Some disease processes that affect the glomerulus are acute and self-limited, whereas others lead to progressive loss of renal function. Glomerular diseases cause more than half the cases of chronic kidney disease. This chapter first briefly reviews normal glomerular structure and function, clinical classifications, terminology, diagnosis, and epidemiology of glomerular disease. Pathogenesis of glomerular injury is discussed, and then more detailed approaches to diagnosis. General principles in the management of glomerular diseases are presented. Specific glomerular diseases and their management, discussed at length, are divided into nephritic, nephrotic, and nephritic-nephrotic syndromes. Figures illustrate the pathogenesis and findings on light microscopy, electron microscopy, and immunostaining of a variety of glomerular diseases, including poststreptococcal glomerulonephritis, IgA nephropathy, anti–glomerular basement membrane disease, focal and segmental glomerulosclerosis (FSGS), membranous nephropathy, and membranoproliferative glomerulonephritis (MPGN). This review contains 9 figures, 25 tables, and 68 references. Keywords: Glomerulonephritis, nephritic syndrome, nephrotic syndrome, microscopy, urinalysis, proteinuria, hematuria, nephropathy, Henoch-Schönlein purpura, nephritis
{"title":"Glomerular Diseases - Part I","authors":"R. Bonegio, D. Salant","doi":"10.2310/im.1163","DOIUrl":"https://doi.org/10.2310/im.1163","url":null,"abstract":"Some disease processes that affect the glomerulus are acute and self-limited, whereas others lead to progressive loss of renal function. Glomerular diseases cause more than half the cases of chronic kidney disease. This chapter first briefly reviews normal glomerular structure and function, clinical classifications, terminology, diagnosis, and epidemiology of glomerular disease. Pathogenesis of glomerular injury is discussed, and then more detailed approaches to diagnosis. General principles in the management of glomerular diseases are presented. Specific glomerular diseases and their management, discussed at length, are divided into nephritic, nephrotic, and nephritic-nephrotic syndromes. Figures illustrate the pathogenesis and findings on light microscopy, electron microscopy, and immunostaining of a variety of glomerular diseases, including poststreptococcal glomerulonephritis, IgA nephropathy, anti–glomerular basement membrane disease, focal and segmental glomerulosclerosis (FSGS), membranous nephropathy, and membranoproliferative glomerulonephritis (MPGN). \u0000This review contains 9 figures, 25 tables, and 68 references.\u0000Keywords: Glomerulonephritis, nephritic syndrome, nephrotic syndrome, microscopy, urinalysis, proteinuria, hematuria, nephropathy, Henoch-Schönlein purpura, nephritis","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86328059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intimate-partner violence describes relationships characterized by intentional controlling or violent behavior by someone who is in an intimate relationship with the victim. The abuser’s controlling behavior may take many forms, including psychological abuse, physical abuse, sexual abuse, economic control, and social isolation. Abuse may ultimately lead to the death of the victim from homicide or suicide. Typically, an abusive relationship goes through cycles of violence. There are periods of calm, followed by increasing tension in the abuser, outbursts of violence, and return to periods of calm. These cycles often spiral toward increasing violence over time. The victims of intimate-partner violence are usually women, but intimate-partner violence is also a significant problem for gay couples and for the disabled and elderly of both sexes. This review discusses the epidemiology, diagnosis, treatment, outcomes, and prevention of intimate-partner violence. Risk factors for experiencing violence, risk factors for perpetrating violence, and consequences of abuse are also analyzed. This review contains 5 figures, 14 tables, and 30 references. Keywords: Domestic abuse, intimate-partner violence, elder abuse, child abuse, batterer, sexual abuse, physical abuse
{"title":"Intimate Partner Violence","authors":"Jane S. Sillman","doi":"10.2310/im.1024","DOIUrl":"https://doi.org/10.2310/im.1024","url":null,"abstract":"Intimate-partner violence describes relationships characterized by intentional controlling or violent behavior by someone who is in an intimate relationship with the victim. The abuser’s controlling behavior may take many forms, including psychological abuse, physical abuse, sexual abuse, economic control, and social isolation. Abuse may ultimately lead to the death of the victim from homicide or suicide. Typically, an abusive relationship goes through cycles of violence. There are periods of calm, followed by increasing tension in the abuser, outbursts of violence, and return to periods of calm. These cycles often spiral toward increasing violence over time. The victims of intimate-partner violence are usually women, but intimate-partner violence is also a significant problem for gay couples and for the disabled and elderly of both sexes. This review discusses the epidemiology, diagnosis, treatment, outcomes, and prevention of intimate-partner violence. Risk factors for experiencing violence, risk factors for perpetrating violence, and consequences of abuse are also analyzed.