Global perspectives on bipolar disorder treatment: in-depth comparative analysis of international guidelines for medication selection

BACKGROUND

Bipolar disorder, a chronic mental health condition characterised by fluctuations in mood, energy and functionality, affects millions of individuals worldwide. Its management requires a comprehensive approach, and, as such, treatment guidelines have a pivotal role in guiding clinicians to alleviate symptoms, prevent relapse and enhance overall patient well-being. However, the treatment landscape is far from homogenous, with significant variations existing across different countries.

AIMS

This study aimed to explore and compare treatment guidelines for bipolar disorder in various regions, shedding light on the factors that influence therapeutic approaches and thus offering insights that could contribute to the ongoing refinement of evidence-based practices in management.

METHOD

The study explores various international treatment guidelines for bipolar disorder that have been updated after 2014. Guidelines from the UK, Canada, Australia/New Zealand, South Korea and the International College of Neuropsychopharmacology are scrutinised to identify factors contributing to the observed differences among them.

RESULTS

The variations in recommended drugs across guidelines arise from the approaches employed in guideline development - whether relying on expert consensus or meta-analysis results. Timing disparities in conducting these analyses and the selection of studies also exert influence. Moreover, differences in metabolic enzymes among diverse races and the health policies implemented by individual nations play a significant part in shaping these differences.

CONCLUSION

The primary hindrance to consistent treatment conclusions lies in the scarcity of high-quality research results, leading to variations in guidelines. Enhancing evidence-based recommendations necessitates the undertaking of large-scale studies dedicated to assessing treatments for bipolar disorder.

Análise da efetividade do estágio prático internacional de enfermagem em relação ao estágio prático nacional de enfermagem

Resumo Objetivo: Este estudo foi conduzido para avaliar a efetividade do estágio prático internacional de enfermagem quanto à autoeficácia, competência cultural e competência global. Foi utilizada a análise fatorial para avaliar a confiabilidade das medidas do estudo. Métodos: Um método de amostragem intencional foi usado para coletar os dados: os participantes eram estudantes de enfermagem (n=66) do segundo semestre do terceiro ano do curso de graduação. Para a análise fatorial, foram agrupados os resultados obtidos dos grupos controle e experimental (n=132) por meio de um questionário. A pesquisa foi realizada antes e após o estágio prático nacional e internacional de enfermagem para os grupos controle e experimental, respectivamente. O teste t foi utilizado para comparar os dois grupos, e Diferença em Diferenças (DD) foi utilizado para determinar a verdadeira alteração entre antes e depois do estágio. A análise do DD também mostrou que o nível de mudança antes e depois de cada estágio de enfermagem foi significativa entre os grupos controle e experimental. Resultados: A análise fatorial demonstrou que o questionário da pesquisa mensurou com confiabilidade os subconceitos. As diferenças na autoeficácia e na competência cultural entre os dois grupos foram estatisticamente significativas antes e depois do tratamento, mas os resultados de DD não foram significativos. Para a competência global, no entanto, tanto o DD quanto a diferença antes e depois do tratamento entre os dois grupos foram estatisticamente significativos. Conclusão: Apesar de algumas limitações do estudo, o desenho inovador gerou resultados que ajudam a preencher uma grande lacuna no conhecimento de enfermagem. Estudos futuros devem incluir um ensaio clínico randomizado para superar as limitações de viés de amostragem e generalização dos resultados do estudo.

Spousal Caregivers of Coronary Artery Bypass Surgery Patients: Differences between Caregivers with Low vs. High Caregiving Demands

PURPOSE

Compared to non-caregivers, caregivers have higher rates of depressive symptoms, caregiver strain, less mutuality, and health care visits. However, few investigators have examined family caregivers after coronary artery bypass (CAB) surgery. The purpose of this study was to examine differences in caregiving difficulties, mutuality (i.e., open communication; avoiding sad thoughts), and depressive symptoms based on low vs. high caregiving demands among spousal caregivers.

DESIGN

A descriptive, comparative design was used to examine 33 spousal caregivers of CAB surgery patients (16 in low and 17 in high caregiving demand groups).

METHODS

Measures included: Caregiving Burden Scale, Mutuality and Interpersonal Sensitivity Scale, and Patient Health Questionnaire-9. Groups were compared using Mann-Whitney U statistics.

FINDINGS

It was found that caregivers with high caregiving demands reported more caregiving difficulties and more open communication about the surgery compared to caregivers with low demands.

CONCLUSION

Caregivers with greater caregiving demands may need additional support to assist them with the caregiving situation.

CLINICAL RELEVANCE

Priority should be given to family caregivers, who take care of patients in cardiac rehabilitation, with higher caregiving demand.

Caregiving demand and difficulty in older adult spousal caregivers after coronary artery bypass surgery

The purpose of this study was to describe the caregiving demands and difficulties for older adult spousal caregivers of coronary artery bypass (CAB) surgery patients. Caregiving demands and difficulties were measured by the Caregiving Burden Scale. The sample size was 35 caregivers of CAB surgery patients who were, on average, 60 years old and 19 days since hospital discharge. Descriptive analysis revealed that the top four most demanding caregiving activities perceived by spousal caregivers were providing transportation, additional household tasks, providing emotional support, and two tied for fourth: monitoring symptoms and additional tasks outside the home. The top four most difficult caregiving tasks were additional household tasks, providing transportation, and two tied for third: additional tasks outside home and managing behavior problems. Also, caregivers reported experiencing more demands than difficulties. Examining the demanding and difficult caregiving tasks provides information from which to develop and test tailored interventions for caregivers of this population.

The state of the science of family caregiver-care receiver mutuality: a systematic review

This review critically examines the current state of the science on the concept of family caregiver-care receiver mutuality, summarizes accomplishments and gaps and identifies directions for future theory development and research. Mutuality between family caregivers and care receivers is of increasing interest to researchers. However, no analysis of the current state of the science of this important concept has been published. Our literature search revealed 34 research articles that met inclusion criteria. The studies were assessed in terms of conceptualization of mutuality, instrument development, populations studied, research designs and methods and findings. Significant scientific progress during the past 30 years includes the development of clear definitions and new instruments, expansion of research beyond the clinical populations in which mutuality was first studied, the use of a variety of research designs, and increasingly sophisticated methods of data analysis. Growing evidence suggests that mutuality is associated with caregiver emotional health outcomes and may decrease over time in the context of chronic illness. Directions for future research include development of new theoretical frameworks grounded in relational theory, development of theory on the dynamics of mutuality over time, exploration of mutuality in diverse cultures and populations, and intervention studies aimed at enhancing mutuality.