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A clinical complexity of olanzapine use: Peripheral edema. 使用奥氮平的临床复杂性:外周水肿。
IF 5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-30 DOI: 10.1111/bdi.13477
Vincent Zhang, Mary-Anne Hennen, Hector Lisboa, Najeeb Hussain
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引用次数: 0
Let us not forget postpartum manic or mixed episodes 让我们不要忘记产后躁狂或混合发作。
IF 5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-28 DOI: 10.1111/bdi.13479
Verinder Sharma
<p>In the nineteenth century, the estimated prevalence of puerperal mania varied from 1 in 80–800 deliveries.<span><sup>1</sup></span> The literature from this era is replete with clinical accounts of puerperal mania and melancholia in women admitted to Victorian asylums. Changes in the nosology and interpretation of postpartum psychiatric disorder in the 20th century have produced lower rates of postpartum mania. For example, some cases of puerperal mania would be diagnosed as delirium or a toxic confusional state in today's terminology. Other factors have contributed to waning interest in puerperal mania. Coinciding with the deinstitutionalization process of replacing long-stay psychiatric hospitals with community mental health services, the research focus shifted from the study of severe psychopathology to commonly encountered conditions in the community such as baby blues and postpartum depression. The term third-day depression after childbirth, also known as the baby blues, was first described in 1952 but has a larger share of literature than postpartum mania. An ‘unofficial’ but popular nomenclature includes baby blues, postpartum depression, and postpartum psychosis but makes no direct mention of manic or mixed episodes. Postpartum psychosis denotes disparate conditions including brief psychotic disorder, manic or mixed episodes with or without psychotic features, and major depressive episodes with psychosis.<span><sup>2</sup></span> The usurping of manic and mixed episodes by postpartum psychosis likely led to a lack of interest in the study of postpartum mania as shown in Figure 1.</p><p>Of mood and anxiety disorders, bipolar disorder carries the highest risk of recurrence in the postpartum period. Studies over the last few decades have demonstrated that postpartum bipolar disorder is common in community and clinical settings. A study of 10.000 women from the US found that approximately 14% of women screened positive for postpartum depression. Of those who screened positively, 23% had bipolar disorder, the most common type being bipolar I disorder (49.7%).<span><sup>3</sup></span> This means that approximately 1.6% of women in the community have a bipolar I mood episode after delivery. A recent study estimated that 39% of women with bipolar I disorder have a postpartum relapse. Of those with a postpartum relapse, 38% had a manic or mixed episode yielding an estimated prevalence of 14.82% among women with bipolar I disorder.<span><sup>4</sup></span> This is likely an underestimate because mania can occur spontaneously in the absence of psychiatric illness. As a comparison, the global prevalence of postpartum psychosis is only 0.089 to 2.6 per 1000 births.<span><sup>5</sup></span></p><p>Detecting, diagnosing, and treating manic or mixed episodes in the postpartum period is challenging. Owing to their onset typically within the first few weeks following childbirth, and the lack of information about the timing of the onset of “postpartum” ep
鉴于躁狂症或混合性发作与分娩时间的接近性、风险期的限定性以及对包括睡眠不足在内的假定风险因素的了解,这些发作应该是很容易预防的。有研究表明,接受药物治疗的妇女与未接受药物治疗的妇女相比,产后复发的风险较低;然而,由于缺乏有关治疗细节的详细信息,因此很难在个人层面应用这些信息。在大多数研究中,患者都接受了包括抗抑郁药、抗焦虑药和情绪稳定剂在内的多种药物治疗。关于药物治疗的随机对照数据仅限于一项单盲试验,该试验发现,在预防产后双相情感障碍发作方面,使用丙戊酸钠并不比不使用药物进行监测更有效。锂通常被推荐用于产后精神病的急性和预防性治疗;然而,对于产后躁狂或混合性发作的妇女,还没有进行过系统的研究。一项小型研究发现,奥氮平单独使用或与其他药物(抗抑郁药和或情绪稳定剂)联合使用,可有效预防躁郁症妇女的精神病和情绪发作。总之,产后躁狂和混合性发作很常见,但似乎被忽视了。人们对产后躁狂和混合性发作的普遍性缺乏认识,因此很少对产后躁狂症状进行筛查,这可能是导致产后躁狂和混合性发作被延误诊断并偶尔造成悲剧性后果的原因之一。采取有针对性的治疗方法来预防产后躁狂或混合发作的复发,可能比专注于预防产后精神病更有效、更经济。一般来说,预防躁狂或混合发作比预防抑郁期更容易。此外,预防躁狂或混合发作可能会预防躁狂-抑郁间歇期妇女患上抑郁症。要弄清产后躁狂症的表型,包括前驱症状、发病时间及其与产后双相抑郁的关系,还需要进行更多的研究。由于分娩的病理性影响,混合症状在产后与非产后发作期间更为常见。另一个重要的研究领域是确定产后躁狂或混合发作占多数的躁郁症妇女的主要极性。目前急需开展研究,评估药物治疗和心理治疗在预防产后躁狂症情绪发作方面的疗效。
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引用次数: 0
Behavioral skill practice as a predictor of mood and family functioning in adolescents with bipolar and depressive mood disorders: Results of a 6-month randomized trial of family-focused therapy 行为技能练习可预测患有双相情感障碍和抑郁情绪障碍的青少年的情绪和家庭功能:为期6个月的家庭焦点疗法随机试验结果。
IF 5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-25 DOI: 10.1111/bdi.13466
Marc J. Weintraub, John A. Merranko, Megan C. Ichinose, Danielle M. Denenny, Patricia D. Walshaw, Georga Morgan-Fleming, Robin D. Brown, Armen C. Arevian, David J. Miklowitz