\u0000This review contains 5 figures, 14 tables, and 30 references.\u0000Keywords: Domestic abuse, intimate-partner violence, elder abuse, child abuse, batterer, sexual abuse, physical abuse","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"17 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72562145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the United States, lung cancer is the second most common cancer, surpassed only by prostate cancer in men and breast cancer in women. But lung cancer is the leading cause of cancer deaths, accounting for 29% and 26% of all cancer-related deaths in men and women, respectively. The four major pathologic cell types of lung cancer are small cell carcinoma, adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Because they have overlapping clinical behaviors and responses to treatment, adenocarcinoma, squamous cell carcinoma, and large cell carcinoma are generally grouped together in the category of non–small cell lung cancer (NSCLC). This review discusses treatment of both NSCLC and small cell lung cancer (SCLC). This review contains 2 figures, 20 tables, and 95 references. Keywords: lung cancer, mediastinoscopy, chemoradiotherapy, TNM staging system, pulmonary parenchyma, segmentectomy
{"title":"Lung Cancer Part II","authors":"J. Crawford","doi":"10.2310/im.1672","DOIUrl":"https://doi.org/10.2310/im.1672","url":null,"abstract":"In the United States, lung cancer is the second most common cancer, surpassed only by prostate cancer in men and breast cancer in women. But lung cancer is the leading cause of cancer deaths, accounting for 29% and 26% of all cancer-related deaths in men and women, respectively. The four major pathologic cell types of lung cancer are small cell carcinoma, adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Because they have overlapping clinical behaviors and responses to treatment, adenocarcinoma, squamous cell carcinoma, and large cell carcinoma are generally grouped together in the category of non–small cell lung cancer (NSCLC). This review discusses treatment of both NSCLC and small cell lung cancer (SCLC).\u0000This review contains 2 figures, 20 tables, and 95 references.\u0000Keywords: lung cancer, mediastinoscopy, chemoradiotherapy, TNM staging system, pulmonary parenchyma, segmentectomy","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81758277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic kidney disease has a high prevalence and a high mortality rate worldwide. Although diabetes and hypertension are common, unique causes of kidney disease may occur driven by infections, exposures, or genetic susceptibilities. Certain agricultural areas in particular have a high incidence of tubulointerstitial kidney disease of unclear etiology. Risk factors may include heat stress, pesticides, heavy metals, and other environmental toxins. Furthermore, countries have disproportionately different prevalence of renal replacement therapy, which seems to correlate in part to the type of health coverage. The future challenges for the nephrology community worldwide will be dealing with the growing number of patients with end-stage kidney disease, the fragmented healthcare in some countries, shortage of kidney transplantation programs, and deficient registries to appropriately assess the prevalence of kidney disease. This review contains 4 figures, 3 tables, and 54 references. Key Words: acute kidney injury, chronic kidney disease, end-stage renal disease, epidemiology, ethnic background, HIV-associated nephropathy, noncommunicable diseases, renal replacement therapy, screening, socioeconomic status
{"title":"Global Aspects of Chronic Kidney Disease","authors":"G. Modi, V. Jha","doi":"10.2310/im.12018","DOIUrl":"https://doi.org/10.2310/im.12018","url":null,"abstract":"Chronic kidney disease has a high prevalence and a high mortality rate worldwide. Although diabetes and hypertension are common, unique causes of kidney disease may occur driven by infections, exposures, or genetic susceptibilities. Certain agricultural areas in particular have a high incidence of tubulointerstitial kidney disease of unclear etiology. Risk factors may include heat stress, pesticides, heavy metals, and other environmental toxins. Furthermore, countries have disproportionately different prevalence of renal replacement therapy, which seems to correlate in part to the type of health coverage. The future challenges for the nephrology community worldwide will be dealing with the growing number of patients with end-stage kidney disease, the fragmented healthcare in some countries, shortage of kidney transplantation programs, and deficient registries to appropriately assess the prevalence of kidney disease.\u0000This review contains 4 figures, 3 tables, and 54 references.