På senare år har antalet slutenvårdsplatser i Sverige minskat. Detta har lett till att patienter med psykisk ohälsa själva behöver bli experter på sin sjukdom. I flera delar av landet erbjuds därför psykopedagogiska interventioner som komplement till farmakologisk behandling vid behandling av bipolär sjukdom. Interventionerna har olika struktur och innehåll, men alla syftar till att stärka patienten och ge denne verktyg för att kunna hantera sin sjukdom. Syftet med denna studie var att belysa deltagarnas erfarenheter av att ha deltagit i den psykopedagogiska interventionen som Psykiatri Södra i Stockholm erbjuder, vilka nya kunskaper de har fått och vad de har tyckt varit givande/ mindre givande. Studiens design var kvalitativ och genomfördes med hjälp av personliga intervjuer. Vi tillfrågade 25 personer vilka samtliga har deltagit i psykopedagogiska interventioner. Av dessa tackade sju ja till intervjuerna. Innehållsanalys användes som metod vid bearbetandet av intervjuerna. Resultatet visar att deltagarna hade blivit stärkta i sig själva, att de hade lärt sig att separera sig själva från sjukdomen och att de hade fått större förståelse för vad de kan göra för att förhindra uppkomsten av nya skov. Framför allt visar dock resultatet att deltagarna hade blivit en del av en grupp, det vill säga fått en känsla av sammanhang, vilket de flesta dittills hade saknat i livet. Psykiatrin har en viktig roll i att aktivt bjuda in patienter och anhöriga till psykopedagogiska interventioner. Trots att forskningen påvisar att det bara finns fördelar med psykopedagogiska interventioner, finns det alldeles för få utbildningsplatser för att täcka patienternas behov. En del av specialistsjuksköterskans roll blir att se till att psykopedagogik implementeras i den psykiatriska vården. / During the last years institutional care in Sweden has decreased, which has led to the fact that patients need to become experts on their own disorder. In several parts of the country psycho educational interventions are offered as a complement to pharmacological treatment when treating people with bipolar disorder. The intervention programs have different structures and contents, but they all aim to strengthen the patient and provide him or her with tools to manage the disease. The aim of the study was to illuminate the participants’ experiences of taking part in a psycho educational intervention program offered by Psykiatri Södra in Stockholm, what sort of new knowledge they acquired, what was good/ less good. The design of the study was qualitativeand it was performed through personal interviews. Everyone who participated in the last intervention was asked to participate in the study. The sample was based on the above, and in the end seven people accepted taking part in an interview. A qualitative content analysis was used to process the interviews. The results showed that the participants felt empowered, they had learned to separate themselves from the disease, they had a bigger understanding for what they themselves could do to prevent new relapses, but most of all they had become a part of a group, and they finally felt a sense of coherence which they previously lacked in life.  Psychiatric caregivers have an important part in actively inviting people with bipolar disorder and their relatives to psycho educational intervention programs. Even though research shows that there only are benefits in psycho educational intervention programs, there aren’t enough programs to cover all in need.  A part of the specialist nurse’s roll therefore is to implement psycho educational intervention programs in psychiatric care.

Background: Research into the benefits of exercise for individuals with Bipolar Disorder (BD) is limited and no current guidelines exist around recommending exercise during a hypomanic/manic state. The Behavioural Activation System (BAS) dysregulation theory is a popular model that attempts to explain the link between approach motivation (AM) and the difficulties that individuals with BD experience. It may offer an explanation for the ‘upward spiral’ reported by individuals with a diagnosis of BD in response to certain types and intensities of exercise. This study looked to investigate the impact of different intensities of exercise on the maintenance of AM levels. The presence of hypomanic traits and how these interacted between AM and exercise was also of interest. Method: Participants filled out an online pre-screening questionnaire identifying hypomanic traits. 61 then completed a computer task designed to induce higher levels of AM before taking part in one of three 15 minute activities (sedentary, moderate exercise or vigorous exercise). Various measures linked to hypomanic symptoms were taken during testing. Results The main findings indicated that vigorous exercise significantly increased individuals AM levels in comparison to moderate or no exercise. This relationship was not however found to be moderated by the presence of hypomanic traits. Conclusions: Vigorous exercise seems to have a greater impact on AM levels regardless of an individual’s levels of hypomanic traits. This has implications in terms of the type of exercise should engage in when experiencing hypomania. Any recommendations however within this study should be taken in light of the limitations identified. Further research replicating these results with a larger sample or using a BD population are recommended.