Objective

Behavioral interventions require considerable practice of treatment skills in between therapy sessions. The effects of these treatments may vary with the degree to which patients are able to implement these practices. In offspring of parents with bipolar and major depressive disorders, we examined whether youth who frequently practiced communication and problem-solving skills between family-focused therapy (FFT) sessions had less severe mood symptoms and better psychosocial functioning over 6 months than youth who practiced less frequently.

Methods

We randomly assigned offspring (ages 12–19) of parents with mood disorders to 12 sessions of FFT plus a mobile app that encouraged the practice of communication, problem-solving and mood management skills (FFT-MyCoachConnect [MCC] condition) or 12 sessions of FFT with an app that only allowed for tracking of symptoms and stress (FFT-Track condition). Independent evaluators assessed youths' mood and psychosocial functioning at 9-week intervals over 27 weeks. Clinicians rated participants' between-session skill practice at each FFT session.

Results

FFT-MCC was associated with more frequent skill practice than FFT-Track over 18 weeks of treatment. Skill practice was associated with reductions in youths' mood instability and perceptions of family conflict over 27 weeks in both app conditions. Skill practice mediated the effects of app condition on youths' mood instability and family functioning.

Conclusions

Mobile applications as adjuncts to family therapy for youth with mood disorders can help increase skill practice. These findings provide preliminary causal evidence for behavioral skill practice improving mood symptoms and family functioning among youth with mood disorders.

目标:行为干预需要在治疗间隙进行大量的治疗技能练习。这些治疗方法的效果可能会随着患者实施这些练习的程度而变化。在患有双相情感障碍和重度抑郁症的父母的后代中,我们研究了在家庭焦点疗法(FFT)疗程之间经常练习沟通和解决问题技能的青少年是否比不经常练习的青少年在 6 个月内情绪症状更轻、社会心理功能更好:我们将患有情绪障碍的父母的后代(12-19 岁)随机分配到 12 次家庭焦点疗法和一个鼓励练习沟通、解决问题和情绪管理技能的移动应用程序(FFT-MyCoachConnect [MCC] 条件)或 12 次家庭焦点疗法和一个仅允许跟踪症状和压力的应用程序(FFT-Track 条件)中。独立评估人员在 27 周内每隔 9 周对青少年的情绪和社会心理功能进行评估。临床医生在每次FFT训练中对参与者在两次训练之间的技能练习情况进行评分:结果:在为期 18 周的治疗中,FFT-MCC 与 FFT-Track 相比,技能练习更为频繁。在两种应用条件下,技能练习都能在 27 周内降低青少年的情绪不稳定性和家庭冲突感。技能练习在应用条件对青少年情绪不稳定性和家庭功能的影响中起着中介作用:结论:移动应用程序作为情绪障碍青少年家庭治疗的辅助工具,有助于增加技能练习。这些发现为行为技能练习改善情绪障碍青少年的情绪症状和家庭功能提供了初步的因果证据。
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引用次数: 0
Who benefits from digital interventions for bipolar disorder? Stage of illness characteristics as predictors of changes in quality of life 谁能从双相情感障碍的数字化干预中受益?预测生活质量变化的疾病阶段特征。
IF 5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-23 DOI: 10.1111/bdi.13462
Hailey Tremain, Kathryn Fletcher, Denny Meyer, Greg Murray

