Abstract:
OBJECTIVE:The purpose of this study was to describe practice patterns of US psychiatrists with regard to the diagnosis and management of depression in adults with bipolar I disorder and to identify relevant gaps in clinical knowledge and competence. METHODS:Two focus groups were conducted using nominal group technique via a web interface and teleconference to elicit barriers that psychiatrists face in managing depression in patients with bipolar I disorder. These results framed a case-based survey that was administered to 200 US-based psychiatrists to explore and quantitatively assess their knowledge and practice patterns with respect to the diagnosis and management of depression in patients with bipolar I disorder. We completed all statistical analyses with PASW Statistics 18 and used descriptive statistics to summarize survey responses. RESULTS:To identify previously undiagnosed mania, 67% of clinician respondents said that they asked depressed patients if they had previously experienced all Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision mania-defining symptoms. To treat a patient with symptoms of depression and no other risk factors for bipolar I disorder, 85% of the respondents said that they would use an antidepressant; 55% of respondents were not concerned that their choice of treatment would lead to a manic episode; 5% thought that there was no greater risk of treatment-emergent mood disorder when treating depression in patients with bipolar I disorder compared with major depressive disorder. If the patient had depression and risk factors for bipolar I disorder, 54% of the respondents said that they would still prescribe an antidepressant as monotherapy. CONCLUSION:The clinician responses were not adherent to evidence-based practice based on clinical trial results or current guideline recommendations. There is an unmet need for education to enable psychiatrists to differentiate between unipolar and bipolar depression, to identify the risk of treatment-emergent mood disorders with the use of antidepressants, and to effectively manage patients at risk for bipolar I disorder.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Glauser TA,Cerenzia W,Wiley S,Howson A,Thase Mdoi
10.3810/pgm.2013.01.2606subject
Has Abstractpub_date
2013-01-01 00:00:00pages
144-53issue
1eissn
0032-5481issn
1941-9260journal_volume
125pub_type
杂志文章abstract:OBJECTIVES:The diagnosis of malignant pleural effusion (MPE) remains a clinical challenge. As a negative regulator of T-cell activation, cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) has been associated with many malignant diseases. However, there is limited data about the relationship between CTLA-4 and MPE. Th...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2017.1331112
更新日期:2017-08-01 00:00:00
abstract::Osteoblasts are mesenchymal cells that play a key role in maintaining bone homeostasis; they are responsible for the production of extracellular matrix proteins, regulation of matrix mineralization, control of bone remodeling and regulate osteoclast differentiation. Osteoblasts have an essential role in the pathogenes...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2017.1362312
更新日期:2017-11-01 00:00:00
abstract::Although a great deal of investigation has led to some novel approaches in treating primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC), no method has been proven to definitively alter the long-term outcome of either disease. In addition, many of the medical regimens reviewed in this article have ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-11-01 00:00:00
abstract::Even modest alcohol ingestion can increase the risk of steatosis, and long-term, excessive consumption can lead to alcoholic hepatitis and eventually cirrhosis. Most patients with clinically significant alcoholic liver disease have histologic findings typical of all three conditions. The only clearly beneficial treatm...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1998.04.462
更新日期:1998-04-01 00:00:00
abstract::Bedside pulmonary artery catheterization has proven to be an important addition to the clinical assessment of critically ill patients. Properly used, the procedure may provide hemodynamic information that is not apparent from physical examination or radiography. It may be safely accomplished through various venous rou...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1991.11700825
更新日期:1991-02-01 00:00:00
abstract::Evidence indicates that preventive healthcare in childhood reduces healthcare costs and enhances health. Physicians can assume a leadership role in promoting children's health by incorporating health promotion measures into their everyday practice, serving as resource persons or leaders in community and school efforts...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699791
更新日期:1987-04-01 00:00:00
