Caregiver burden in older adults with bipolar disorder: relationship to functionality and neuropsychiatric symptoms

BACKGROUND

There are few studies addressing caregivers of bipolar disorder (BD) patients, especially patients who are older adults with an increased need for care, often given by a relative. The aim of this study was to describe which factors increase caregiver burden among caregivers of elderly BD outpatients.

METHODS

Patients were older than 60 years and met the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, criteria for BD. They were evaluated for current mood, cognitive and other neuropsychiatric symptoms, functionality, medical comorbidities, quality of life, years since BD diagnosis, and number of psychiatric admissions. The caregiver who spent the greatest time with each patient was evaluated with the Zarit Caregiver Burden Interview. The caregivers' global health, mood symptoms, quality of life, and tasks performed for the patient were also assessed.

RESULTS

Thirty-six BD patients and their caregivers were assessed. The Zarit Caregiver Burden Interview was positively correlated with patients' neuropsychiatric symptoms (r = 0.508, P = 0.002) and functional impairment (r = 0.466, P = 0.004). The Zarit Caregiver Burden Interview was also correlated with caregivers' own depression (r = 0.576, P < 0.001), anxiety (r = 0.360, P = 0.031), quality of life (r = -0.406, P = 0.014), medical comorbidities (r = 0.387, P = 0.020), and number of tasks that they completed for the patient (r = 0.480, P = 0.003).

CONCLUSIONS

In this group of elderly BD patients, caregiver burden was more associated with symptoms frequently seen in others diseases as in dementia than with depressive, manic, or anxiety symptoms, which are often used as treatment outcomes measures goals in BD. Potential treatable and modifiable factors associated with caregiver burden could be caregivers' depression, anxiety, and medical comorbidities, as well as support for caregivers in terms of services and social relationships.

[Gait analysis and quality of life evaluation after gait training in patients with spinal cord injury]

INTRODUCTION

Over recent years it has become possible to retrain motor activity among patients with partial spinal cord injury, especially for walking. AIM. To assess the impact of gait training on a treadmill with body weight support, regarding temporospatial parameters and quality of life.

PATIENTS AND METHODS

Twelve patients of both sexes were evaluated. They had been diagnosed with partial spinal cord injury of traumatic origin at least 12 months earlier. They were able to walk and their motor function below the level of the injury was partially preserved and classified as level C or D. After the initial evaluation, the participants were trained on a treadmill with body weight support, with two sessions per week lasting 30 minutes each, over a four-month period, thus totaling 30 sessions. The patients' temporospatial gait parameters and quality of life were analyzed before and after the training.

RESULTS

There were improvements in all the temporospatial parameters evaluated (p < 0.0001), but no changes in quality of life were seen (p > 0.05).

CONCLUSION

Treadmill training with body weight support among patients with spinal cord injury was effective in improving the temporospatial gait parameters, but without changing their quality of life.

[Vegetative pyoderma gangrenosum associated with renal failure]

A case report was presented in which a patient developed vegetative pyoderma gangrenosum that was concomitant with acute renal failure; this led to the critical condition of the patient. He was initially treated with systemic antibiotics because his clinical picture was considered to be pyodermitis, but the response was unsatisfactory. After being treated with levamizol and alfa interferon, an improvement in his general condition and skin lesions was observed. Then surgical exeresis was successfully performed, with skin self-grafting in the face and penis lesions. Pyoderma gangrenosum lesions relapsed but they were treated with prednisone, and then there was a rapid elimination of lesions every time they came up.

Proteína Bruta e Proteína Ideal para Frangos de Corte no Período de 1 a 21 Dias de Idade

Dois experimentos foram realizados com o objetivo de avaliar o desempenho de frangos de corte no período de 1 a 21 dias alimentados com dietas formuladas nos conceitos de proteína bruta e proteína ideal. No primeiro experimento, foram utilizados 400 pintos machos de um dia de idade da linhagem Cobb, distribuídos em delineamento inteiramente casualizado, com 2 tratamentos (proteína total e proteína ideal) e 5 repetições de 40 aves cada. No segundo experimento, foram utilizados 800 pintos, 400 machos e 400 fêmeas, em arranjo fatorial 2x2 (2 formulações - proteína bruta e proteína ideal e 2 sexos) com 4 tratamentos e 5 repetições de 40 aves cada. As dietas foram formuladas atendendo às exigências estabelecidas pela DEGUSSA (1997). Aos 21 dias, foram avaliados, o ganho de peso, o consumo de ração e a conversão alimentar. No experimento 1, as aves alimentadas com dietas formuladas no conceito de proteína ideal apresentaram maior ganho de peso e maior consumo de ração. No experimento 2, as aves que se alimentaram com a dieta formulada com base da proteína ideal apresentaram melhor ganho de peso e melhor conversão alimentar, não influenciando o consumo de ração. Os resultados demonstraram que as aves alimentadas com dietas baseadas no conceito de proteína ideal apresentam melhor desempenho.

