm fractures treated with internal fixation. Eight patients (7%, 8/117) had delayed unions, all were boys treated with intramedullary fixation for a fracture in the middle-third of the bone; and in seven patients, the ulna was the site of the delayed union. Older age, double-bone fixation, increased initial fracture displacement, and opening a closed ulna fracture were associated with longer time to union (P<0.

The ketogenic diet for type II bipolar disorder.

Successful mood stabilizing treatments reduce intracellular sodium in an activity-dependent manner. This can also be achieved with acidification of the blood, as is the case with the ketogenic diet. Two women with type II bipolar disorder were able to maintain ketosis for prolonged periods of time (2 and 3 years, respectively).

Amber lenses to block blue light and improve sleep: a randomized trial.

All light is not equal: blue wavelengths are the most potent portion of the visible electromagnetic spectrum for circadian regulation. Therefore, blocking blue light could create a form of physiologic darkness. Because the timing and quantity of light and darkness both affect sleep, evening use of amber lenses to block blue light might affect sleep quality.

A case study of negative pressure wound therapy to manage acute necrotizing fasciitis.

Acute necrotizing fasciitis is a devastating infectious process that requires immediate surgical debridement. Intravenous antibiotic treatment, hyperbaric oxygen therapy, and wound management are considered the standard of care. Subsequent wound closure is achieved with split-thickness skin grafting, delayed surgical closure, or healing by secondary intention.

Improving the diagnosis of bipolar disorder: predictive value of screening tests.

Objective: To examine the impact of assumptions about prevalence or prior clinical probability of bipolar disorder on the clinical performance (predictive values) of diagnostic screening tests.

Method: Sensitivity and specificity data from four reports on two bipolar screening instruments (the Mood Disorders Questionnaire and the Bipolar Spectrum Diagnostic Scale) were used to calculate positive and negative predictive values at varying prevalence levels. Bayesian statistical concepts were employed.

Agitated dysphoria after late-onset loss of response to antidepressants: a case report.

Background: Antidepressants can sometimes cause agitation, particularly in patients with bipolar disorder, but concern about such effects is generally limited to the first weeks and months of treatment.

Method: Demonstration of the occurrence of agitated dysphoria after loss of response to an antidepressant following continuous administration through 7 years of euthymia; with a worsening on dose increase; and recurrence of agitation on re-exposure 1 year later; in a patient whose previous dysthymia and recurrent depressions had no recognizable manic or hypomanic features.

Results: Only when the antidepressant was removed, twice, was treatment an atypical antipsychotic and lithium effective.