Objectives

This study explored the potential role of stage-related variables in intervention outcomes in bipolar disorder (BD). Specifically, we aimed to identify which subgroups of individuals were most likely to experience improved quality of life following digitally delivered psychosocial interventions for BD.

Methods

The study involved a secondary analysis of combined data from two randomised control trials (RCTs). Each trial assessed the effectiveness of digitally delivered interventions for improving quality of life, in late-stage (ORBIT RCT) or early-stage (BETTER RCT) BD. Three iterations of cluster analyses were performed, identifying subgroups of individuals based on (i) current phenomenology, (ii) course of illness and (iii) medication response. The resultant subgroups were compared with regard to changes in quality of life pre-post intervention, via repeated measures ANOVAs.

Results

In each cluster analysis, two clusters were found. The current phenomenology clusters reflected two impairment levels, ‘moderate impairment’ and ‘low impairment’. The course of illness clusters reflected ‘more chronicity’ and ‘less chronicity’ and the medication response clusters reflected ‘good medication response’ and ‘poor medication response’. Differences in changes in quality of life over time were observed between the two current phenomenology clusters and between the medication response clusters, while the course of illness subgroups did not respond differently.

Conclusions

There are at least two distinct groups of treatment-seeking individuals with established BD, based on illness features with previously established links to different illness stages. Clusters within the current phenomenology and medication response domains demonstrated significantly different trajectories of QoL change over time in the context of our interventions, highlighting potential implications for treatment selection aligned with precision psychiatry.