Utilização de Prebióticos, Probióticos ou Simbióticos em Dietas para Frangos

Foi investigado o efeito da substituição de antibióticos por prebiótico, probiótico e simbiótico em dietas para frangos de corte de 1 a 45 dias de idade. Foram utilizados 750 pintos de 1 dia de idade, distribuídos em cinco tratamentos, sendo: T1-sem aditivos, T2-antibiótico (Olaquindox<FONT FACE=Symbol>â</FONT> e Nitrovin<FONT FACE=Symbol>â</FONT> ), T3-prebiótico (0,2% de parede celular de S. cerevisiae), T4-probiótico (300 ppm de B. subtilis) e T5-simbiótico (T3 + T4). O desempenho dos frangos de 1-45 dias de idade foi influenciado pelos diferentes tratamentos, sendo o melhor ganho de peso observado em aves que receberam o simbiótico, seguido daquelas com antibiótico, prebiótico e probiótico. O pior ganho de peso foi observado nas aves que não receberam qualquer tipo de aditivo na dieta. A conversão alimentar, no período de 1 a 45 dias de idade, também foi influenciada pelo tipo de aditivo. As aves que não receberam suplementação apresentaram pior conversão alimentar quando comparadas com as aves dos demais tratamentos. Os resultados deste experimento permitem concluir que a substituição de antibióticos por simbióticos na ração de frangos é uma alternativa viável, pois não compromete o desempenho das aves, contudo a ausência de aditivos na dieta piora o desempenho das mesmas.

Relapse rates in lepromatous leprosy according to treatment regularity

In Gudiyatham Taluk, South India, 1008 lepromatous (LL) and borderline lepromatous (BL) patients were studied. They had previously been smear positive, had attained smear negativity, and continued on DDS monotherapy. "Relapse" was defined as the reappearance of Mycobacterium leprae in skin smears. The area is endemic for leprosy. The lower relapse rates in the first three years of smear negativity alone were associated with more-regular treatment during both past smear positivity and smear negativity. From the fourth year of smear negativity onward, only the more-regular treatment during smear negativity was associated with lower relapse rates; whereas patients with more-regular treatment during past smear positivity had no lower risk of relapse than those with less-regular treatment. The finding that regularity of treatment during smear positivity seems to have no effect on relapse rates beyond the third year of smear negativity is discussed. In a leprosy-endemic area, it is argued that beyond the first three years of smear negativity in an LL or BL patient, sources of M. leprae outside the patient may be more responsible for relapse than the patient's own bacilli.

Computerized mathematical model of M. leprae population dynamics during multiple drug therapy

A computerized mathematical model of M. leprae populations during multiple drug therapy (MDT) was constructed. Relevant published information available to date was fed into it, and reasoned assumptions were made. From the model, it seems likely that MDT steadily selects bacteria resistant to the most powerful of the three drugs used: unless the individual bactericidal potencies of the drugs balance one another. If the drugs used have differing potencies, cure probably hinges on treatment being continued until all metabolically active bacteria are killed. Withdrawal of treatment before that could lead to relapse with bacteria resistant to the most powerful of the drugs used.

"Drug-resistant proportion test" for M. leprae to quantify the proportion of drug-resistant M. leprae in a sample using the mouse foot pad

The mouse foot pad test has not previously been used quantitatively to discriminate between samples of Mycobacterium leprae with differing proportions of drug-resistant M. leprae. The "drug-resistant proportion test" is a simple modification of the routine mouse foot pad test. It is demonstrated to distinguish between samples of M. leprae with a tenfold difference in the proportion of dapsone-resistant M. leprae.

The mouse footpad test--sensitive to small proportions of drug-resistant bacilli in a sample of M. leprae

In experiments at the Radda Barnen Research Laboratories of the SLR & TC Karigiri, the mouse footpad test was demonstrated to detect DDS-resistant M.leprae even if as few as 0.1% (1 in 1000) of the M. leprae tested were DDS-resistant. The mouse footpad test appears to be sensitive to minute proportions of drug-resistant bacilli in samples of M. leprae tested.

Response to dapsone (DDS) monotherapy in leprosy patients of Gudiyatham Taluk, South India: comparison between the 1960s and the 1970s

At the Schieffelin Leprosy Research and Training Centre, Karagiri, India, 148 lepromatous (LL) and borderline lepromatous (BL) leprosy patients registered for treatment in the years 1971 to 1973 were found to respond as well to dapsone (DDS) monotherapy as 391 LL and BL patients registered in 1964 to 1966, as indicated by clearance of Mycobacterium leprae from skin smears during the initial seven years of therapy in each patient. Apparently, the efficacy of DDS monotherapy has not been progressively diminishing since the introduction of DDS monotherapy into the area.