\u0000Key Words: acute kidney injury, chronic kidney disease, end-stage renal disease, epidemiology, ethnic background, HIV-associated nephropathy, noncommunicable diseases, renal replacement therapy, screening, socioeconomic status","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90436673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The destructive potential of intracellular crystals has been recognized for over a century. The mechanisms by which crystals induce inflammation and bone and cartilage destruction have been elucidated over the past decade. The three most common crystal-induced arthropathies are caused by precipitation of monosodium urate monohydrate, calcium pyrophosphate dihydrate (CPP) and basic calcium phosphate. The definition, epidemiology, pathogenesis and etiology, diagnosis, and treatment of gout and CPP crystal deposition are reviewed, as well as the clinical stages of gout (i.e., acute gouty arthritis, intercritical gout, advanced gout, nonclassic presentations of gout, and other conditions associated with gout). Also reviewed are the clinical manifestations of calcium pyrophosphate dihydrate deposition disease (CPPD), such as asymptomatic CPPD, osteoarthritis with CPPD, acute CPP crystal arthritis, and chronic CPP crystal inflammatory arthritis. Figures illustrate renal transport of urate, monosodium urate crystals, acute gouty flare, advanced gouty arthritis, gouty synovial fluid, radiographic changes of advanced gout, ultrasound appearance of the femoral intercondylar cartilage, pharmacologic management of gout, the effect of gender and age on knee chondrocalcinosis, radiographs of chondrocalcinosis, and compensated polarized microscopy of CPPD. Tables present the major factors responsible for hyperuricemia, characteristics of classic gouty flares, antiinflammatory therapy for gout, and urate-lowering therapy. This chapter contains 90 references. This review contains 11 figures, 12 tables, and 88 references. Keywords: acute gouty arthritis, intercritical gout, advanced gout, asymptomatic CPPD, osteoarthritis with CPPD, acute CPP crystal arthritis, chronic CPP crystal inflammatory arthritis
{"title":"Crystal-Induced Joint Disease","authors":"N. Edwards","doi":"10.2310/FM.1213","DOIUrl":"https://doi.org/10.2310/FM.1213","url":null,"abstract":"The destructive potential of intracellular crystals has been recognized for over a century. The mechanisms by which crystals induce inflammation and bone and cartilage destruction have been elucidated over the past decade. The three most common crystal-induced arthropathies are caused by precipitation of monosodium urate monohydrate, calcium pyrophosphate dihydrate (CPP) and basic calcium phosphate. The definition, epidemiology, pathogenesis and etiology, diagnosis, and treatment of gout and CPP crystal deposition are reviewed, as well as the clinical stages of gout (i.e., acute gouty arthritis, intercritical gout, advanced gout, nonclassic presentations of gout, and other conditions associated with gout). Also reviewed are the clinical manifestations of calcium pyrophosphate dihydrate deposition disease (CPPD), such as asymptomatic CPPD, osteoarthritis with CPPD, acute CPP crystal arthritis, and chronic CPP crystal inflammatory arthritis. Figures illustrate renal transport of urate, monosodium urate crystals, acute gouty flare, advanced gouty arthritis, gouty synovial fluid, radiographic changes of advanced gout, ultrasound appearance of the femoral intercondylar cartilage, pharmacologic management of gout, the effect of gender and age on knee chondrocalcinosis, radiographs of chondrocalcinosis, and compensated polarized microscopy of CPPD. Tables present the major factors responsible for hyperuricemia, characteristics of classic gouty flares, antiinflammatory therapy for gout, and urate-lowering therapy. This chapter contains 90 references.\u0000This review contains 11 figures, 12 tables, and 88 references.\u0000Keywords: acute gouty arthritis, intercritical gout, advanced gout, asymptomatic CPPD, osteoarthritis with CPPD, acute CPP crystal arthritis, chronic CPP crystal inflammatory arthritis","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"142 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82266076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Since it was first described, the overall patient and graft survival after liver transplant have improved with advances in immunosuppression and surgical and anesthetic techniques. Despite this improvement, there continues to be both biliary and vascular complications associated with this life-saving operation, which can lead to further procedures, reoperation, and retransplant. Advances in endoscopic and percutaneous techniques have had a significant impact on the perioperative management of posttransplant complications, resulting in a reduction in reoperations and retransplants. Changes in intraoperative management with the use of thrombolytic therapy have allowed for the expansion of the donor pool, allowing the use of donation after cardiac death with increased safety and decreased risk of ischemic biliary tract injury. This article serves to highlight the vascular and biliary complications following transplant, their etiology, diagnosis, and management. This review contains 9 figures, 1 table, and 33 references. Key Words: bile leak, biliary stricture, deceased donor liver transplant, donation after brain death (DBD), donation after cardiac death, hepatic artery thrombosis, ischemic cholangiopathy, living donor liver transplant, portal vein thrombosis, thrombolytic therapy, venous outflow obstruction.