The objective of this dissertation is to evaluate whether two different types of policy interventions in the United States are associated with health service utilization and economic outcomes. Paper 1: The number of government lawsuits accusing pharmaceutical companies of off-label marketing has risen in recent years. We use Medicare and Medicaid claims data to evaluate how an off-label marketing lawsuit and its accompanying media coverage affected utilization and spending on gabapentin as well as other anticonvulsant medications. In this interrupted time series analysis of dual eligible patients with bipolar disorder, we found that the lawsuit and accompanying media coverage corresponded with a decrease in market share of gabapentin, a substitution of newer and expensive anticonvulsants, and a substantial increase in overall spending on anticonvulsants. Paper 2: Medicare Part D was a major expansion of Medicare benefits to cover pharmaceuticals. There were initial concerns about how the dually eligible population who previously had drug coverage through Medicaid would fare after transitioning to Part D plans. Using a nationally representative longitudinal panel survey of Medicare Beneficiaries that are dually eligible for Medicaid, we investigated whether differences in generosity of Medicaid drug benefits were associated with differential changes in drug utilization and out-of-pocket spending for duals after they transitioned to Part D. Our finding suggest that those who previously encountered a monthly drug cap prior to Part D implementation experienced a differentially higher increase in annual prescription drug fills compared with those who did not face a cap.

This thesis explores the subject positions available to users of genetic tests for bipolar disorder in the United States. In advanced liberal societies, tests for genetic susceptibility to complex disorders may be promoted and used as means of performing responsible citizenship through the consumption of health care services. In the context of mental illness, however, key assumptions about the characteristics of consumers may not be met. The research found that because the category of “potential test user” substantially overlaps with the category of “mental health care user,” both the rationality and autonomy of these individuals is subject to question. Test users are framed in relational terms: as family members, as patients, and as consumers – but the last of these relational frames is considered problematic. Therefore, while the tests are framed as tools for proactive health management, responsibilities surrounding their use are largely allocated to family members and doctors.

This study was aimed at evaluating effects of psycho education on medication compliance and symptom management for clients with bipolar affective disorder attending community psychiatric clinics in the Ethekwini Health District of KwaZulu-Natal Province. A quantitative study was done using a quasi-experimental design. A one group pre-test and post-test design was used to assess the effects of psycho education. The population of the study were all clients with bipolar affective disorder attending Escoval House community psychiatric clinic and its satellite clinic (Austerville). Systematic sampling was used to select clients to participate in the study and a total of forty clients were selected. Two self-administered questionnaires were used to collect data. Clients were assessed in areas of their knowledge, medication compliance and symptom management (Pre-test). The group was then exposed to six sessions of psycho education, and they were assessed again a week after the psycho education (post-test) using the same instruments. The data was analyzed using the Statistical Package for Social Sciences (SPSS). Descriptive statistics were used to analyse participants' characteristics and some selected variables. Cross tabulations, chi-squares and paired t-tests were used on dependent variables and on social variables of interest to compare the changes in scores and means respectively and lastly to determine the relationship of social variables and the dependent variables. The findings of this study revealed that psycho education improved respondents' knowledge about their illness and symptom management techniques (with P-values ranging from 0.0001- 0.03), psycho education also improved medication compliance with P-value =0.000, but it did not affect the respondents' ability to use new techniques in managing their symptoms (with P-values ranging from 0.125- 0.75). / Thesis (M.A.)-University of KwaZulu-Natal, 2005.

No description available.

Bipolar disorder is a psychiatric illness characterized by recurrent fluctuations in mood and increased risk of suicide. Twin and family studies have identified the highly heritable nature of the disorder, but the limitations of the current DNA-centric paradigm underscore the need for a new perspective to gain a clearer understanding of its basis. This project investigates various facets of bipolar disorder from an epigenetic standpoint. We used mass spectrometry-based mapping of individual DNA modification differences of the brain-derived neurotrophic factor gene. Moreover, the epigenetic basis of suicidal behaviour in bipolar disorder was investigated using DNA methylation microarrays. We also used a newly-developed enrichment technique, mTAG, to interrogate chromosome-wide DNA modification profiles using tiling microarrays in post-mortem brains of bipolar disease patients and controls. Findings from these experiments highlight observable features of epigenomes of patients affected with mood disorders, and may further the understanding of the molecular origin of psychiatric diseases.