Follow-up of lepromatous (LL and BL) patients on dapsone (DDS) monotherapy after attainment of smear negativity in Gudiyatham Taluk, South India

At the Schieffelin Leprosy Research and Training Centre, Karigiri, India, an analysis of "relapse" rates was undertaken on all the 1293 residents of Guidyatham Taluk who were known to have lepromatous (LL) or borderline lepromatous (BL) leprosy and had attained "smear negative" status. "Relapse" was defined as the reappearance of acid-fast bacilli (AFB) in skin smears, whether by reinfection from other patients or from the patient's own persisting organisms. The "relapse" rate decreased steadily with the time elapsed after the attainment of smear negativity: 2.8% (2.8 per 100 patients per year) in the initial two years; 1.1% from the third year onwards; and 0.9% from the ninth year onwards. Of the 1293 patients, 694 (53.7%) had taken greater than or equal to 80% regular dapsone (DDS) treatment during smear negativity. In this group, the "relapse" rate from the third year onwards was only 0.7% per year. The vast majority (90.9%) of LL and BL patients on DDS monotherapy in the area had at some point attained smear negative status. It appears important to study whether a limited period of DDS monotherapy after the attainment of negative skin smears would be an effective alternative to life-long DDS treatment in LL and BL patients.

Results of long-term domiciliary dapsone (DDS) monotherapy for lepromatous leprosy in Gudiyatham Taluk, South India

At the Schieffelin Leprosy Research and Training Centre, Karigiri, India, data were assembled on all 58 living patients with lepromatous leprosy residing in Gudiyatham Taluk who had been registered in 1960 or earlier. They had received domiciliary oral DDS monotherapy for greater than 20 years. Fifty-one of the 58 patients were currently smear negative and clinically inactive. Patients with a Bacterial Index that had at some time been greater than or equal to 2+ were currently found smear positive more frequently than the remaining patients.

The significance of dapsone (DDS)-resistant Mycobacterium leprae in untreated patients

In a stable rural population of South India, 18 consecutive untreated persons newly discovered to have leprosy with a Bacterial Index (BI) greater than or equal to 2+ were tested for Mycobacterium leprae resistant to dapsone (DDS) by the mouse foot pad test. Of 12 successful tests, five detected resistant M. leprae. Known contact with a treated patient in the ten years preceding the diagnosis of leprosy was not found to increase the risk of DDS-resistant M. leprae occurring in an untreated, newly diagnosed patient. This data is consistent with the bulk of evidence in the field of bacteriology, which makes it seem unlikely that treated patients are the only source, or even the major source, of resistant M. leprae in untreated patients. Bacterial mutants resistant to a drug have been shown to precede initial use of the drug. Tests for drug-resistant bacteria in untreated patients before a drug is widely used in a community are likely to be important for subsequent evaluation of resistance to the drug in that community.

DDS-resistant infection among leprosy patients in the population of Gudiyatham Taluk, South India. Part 3. Prevalence, incidence, risk factors, and interpretation of mouse foot pad test results

At the Schieffelin Leprosy Research and Training Centre, Karigiri, India, a study of the population of Gudiyatham Taluk revealed that the prevalence of dapsone (DDS)-resistant infection among lepromatous (LL) and borderline lepromatous (BL) leprosy patients treated for a minimum of three years was 3.3% (33 per 1000), with an average annual incidence of 0.28% per year. DDS-resistant infection was diagnosed when review of skin smear readings showed a continuing increase in the number of Mycobacterium leprae in successive smears despite adequate DDS treatment. The attainment of smear negativity in an LL or BL patient was found to be a favorable prognostic sign, indicating a reduced risk of DDS-resistant infection. No association was found between the incidence of DDS-resistant infection on the one hand and either the regularity or the initial dosage of DDS treatment on the other. Ninety-five (88.0%) out of 108 successful mouse foot pad tests on patients with a Bacterial Index (BI) greater than or equal to 2+ detected DDS-resistant M. leprae. The mouse test detected bacilli resistant to 0.01% w/w DDS in mouse diet not only among patients deteriorating despite adequate DDS monotherapy, but also among patients improving on DDS monotherapy. Since the mouse test as presently used does not measure the proportion of M. leprae in a sample that are resistant to DDS, the detection of DDS-resistant bacilli in the mouse test may not always indicate that the patient will fail to respond to DDS monotherapy.