研究目的本研究探讨了阶段相关变量在双相情感障碍(BD)干预结果中的潜在作用。具体而言,我们旨在确定哪些亚群最有可能在对躁狂症进行数字社会心理干预后生活质量得到改善:本研究对两项随机对照试验(RCT)的综合数据进行了二次分析。每项试验都评估了数字化干预对改善晚期(ORBIT RCT)或早期(BETTER RCT)BD患者生活质量的有效性。该研究进行了三次迭代聚类分析,根据(i)当前现象、(ii)病程和(iii)药物反应确定了个人亚组。通过重复测量方差分析,比较了由此产生的亚组在干预前和干预后生活质量的变化:结果:在每个聚类分析中都发现了两个聚类。目前的现象群组反映了两种障碍程度,即 "中度障碍 "和 "低度障碍"。病程聚类反映了 "慢性化程度较高 "和 "慢性化程度较低",药物反应聚类反映了 "药物反应良好 "和 "药物反应较差"。随着时间的推移,生活质量的变化在当前的两个现象群组和药物反应群组之间出现了差异,而病程亚群的反应并无不同:结论:至少有两类不同的已确诊 BD 患者寻求治疗,他们的疾病特征与先前确定的不同疾病阶段存在联系。在我们的干预措施下,当前现象学和药物反应领域中的分组随着时间的推移显示出明显不同的质量生活变化轨迹,这凸显了精准精神病学对治疗选择的潜在影响。
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引用次数: 0
Need for further exploring at the intersection of ADHD medications and bipolar disorder 需要进一步探讨多动症药物与双相情感障碍的交叉问题。
IF 5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-23 DOI: 10.1111/bdi.13467
U. Volpe
<p>Bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD) may copresent and manifest as complex clinical presentations, often accompanied by further comorbidities such as anxiety and substance use disorders. ADHD/BD comorbidity not only relies on a widely reported symptomatological and neurobiological overlap, but it also creates an intricate interplay between ADHD, affective and other psychiatric conditions, requiring a more nuanced understanding of their comorbid nature. Moreover, clinical and nosological perspectives on the nature of the ADHD/BD comorbidity may significantly vary across developmental stages, ranging from an overestimated comorbidity (possibly due to the confound role of greater symptoms' overlap in childhood, adolescence and youth cases) to a prodromal developmental pattern (i.e., from ADHD to BD) or a separate nosological entity (“ADHD-BD”).<span><sup>1</sup></span> In younger patients, in particular, recent literature also suggests a possible specific role of emotional dysregulation, a common key feature of ADHD and bipolar spectrum disorders, acting as a confound variable that may enhance the misconception of ADHD/BD comorbidity and favor the misdiagnosis of ADHD as a BD spectrum disorder.<span><sup>2</sup></span> Clearly, the emphasis on the need to disentangle the complex relationship between juvenile ADHD and BD highlights the challenges in delineating these disorders for better diagnostic characterization and therapeutic indications.</p><p>The systematic review by Miskowiak et al.<span><sup>3</sup></span> addresses a highly relevant clinical topic, reporting on the available evidence on the efficacy and safety of ADHD pharmacotherapies to treat cognitive impairment and ADHD symptoms in juvenile and adult BD. Shared neurobiological dysregulations, particularly involving dopamine and norepinephrine signalling pathways, may significantly contribute to the symptomatic overlap between BD and ADHD. However, pharmacological interventions targeting dopamine and noradrenaline pathways (such as stimulants and alpha-2-adrenergic agonists) long held promise to ameliorate cognitive deficits and ADHD symptoms in individuals with BD. Indeed, the evidence relative to dysfunctions of the dopamine transporter (DAT) gene and catechol-O-methyltransferase (COMT) gene variants underscores the intricate interplay between these disorders and prompts for therapeutic implications.<span><sup>4</sup></span> Miskowiak et al.<span><sup>3</sup></span> also report preliminary favorable evidence of efficacy of ADHD drugs in treating ADHD symptoms in BD, with a current lack of evidence for psychostimulants to trigger or exacerbate mania and insufficient evidence to conclude on their role in improving cognitive symptoms in BD.</p><p>Also in our previous work,<span><sup>5</sup></span> we underscored the potential benefits of adjunctive therapy in alleviating ADHD symptoms in BD patients. Indeed, while mood stabilization should remain th
双相情感障碍(BD)和注意力缺陷多动障碍(ADHD)可能共同出现并表现为复杂的临床表现,通常还伴有其他合并症,如焦虑症和药物使用障碍。注意力缺陷多动障碍(ADHD)/注意力缺陷多动障碍(BD)合并症不仅在症状学和神经生物学方面存在广泛报道的重叠,而且还在注意力缺陷多动障碍、情感障碍和其他精神疾病之间产生了错综复杂的相互作用,因此需要对其合并症的性质有更细致的了解。此外,关于多动症/BD 合并症性质的临床和命名学观点在不同发育阶段可能会有很大不同,从高估合并症(可能是由于童年、少年和青年病例中更多症状重叠的混淆作用)到前驱发展模式(即从多动症到 BD),不一而足、1 尤其是在年轻患者中,最近的文献还表明,情绪调节障碍(ADHD 和躁狂症谱系障碍的共同主要特征)可能起着特殊作用,它是一个混淆变量,可能会加深对 ADHD/BD 合并症的误解,并有利于将 ADHD 误诊为躁狂症谱系障碍。Miskowiak 等人3 的系统综述探讨了一个高度相关的临床课题,报告了现有证据显示 ADHD 药物疗法治疗青少年和成人 BD 认知障碍和 ADHD 症状的有效性和安全性。共同的神经生物学失调,尤其是涉及多巴胺和去甲肾上腺素信号通路的失调,可能是导致BD和ADHD症状重叠的重要原因。然而,长期以来,针对多巴胺和去甲肾上腺素通路的药物干预(如兴奋剂和α-2-肾上腺素能激动剂)有望改善 BD 患者的认知缺陷和 ADHD 症状。事实上,与多巴胺转运体(DAT)基因和儿茶酚-O-甲基转移酶(COMT)基因变体功能障碍有关的证据强调了这些疾病之间错综复杂的相互作用,并提示了治疗意义。4 Miskowiak 等人3 也报告了 ADHD 药物治疗 BD 患者 ADHD 症状疗效的初步有利证据,目前缺乏精神刺激剂引发或加剧躁狂症的证据,也没有足够的证据证明其在改善 BD 认知症状方面的作用。事实上,尽管情绪稳定仍应是 BD 患者的主要治疗目标(因为冲动、多动和注意力不集中症状在情绪稳定后可能会消退),但 "残余"(尤其是认知)症状的存在可能需要特定的 ADHD 药物。我们一致认为,哌醋甲酯和混合苯丙胺盐是治疗多动症最有前景的选择,尤其是在儿童和青少年群体中观察到了显著的疗效。然而,由于有关阿托西汀、维洛西汀、莫达非尼、阿莫达非尼和利司地辛(重要的是,利司地辛是市场上唯一一种用于治疗多动症的兴奋剂,也是唯一一种被研究用于治疗耐药双相抑郁症的附加策略)的数据较少,因此仍需采取谨慎和高度个体化的方法。另一方面,我们也强调了ADHD药物具有良好的安全性,不会增加躁狂发作的风险,尤其是在与情绪稳定剂同时使用的情况下,这一证据应有利于它们在双相抑郁症中的应用。6 这篇综述强调了定制干预措施的相关性,以有效满足这一患者群体的不同需求。尽管 ADHD 药物具有良好的疗效和安全性,但我们对这些药物对 BD 患者的认知影响和长期疗效的认识仍存在很大差距。未来的研究工作应优先考虑全面的认知评估、患者的个体特征和更大的样本量,以阐明这些药物对认知的潜在益处。此外,还应特别关注针对不同发育阶段的情绪失调开展对照临床试验,以真正改善这些高度复杂的患者的预后,这些患者需要精细的诊断过程和高度个性化的疗法。
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引用次数: 0
How to study psychological mechanisms of mania? A systematic review on the methodology of experimental studies on manic mood dysregulation of leading theories on bipolar disorder 如何研究躁狂症的心理机制?对双相情感障碍主要理论中有关躁狂情绪失调的实验研究方法进行系统回顾。
IF 5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-23 DOI: 10.1111/bdi.13463
V. F. J. Glas, M. A. Koenders, R. W. Kupka, E. J. Regeer