abstract::The evaluation of the bleeding patient starts with the integration of data from the history and physical examination. From this results either one probable explanation that can easily be substatniated by laboratory studies or, as more commonly occurs in practice, several possibilities that are reasonable and must be i...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1977.11712257
更新日期:1977-07-01 00:00:00
abstract::Diagnosing acute otitis media (AOM) is quite challenging for physicians and especially other healthcare providers. Although the new guidelines from the American Academy of Pediatrics/American Academy of Family Physicians provide some guidance for making the correct diagnosis of AOM, overdiagnosis will still remain a p...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.12.2005.suppl42.215
更新日期:2005-12-01 00:00:00
abstract::Anemia of chronic disease (ACD) is a prevalent condition commonly observed in patients with chronic infections, cancer, trauma, and inflammatory disorders. In this article, Dr Andrews examines new research findings that enhance the understanding of the pathophysiologic mechanisms of ACD. After a brief review of iron h...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.11.2004.suppl36.250
更新日期:2004-11-01 00:00:00
abstract::Asthma and chronic obstructive pulmonary disease (COPD) are disorders that affect millions of people in the United States and other countries in the world. Asthma is a chronic inflammatory disease of the airways that has cellular and molecular pathways. Affected patients have recurrent episodes of wheezing, dyspnea, c...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.12.2005.suppl44.232
更新日期:2005-12-01 00:00:00
abstract::The goals of therapy for congestive heart failure (CHF) are to improve quality of life and to prolong it. Improvement in patients with CHF can only be realized, however, if a multidisciplinary healthcare team can provide effective management in both the inpatient and outpatient settings. Inhibition of compensatory mec...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1997.01.143
更新日期:1997-01-01 00:00:00
abstract::Sinusitis may present as an indolent infection, without the classic symptoms and signs commonly expected, and will probably be missed in children who have only cough and persistent rhinorrhea unless this diagnosis is kept in mind. Plain radiography is the most commonly used diagnostic procedure for sinusitis, but comp...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1990.11704634
更新日期:1990-04-01 00:00:00
abstract::The goal of screening for colorectal cancer is to find early, asymptomatic cancers and adenomatous polyps that are 1 cm or more in diameter or that are villous or tubulovillous histologically. A study using fecal occult blood testing with rehydration and no sigmoidoscopy found that deaths from colorectal cancer can be...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-07-01 00:00:00
abstract::The solitary pulmonary nodule observed on chest films should be pursued aggressively, usually by means of tissue study, since the clinical and roentgenographic characteristics of the nodule are often misleading and do not permit a reliable diagnosis. A decision to follow a patient without definitive tissue study shoul...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11697794
更新日期:1983-03-01 00:00:00
abstract::Recurrent herpes simplex labialis (HSL), also known as orofacial herpes or cold sores, is a common clinical presentation of herpes simplex virus (HSV) infection. It may manifest as painful, distressing, and cosmetically displeasing vesicles on the lips, nose, and nasal septum. Although oral or topical treatment with a...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2010.09.2216
更新日期:2010-09-01 00:00:00
abstract::The maximal exercise stress test continues to be an important diagnostic and prognostic tool in the primary care office setting. But are you getting the most accurate information possible? Drs Driggers and Marchant discuss several factors that are crucial to the test's validity--and thus to its usefulness in your clin...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1999.05.1.737
更新日期:1999-05-01 00:00:00
abstract::Preview The effects of waning ovarian function start before menstruation stops, and they can be medically important. What changes should women expect, and what preventive health measures can they take? When is oral contraceptive therapy appropriate? How can irregular bleeding and decreased vaginal lubrication best be ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1994.11945822
更新日期:1994-04-01 00:00:00
abstract::Given the present state of the art, any case of apparent pneumonia that is not responding to optimum therapy, or of "viremia" which appears to be progressively deteriorating, should be considered Legionnaires' disease and treated accordingly until proven otherwise. Titers for antibody to the disease in serum obtained ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715346
更新日期:1980-01-01 00:00:00
