Seth Cohen

Morning or evening bright light treatment of winter depression ? : the significance of hypersomnia

In a randomized crossover design 19 patients with winter depression were treated with 7 days of bright morning light (6:00 to 8:00 AM) and 7 days of evening light (7:00 to 9:00 PM). Bright light in the morning reduced the Hamilton Depression Rating Scale score from 22.3 to 5.5; bright light in the evening decreased the Hamilton score from 21.0 to 12.2. Improvement in the depression as measured by the Hamilton Depression Rating scores was greater with morning light compared with evening lights. Hypersomnia was associated (p less than 0.05) with a superior response to morning light.

Significance of mixed features in acute mania

We studied a group of 23 manic patients to ascertain the prognostic significance of mixed affective features. Eight patients (34.8%) presented with a mixed manic state. This mixed state correlated with a longer hospitalization and significantly worse disposition outcome. In the light of previous conceptual models the authors speculate about the meaning of DSM-III defined mixed bipolar disorder.

Demographic and clinical features predictive of recovery in acute mania.

Discrepancies exist in previous reports regarding clinical and demographic features associated with recovery in acute mania. The authors studied 44 hospitalized patients with bipolar affective disorder, manic type. They report a significant association between more depressive symptomatology and perhaps younger age of illness onset, and poor immediate treatment response. They also found the total amount of psychopathology at admission, as measured by the Brief Psychiatric Rating Scale and Manic State Rating Scale, and the degree of psychosis to be unrelated to immediate outcome. The authors suggest that the not recovered manic subgroup has a distinct illness or a variant of bipolar disorder with poor prognosis that warrants further and separate investigation.

Antipsychotic effect of milieu in the acute treatment of schizophrenia

We studied 35 patients meeting DSM-III criteria for schizophrenia, paranoid or undifferentiated type, chronic with acute exacerbation. All were treated in hospital, 13 on a psychiatric intensive care unit, and 22 on an open ward. The former unit is a more structured and less stimulating one. We found those patients treated on that ward to show greater improvement in BPRS ratings during the first 2 days of hospitalization compared to the open-ward group, despite similar doses of medication being utilized. Additionally, this improvement was noted to occur among BPRS items comprising a psychotic subscale.

Pharmacological management of manic psychosis in an unlocked setting

There has been a resurgence in the past few years of exploring alternative pharmacological agents in the management of manic psychosis. An open clinical trial was conducted on an unlocked ward investigating the use of benzodiazepines as adjunctive therapy with lithium or carbamazepine, with some of the patients also receiving neuroleptics. Twelve patients meeting DSM-III criteria for bipolar affective disorder, manic type, were treated. Patient response was monitored with use of the Brief Psychiatric Rating Scale and the Biegel Mania Rating Scale. The patients all had moderately severe illness upon initiation of the trial. Results indicate that those patients who received benzodiazepines alone were among the better responders, and that when used in combination with neuroleptics, the dose of each drug was quite small. Minimal side effects were noted with this regimen. Our preliminary results suggest that benzodiazepines may be useful as adjunctive treatment in the management of patients with bipolar affective disorder, manic type.

Patients’ Satisfaction With Care Received in Teaching Settings

Voluntary psychiatric patients (N=118) on a teaching ward were asked to identify their medical personnel and rate their satisfaction with the care they received. The patients were proficient in distinguishing between psychiatrists, psychiatric residents, and medical students and were highly satisfied with the care they received. Patients over 35 were better at identifying residents than younger patients and also rated the quality of care pro-vided by psychiatrists more highly. Patients with adjustment reaction with depressed mood rated the quality of care provided by psychiatrists lower than did patients with major depression, bipolar affective disorder, or psychosis. Female patients rated their psychiatrists more highly than did male patients.

Antimicrobial Stewardship Training for Infectious Diseases Fellows: Program Directors Identify a Curriculum Need

A needs assessment survey of infectious diseases (ID) training program directors identified gaps in educational resources for training and evaluating ID fellows in antimicrobial stewardship. An Infectious Diseases Society of America-sponsored core curriculum was developed to address that need.