Introduction

Although there are several psychological theories on bipolar disorders (BD), the empirical evidence on these theories through experimental studies is still limited. The current study systematically reviews experimental methods used in studies on the main theories of BD: Reward Hypersensitivity Theory (RST) or Behavioral Activation System (BAS), Integrative Cognitive Model (ICM), Positive Emotion Persistence (PEP), Manic Defense theory (MD), and Mental Imagery (MI). The primary aim is to provide an overview of the used methods and to identify limitations and suggest areas of improvement.

Methods

A systematic search of six databases until October 2023 was conducted. Study selection involved two independent reviewers extracting data on experimental study design and methodology.

Results

A total of 84 experimental studies were reviewed. BAS and RST were the most frequently studied theories. The majority of these experimental studies focus on mechanisms of reward sensitivity. Other important elements of the reviewed theories, such as goal setting and—attainment, situation selection (avoidance or approach), activation, affective/emotional reactivity, and regulatory strategies, are understudied. Self-report and neuropsychological tasks are most often used, while mood induction and physiological measures are rarely used.

Conclusion

There is a need for more consensus on the operationalization of psychological theories of mania. Standardization of test batteries could improve comparability among studies and foster a more systematic approach to experimental research. Research on affective (activated) states is still underrepresented in comparison with studies on trait vulnerabilities.

导言:尽管有多种关于躁郁症(BD)的心理学理论,但通过实验研究对这些理论进行实证的证据仍然有限。本研究系统回顾了有关躁狂症主要理论研究中使用的实验方法:奖赏过度敏感理论(RST)或行为激活系统(BAS)、整合认知模型(ICM)、积极情绪持续(PEP)、躁狂防御理论(MD)和心理想象(MI)。主要目的是概述所使用的方法,找出局限性并提出改进建议:对截至 2023 年 10 月的六个数据库进行了系统检索。研究选择包括两名独立审稿人提取有关实验研究设计和方法的数据:结果:共审查了 84 项实验研究。BAS 和 RST 是最常被研究的理论。这些实验研究大多侧重于奖赏敏感性的机制。其他重要的理论要素,如目标设定和实现、情境选择(回避或接近)、激活、情感/情绪反应和调节策略等,都未得到充分研究。自我报告和神经心理学任务最常用,而情绪诱导和生理测量则很少使用:结论:有必要就躁狂症心理理论的可操作性达成更多共识。测试组的标准化可以提高研究之间的可比性,促进实验研究采用更系统的方法。与有关特质脆弱性的研究相比,有关情感(激活)状态的研究仍然偏少。
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引用次数: 0
Comorbidity of bipolar disorder and borderline personality disorder: Phenomenology, course, and treatment considerations 双相情感障碍与边缘型人格障碍的并发症:现象学、病程和治疗考虑。
IF 5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-21 DOI: 10.1111/bdi.13465
Christina M. Temes, Chelsea Boccagno, Alexandra K. Gold, Hadi Kobaissi, Ingrid Hsu, Sofia Montinola, Louisa G. Sylvia