abstract::The rate of decrease in coronary heart disease (CHD) mortality in the United States has slowed, probably in association with the aging of the population and the increasing rates of obesity, metabolic syndrome, and diabetes. Worldwide, guidelines for reducing risk of CHD and lowering lipid levels must continue to evolv...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.09.2004.suppl34.206
更新日期:2004-09-01 00:00:00
abstract::Evaluation and diagnosis of obstructive lung disease call for careful history taking to distinguish asthma from chronic obstructive pulmonary disease (COPD). A history of atopy and intermittent, reactive symptoms points toward a diagnosis of asthma, whereas smoking and advanced age are more indicative of COPD. Clinica...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2005.03.1593
更新日期:2005-03-01 00:00:00
abstract::There are three key goals in current management of the diabetic pregnancy. Normal diabetes control before conception and during the first trimester in an attempt to reduce the incidence of congenital abnormalities. This implies that all diabetic women of childbearing age should have counseling before pregnancy. Routin...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698879
更新日期:1985-02-01 00:00:00
abstract::Pneumococcal disease, which includes pneumococcal pneumonia, meningitis, and bacteremia, is associated with substantial morbidity, mortality, and health care costs in adults. Advanced age, chronic lung or cardiovascular disease, immunosuppressive conditions, and smoking increase the risk for infection. Despite the ava...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2009.11.2069
更新日期:2009-11-01 00:00:00
abstract::Introduction: Adolescents and young adults are the primary reservoirs and transmitters of meningococci. In the US, meningococcal serogroup B (MenB) disease predominates over A, C, W, and Y; ACIP-recommended MenACWY and MenB vaccines are available. We investigated invasive meningococcal disease (IMD) burden and vaccina...
journal_title:Postgraduate medicine
pub_type: 社论
doi:10.1080/00325481.2019.1671667
更新日期:2019-11-01 00:00:00
abstract::Patients presenting with typical signs and symptoms of allergic rhinitis may respond to avoidance of allergens and to medications for symptomatic relief. Treatment may include antihistamines, decongestants, cromolyn sodium, and/or topical nasal steroids. Patients whose symptoms are refractory to these therapeutic meas...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699668
更新日期:1987-01-01 00:00:00
abstract::Primary care physicians have a crucial role in recognition of potentially emergent conditions in patients with known or suspected cancer. This task presents a significant challenge because the initial manifestations of these conditions are usually nonspecific. In most cases, therapy is far more effective when diagnosi...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1990.11704773
更新日期:1990-12-01 00:00:00
abstract::Because of the broad range of physiologic problems and the many potential sources of complications, liver transplantation patients require contributions from virtually the complete spectrum of medical science. The evolving specialty of liver transplantation has eagerly assimilated advances in surgical techniques, anes...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1990.11704566
更新日期:1990-02-01 00:00:00
abstract:BACKGROUND:Asian Americans exhibit a high prevalence of chronic hepatitis B (CHB) compared with the general population in the United States. However, there are specific barriers to appropriate health care in the Asian American population, and CHB awareness is low. The aim of this study was to examine CHB awareness amon...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2010.09.2213
更新日期:2010-09-01 00:00:00
abstract::Not since the early 1950s has the number of new cases of syphilis been as high as it is now. The infectious agent, Treponema pallidum, is extremely difficult to culture in vitro and almost impossible to see by conventional light microscopy. A nonspecific antibody test is used for screening and a specific treponemal an...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1990.11704578
更新日期:1990-02-15 00:00:00
abstract::Ovulatory dysfunctional uterine bleeding (DUB), a disease prevalent in the latter half of the reproductive years, is diagnosed when organic causes for bleeding have been excluded by clinical, laboratory, and surgical diagnostic means. Disordered prostaglandin metabolism within the endometrium explains most cases of DU...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698855
更新日期:1985-01-01 00:00:00
abstract::When a patient presents with involuntary weight loss, the etiologic considerations can be overwhelming. To plan a cost-effective workup, physicians need to be aware of the most common causes of weight loss and the tests that yield the most pertinent data. Drs Wise and Craig review the clinical studies on unintentional...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-03-01 00:00:00