Objective: To explore the measurement of subsyndromal mood symptoms in relation to studies of maintenance therapy for bipolar disorder. Methods: Literature review of the Medline database using the following selection criteria: (1) ‘bipolar disorder’ plus ‘inter-episode or interepisode or subsyndromal or subclinical or residual or subthreshold’ and (2) ‘bipolar disorder’ plus ‘maintenance or prophylaxis or longitudinal’. Studies of children or adolescents and non-English-language reports were excluded. Results: Of the studies published between 1987 and October 2007, 77 articles about subsyndromal mood symptoms and 257 studies of maintenance therapy agents were found. Only 11 of the 257 studies of maintenance therapy agents discussed subsyndromal mood symptoms. Of the 77 articles, two thirds were published after 2000. Inconsistent definitions of subsyndromal mood symptoms and different evaluation tools and methodologies were used in the studies. Conclusions: There is a need to standardize definitions and validate measuring approaches for subsyndromal mood symptoms. However, when measured in both naturalistic studies and clinical trials, subsyndromal mood symptoms were frequently reported by patients receiving maintenance therapy and were associated with poor functioning. As with other chronic illnesses, knowledge of the patient’s perspective of daily morbidity is important for improving the clinical outcome. Studies of maintenance therapy for bipolar disorder, regardless of the approach, should measure subsyndromal mood symptoms as an additional outcome. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Bipolar disorder is a psychiatric illness characterized by recurrent fluctuations in mood and increased risk of suicide. Twin and family studies have identified the highly heritable nature of the disorder, but the limitations of the current DNA-centric paradigm underscore the need for a new perspective to gain a clearer understanding of its basis. This project investigates various facets of bipolar disorder from an epigenetic standpoint. We used mass spectrometry-based mapping of individual DNA modification differences of the brain-derived neurotrophic factor gene. Moreover, the epigenetic basis of suicidal behaviour in bipolar disorder was investigated using DNA methylation microarrays. We also used a newly-developed enrichment technique, mTAG, to interrogate chromosome-wide DNA modification profiles using tiling microarrays in post-mortem brains of bipolar disease patients and controls. Findings from these experiments highlight observable features of epigenomes of patients affected with mood disorders, and may further the understanding of the molecular origin of psychiatric diseases.

Intracellular calcium and oxidative stress dyshomeostasis, which can be highly interactive, occur in bipolar disorder (BD), but the pathogenesis of these disturbances is unknown. The transient receptor potential (TRP) melastatin subtype 2 (TRPM2) and canonical subtype 3 (TRPC3) calcium-permeable non-selective ion channels, already implicated in BD, are involved in calcium and oxidative stress signalling. Thus, I sought to determine whether the expression and function of these channels are modulated by oxidative stress exposure in rat cortical neurons, astrocytes, and in human B lymphoblast cell lines (BLCLs), a cell model that reports diagnostically relevant abnormalities in BD. This thesis work demonstrated that TRPC3 expression and function are decreased after chronic, but not acute oxidative stress exposure in both human and rat cell models. TRPM2 expression, on the other hand, was increased after both acute and chronic stressor treatments in rat cortical neurons. In BLCLs, TRPM2-mediated calcium entry was blunted although no difference in TRPM2 mRNA expression was detected. Moreover, BLCLs from BD-I patients exhibited greater susceptibility to cell death and a differential sensitivity of TRPM2-mediated calcium influx to acute oxidative stress compared with healthy subjects, further supporting reduced cellular resilience in the pathophysiology of BD-I. I also demonstrated that TRPC3 protein is expressed in human brain from 8 days to 83 years old supporting an ongoing role in the developing and adult human brain. These findings support an important role for TRPM2 and TRPC3 in sensing and responding to oxidative stress, and in transducing oxidative stress signalling to intracellular calcium homeostatic and cellular stress responses, which have been implicated in the pathophysiology of BD. Finally, this work has highlighted an inherent difference in TRPM2 channel functionality in BD type I subjects compared with controls, adding functional evidence to the genetic and differential expression findings implicating TRPM2 dysfunction in BD.