Aim

Bipolar disorder (BD) and borderline personality disorder (BPD) are both serious psychiatric conditions that elevate the risk for harmful outcomes. Although these conditions represent distinct diagnostic entities, existing research suggests that approximately 20% of individuals with BD meet the criteria for comorbid BPD. Individuals with comorbid BD/BPD appear to have a markedly more severe and phenomenologically distinct clinical course when compared with those with BD alone. However, treatments have generally not been tested in this specific population, and currently, no formal treatment guidelines exist for this subgroup of patients.

Method

In the current paper, we review the epidemiological and descriptive research characterizing those with comorbid BD/BPD and discuss the impact of this comorbidity on psychosocial treatment. We also review current findings on evidence-based treatments for BD and BPD that show promise in treating those with comorbid BD/BPD.

Results

In our review of the literature, we highlight the importance of recognizing this comorbidity and discuss avenues for developing and integrating evidence-based treatment approaches for this understudied clinical population.

Conclusions

Although formal trials of interventions targeted to comorbid BD/BPD are limited, there is promising evidence regarding the possibility of using or integrating existing evidence-based approaches for this population. There are also several areas of clinical practice improvement and future research directions that stem from this literature.

目的:双相情感障碍(BD)和边缘型人格障碍(BPD)都是严重的精神疾病,会增加产生有害结果的风险。虽然这两种疾病是不同的诊断实体,但现有的研究表明,大约 20% 的躁郁症患者符合合并 BPD 的标准。与单独患有 BD 的患者相比,合并 BD/BPD 的患者的临床病程似乎明显更严重,症状也更明显。然而,治疗方法一般尚未在这一特定人群中进行测试,目前也没有针对这一患者亚群的正式治疗指南:在本文中,我们回顾了关于合并 BD/BPD 患者特征的流行病学和描述性研究,并讨论了这种合并症对社会心理治疗的影响。我们还回顾了目前对 BD 和 BPD 的循证治疗结果,这些结果显示了治疗合并 BD/BPD 患者的前景:在文献综述中,我们强调了认识到这一合并症的重要性,并讨论了针对这一研究不足的临床人群开发和整合循证治疗方法的途径:尽管针对合并 BD/BPD 的干预措施的正式试验有限,但有证据表明,针对这一人群使用或整合现有循证方法的可能性很大。从这些文献中还可以看出一些临床实践改进的领域和未来的研究方向。
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引用次数: 0
How far have we advanced in early intervention for bipolar disorder? 我们在双相情感障碍的早期干预方面取得了多大进展?
IF 5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-06-02 DOI: 10.1111/bdi.13461
Raphael Cerqueira, Juliana Surjan, Acioly L. T. Lacerda, Cristiano Noto
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引用次数: 0
Decoding the enigma: Valproate encephalopathy in a bipolar affective disorder without hyperammonemia 破解谜团:没有高氨血症的双相情感障碍患者的丙戊酸钠脑病。
IF 5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-06-02 DOI: 10.1111/bdi.13460
Bárbara Sofia Gonçalves Castro Sousa, Zoé Correia de Sá, Joana Ramos
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引用次数: 0
Cultural narratives and modern psychiatry: Bridging perspectives on bipolar disorder's impact on sexual and familial dynamics 文化叙事与现代精神病学:双相情感障碍对性和家庭动态影响的桥梁视角。
IF 5 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-05-27 DOI: 10.1111/bdi.13445
Lien-Chung Wei, Wei-Ching Huang
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引用次数: 0
期刊
Bipolar Disorders
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