{"title":"Posttransplant Complications: Biliary and Vascular","authors":"Ester Coelho Little, M. Berenguer","doi":"10.2310/im.14055","DOIUrl":"https://doi.org/10.2310/im.14055","url":null,"abstract":"Since it was first described, the overall patient and graft survival after liver transplant have improved with advances in immunosuppression and surgical and anesthetic techniques. Despite this improvement, there continues to be both biliary and vascular complications associated with this life-saving operation, which can lead to further procedures, reoperation, and retransplant. Advances in endoscopic and percutaneous techniques have had a significant impact on the perioperative management of posttransplant complications, resulting in a reduction in reoperations and retransplants. Changes in intraoperative management with the use of thrombolytic therapy have allowed for the expansion of the donor pool, allowing the use of donation after cardiac death with increased safety and decreased risk of ischemic biliary tract injury. This article serves to highlight the vascular and biliary complications following transplant, their etiology, diagnosis, and management.\u0000This review contains 9 figures, 1 table, and 33 references. \u0000Key Words: bile leak, biliary stricture, deceased donor liver transplant, donation after brain death (DBD), donation after cardiac death, hepatic artery thrombosis, ischemic cholangiopathy, living donor liver transplant, portal vein thrombosis, thrombolytic therapy, venous outflow obstruction.","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78850725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
So rapidly has the field of health care ethics continued to grow that, when recently “googled,” the term produced 28.2 million hits. The challenge is to address the ethical and social issues in medicine in this very limited article space. It remains an impossible task to present more than a superficial discussion of these complex issues and the complicated cases in which they are to be found. Like good medicine, good ethics cannot be practiced by algorithm. The authors have opted to provide an operational guide to help clinicians sort through the ethical and social quandaries they must face on a daily basis. To that end, the authors have chosen to divide this chapter into the following sections: 1. A brief description of the biopsychosocial nature of ethics and how it differs from personal morality 2. A method for identifying and dealing with ethical issues 3. A discussion of the role of bioethicists and ethics committees 4. The professional fiduciary role of clinicians 5. Listings of some of the common key bioethical and legal terms (online access only) 6. A very brief discussion of the terms cited in the above listings (online access only) This reviews contains 4 tables, 8 references, 1 appendix, and 20 additional readings. Keywords: Ethical, social, right, wrong, good, bad, obligation, moral authority, critically reflective, and multiperspectival activity, Curiosity, Honesty, Patience, Open-mindedness
{"title":"Ethical and Social Issues in Medicine","authors":"R. Loewy, E. Loewy, Faith T. Fitzgerald","doi":"10.2310/im.1222","DOIUrl":"https://doi.org/10.2310/im.1222","url":null,"abstract":"So rapidly has the field of health care ethics continued to grow that, when recently “googled,” the term produced 28.2 million hits. The challenge is to address the ethical and social issues in medicine in this very limited article space. It remains an impossible task to present more than a superficial discussion of these complex issues and the complicated cases in which they are to be found. Like good medicine, good ethics cannot be practiced by algorithm. The authors have opted to provide an operational guide to help clinicians sort through the ethical and social quandaries they must face on a daily basis. To that end, the authors have chosen to divide this chapter into the following sections: 1. A brief description of the biopsychosocial nature of ethics and how it differs from personal morality 2. A method for identifying and dealing with ethical issues 3. A discussion of the role of bioethicists and ethics committees 4. The professional fiduciary role of clinicians 5. Listings of some of the common key bioethical and legal terms (online access only) 6. A very brief discussion of the terms cited in the above listings (online access only)\u0000This reviews contains 4 tables, 8 references, 1 appendix, and 20 additional readings.