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The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder.
OBJECTIVES: Although clinically highly relevant, the recognition and treatment of bipolar mixed states has played only an underpart in recent guidelines. This WFSBP guideline has been developed to supply a systematic overview of all scientific evidence pertaining to the acute and long-term treatment of bipolar mixed states in adults. METHODS: Material used for these guidelines is based on a systematic literature search using various data bases. Their scientific rigour was categorised into six levels of evidence (A-F), and different grades of recommendation to ensure practicability were assigned. We examined data pertaining to the acute treatment of manic and depressive symptoms in bipolar mixed patients, as well as data pertaining to the prevention of mixed recurrences after an index episode of any type, or recurrence of any type after a mixed index episode. RESULTS: Manic symptoms in bipolar mixed states appeared responsive to treatment with several atypical antipsychotics, the best evidence resting with olanzapine. For depressive symptoms, addition of ziprasidone to treatment as usual may be beneficial; however, the evidence base is much more limited than for the treatment of manic symptoms. Besides olanzapine and quetiapine, valproate and lithium should also be considered for recurrence prevention. LIMITATIONS: The concept of mixed states changed over time, and recently became much more comprehensive with the release of DSM-5. As a consequence, studies in bipolar mixed patients targeted slightly different bipolar subpopulations. In addition, trial designs in acute and maintenance treatment also advanced in recent years in response to regulatory demands. CONCLUSIONS: Current treatment recommendations are still based on limited evidence, and there is a clear demand for confirmative studies adopting the DSM-5 specifier with mixed features concept.
Living well in the Neuropolis.
This paper is about the relationship between cities and brains: it charts the back-and-forth between the hectic, stressful lives of urban citizens, and a psychological and neurobiological literature that claims to make such stress both visible and knowable. But beyond such genealogical labour, the paper also asks: what can a sociology concerned with the effects of 'biosocial' agencies take from a scientific literature on the urban brain? What might sociology even contribute to that literature, in its turn? To investigate these possibilities, the paper centres on the emergence and description of what it calls 'the Neuropolis' - a term it deploys to hold together both an intellectual and scientific figure and a real, physical enclosure. The Neuropolis is an image of the city embedded in neuropsychological concepts and histories, but it also describes an embodied set of (sometimes pathological) relations and effects that take places between cities and the people who live in them. At the heart of the paper is an argument that finding a way to thread these phenomena together might open up new paths for thinking about 'good' life in the contemporary city. Pushing at this claim, the paper argues that mapping the relations, histories, spaces, and people held together by this term is a vital task for the future of urban sociology.
Revitalizing sociology: urban life and mental illness between history and the present.
This paper proposes a re-thinking of the relationship between sociology and the biological sciences. Tracing lines of connection between the history of sociology and the contemporary landscape of biology, the paper argues for a reconfiguration of this relationship beyond popular rhetorics of 'biologization' or 'medicalization'. At the heart of the paper is a claim that, today, there are some potent new frames for re-imagining the traffic between sociological and biological research - even for 'revitalizing' the sociological enterprise as such. The paper threads this argument through one empirical case: the relationship between urban life and mental illness. In its first section, it shows how this relationship enlivened both early psychiatric epidemiology, and some forms of the new discipline of sociology; it then traces the historical division of these sciences, as the sociological investment in psychiatric questions waned, and 'the social' become marginalized within an increasingly 'biological' psychiatry. In its third section, however, the paper shows how this relationship has lately been revivified, but now by a nuanced epigenetic and neurobiological attention to the links between mental health and urban life. What role can sociology play here? In its final section, the paper shows how this older sociology, with its lively interest in the psychiatric and neurobiological vicissitudes of urban social life, can be our guide in helping to identify intersections between sociological and biological attention. With a new century now underway, the paper concludes by suggesting that the relationship between urban life and mental illness may prove a core testing-ground for a 'revitalized' sociology.
Selective patient and public involvement: The promise and perils of pharmaceutical intervention for autism.
BACKGROUND: Guidelines suggest the patient community should be consulted from the outset when designing and implementing basic biomedical research, but such patient communities may include conflicting views. We examined how engagement occurred in one such instance. OBJECTIVE: Our objective was to scrutinize patient and public involvement (PPI) by a pan-European biomedical consortium working to develop drugs to treat autism. We aimed to use this as an example to illustrate how PPI has been utilized in biomedical research. SETTING, PARTICIPANTS AND ANALYSIS: Two public events, one in the UK and one in Denmark were conducted as part of the consortium's on-going PPI activities in 2014 and 2015. Sixty-six individuals submitted written comments on the consortium's research after these events. The textual data produced were analysed using a thematic approach. Approximately 71% of respondents reported themselves to be adults on the autism spectrum or parents of children with autism. RESULTS: The themes identified illustrated major differences between some community concerns and the biomedical research agenda. While treating autism per se. was seen as problematic by some, treating specific co-occurring problems was seen as helpful in some circumstances. The biomedical consortium selected PPI with a limited user viewpoint at its outset and more widely once basic research was on-going. DISCUSSION: This case illustrates what we term "selective PPI" where only a sympathetic and/or limited patient viewpoint is included. Findings highlight the perils of using selective PPI to legitimise scientific endeavours, and the possibilities for constructive dialogue.
The Case for Clinical Management of Neuroenhancement in Young People
© Oxford University Press, 2015. All rights reserved. This chapter defends that over time, stimulants and other neuroenhancers will increasingly be used to enhance young people's cognitive and behavioural functioning, alongside growing general public acceptability of neuroenhancers as tools to improve academic, social and workplace performance. The chapter focuses on the most common current neuroenhancers used in young people - stimulant drugs. The chapter outlines the key social and ethical concerns raised by the use of stimulant drugs for enhancement in young people, and makes specific research, practice and policy recommendations. The chapter also suggests a rationale for clinical management of psychotropic neuroenhancers in young people, attending closely to the necessary boundaries on such practice asserted by structural and clinical factors, as well as by potential ethical conflicts. This outline and the subsequent rationale for management focuses on stimulants, but it can serve as a template for novel neuroenhancers that reach the child market.