\u0000Keywords: Ethical, social, right, wrong, good, bad, obligation, moral authority, critically reflective, and multiperspectival activity, Curiosity, Honesty, Patience, Open-mindedness","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73439070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The small molecule diseases include the inborn errors of carbohydrate, ammonia, amino acid, organic acid, and fatty acid metabolism. They are central to the cohort of biochemical genetic diseases that are often associated with catastrophic presentations and life-threatening illness during infancy and childhood. Many of these entities are now routinely detected through newborn screening in the majority, if not all, of the states in the United States. Several of these diseases have effective therapies that largely eliminate the signs and symptoms of disease. In many, however, the disease process is without an effective treatment or may be brought under control but not corrected. This review contains 1 figure, 6 tables, and 11 references. Keywords: glycogen storage diseases, galactosemia, hyperbilirubinemia, hyperchloremic metabolic acidosis, hypofibrinogenemia, and thrombocytopenia, hypophosphatemia, fructose-1,6-bisphosphatase deficiency
{"title":"Metabolic Disorders: Inborn Errors of Carbohydrate Metabolism","authors":"S. Chopra, G. Berry","doi":"10.2310/im.1332","DOIUrl":"https://doi.org/10.2310/im.1332","url":null,"abstract":"The small molecule diseases include the inborn errors of carbohydrate, ammonia, amino acid, organic acid, and fatty acid metabolism. They are central to the cohort of biochemical genetic diseases that are often associated with catastrophic presentations and life-threatening illness during infancy and childhood. Many of these entities are now routinely detected through newborn screening in the majority, if not all, of the states in the United States. Several of these diseases have effective therapies that largely eliminate the signs and symptoms of disease. In many, however, the disease process is without an effective treatment or may be brought under control but not corrected.\u0000This review contains 1 figure, 6 tables, and 11 references.\u0000Keywords: glycogen storage diseases, galactosemia, hyperbilirubinemia, hyperchloremic metabolic acidosis, hypofibrinogenemia, and thrombocytopenia, hypophosphatemia, fructose-1,6-bisphosphatase deficiency","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83963776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bipolar disorder is a biologically and phenotypically diverse disorder and its diagnosis and treatment provides a significant challenge to even the most seasoned clinician. We provide an update on the diagnosis and differential diagnosis of bipolar disorder, reflecting recent changes in DSM-5. Our review provides a succinct summary of the treatment literature, encompassing pharmacologic and psychosocial interventions for bipolar depression, mania/hypomania, mixed states, and prevention of disease recurrence. We provide a brief critical review of emerging treatment modalities, including those used in treatment resistance. Challenges involved in maintaining adherence are further discussed. Additionally, we review common treatment adverse effects and provide recommendations for proper side effect monitoring. There is evidence of significant functional impairment in patients with bipolar disorder and we conclude with a discussion of the impact of impairment on prognosis and quality of life. This review contains 4 figures, 8 tables, and 45 references. Key Words: bipolar disorders, differential diagnosis, maintenance pharmacotherapy, prognosis, psychosocial interventions, treatment, quality of life
{"title":"Bipolar Disorders and Their Clinical Management, Part II: Diagnosis, Differential Diagnosis, and Treatment","authors":"Bernadette DeMuri-Maletic, V. Maletić","doi":"10.2310/im.13100","DOIUrl":"https://doi.org/10.2310/im.13100","url":null,"abstract":"Bipolar disorder is a biologically and phenotypically diverse disorder and its diagnosis and treatment provides a significant challenge to even the most seasoned clinician. We provide an update on the diagnosis and differential diagnosis of bipolar disorder, reflecting recent changes in DSM-5. Our review provides a succinct summary of the treatment literature, encompassing pharmacologic and psychosocial interventions for bipolar depression, mania/hypomania, mixed states, and prevention of disease recurrence. We provide a brief critical review of emerging treatment modalities, including those used in treatment resistance. Challenges involved in maintaining adherence are further discussed. Additionally, we review common treatment adverse effects and provide recommendations for proper side effect monitoring. There is evidence of significant functional impairment in patients with bipolar disorder and we conclude with a discussion of the impact of impairment on prognosis and quality of life.\u0000This review contains 4 figures, 8 tables, and 45 references.\u0000Key Words: bipolar disorders, differential diagnosis, maintenance pharmacotherapy, prognosis, psychosocial interventions, treatment, quality of life","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84631137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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