Aim: The aim of this article is to discuss the difficulties and complexities of the bipolar affective disorder (BPAD) diagnostic process in an adolescent. The case of suspected occurrence of bipolar affective disorder in an adolescent who was diagnosed with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in childhood was presented.
Case report: A 16-year-old boy was treated in the past for ADHD and ODD. The reason for the current admission to the pediatric psychiatry ward was the behavioral change that disturbed the caregivers: he has become more restless, irritable, explosive. A few nights prior to hospitalization, he was very agitated, chaotic, physically and verbally aggressive.
At admission he was disorganized, tense, in strong hand manipulation anxiety. He displayed alternating attention and loquacity. His statements were chaotic, his thinking accelerated. He displayed grandiose delusions. He was uncritical.
After the treatment, mood, psychomotor drive and circadian rhythms stabilisation were achieved. Discharged from the ward with the recommendation of further outpatient treatment and continuation of psychotherapeutic interactions.
1. The diagnosis of bipolar affective disorder in adolescents is a complex and difficult process. The expression of symptoms of this disorder during adolescence is different than in adults.
2. Differential diagnosis of bipolar affective disorder for a 16-year-old boy should also consider both past ADHD and ODD and their possible sequelae should be taken into account, as well as the risk of abnormal personality development.
3. Due to the high dynamics of changes associated with the adolescence period, further pharmacological treatment of bipolar affective disorder should be combined with psychotherapeutic interventions.
Introduction: Manganese has a role in the membrane transport systems, synthesis of protein, vitamin C, and vitamins B, catalysis of hematopoiesis, regulation of the endocrine, immune system, blood sugar, reproduction, digestion, and blood coagulation. Furthermore, the level of manganese concentrations in human body appears to affect the occurrence of schizophrenia. The aim of this study was to search for relationships between the manganese level and the onset of schizophrenia.
Material and methods: A descriptive review was performed based on a literature search on Medline and Google scholar from 2003 to 2020, using keywords: schizophrenia, manganese, Mn. The included studies were meta-analyses, case-control studies, and cohort studies that examined differences in manganese concentrations in patients with schizophrenia and healthy controls.
Result: Eight studies were selected for the review, with one reporting elevated levels of manganese, two showing no significant differences, and the rest including two meta-analyses stating lower manganese concentrations in patients with schizophrenia in comparison with controls.
Conclusion: In most of the researched studies, manganese concentrations in patients with schizophrenia were lower than in control groups, but not all of them reached the same conclusions. The relationship between manganese levels and schizophrenia must be further investigated.
Introduction: The perception of disease depends on the patient’s beliefs related to the nature of the illness, the previous personal or family experiences and his/her attitude to them. Patients try to understand and cope with health problems. The purpose of the present study was to answer the question which components of the relationship between the strategies for coping with stress and mental disease perception are moderated by gender.
Material and Methods: The study involved 98 patients with depressive disorders, anxiety disorders, schizophrenia, alcohol related disorders. The research of the variables was carried out using the COPE Inventory and Disease Perception Questionnaire.
Results: It has been noticed that in men, when their perception of the mental disorder as beneficial increases, the religious strategies for coping with stress become more frequent. Furthermore, the opposite sex pattern emerged. In the situation when an individual’s perception of the illness as a threat increased, female patients less frequently employed religious coping and planning. Furthermore, in women, when the perception of the mental disease as a weakness increases, the frequency of using emotional social support and acceptance decreases.
Conclusions: The result indicated that there are opposite patterns of gender specific coping strategy dependent on the mental illness perception.
A growing body of evidence supports the recommendation of both physiotherapy and physical activity in people with haemophilia. Physical benefits include increasing strength and flexibility and reducing the risks of osteoporosis, arthropathy, and intramuscular and joint bleeds; social benefits have also been observed. However, anecdotal evidence suggests that people with haemophilia may still be averse to engaging with physical activity due to fears of causing bleeding, joint pain and joint damage.
Qualitative interviews were conducted with young men with haemophilia treated at comprehensive care centres in London, to explore and identify the reasons behind risk-averse behaviours towards exercise and physical activity. The interview questions were designed to prompt discussion and capture opinions relating to participants’ physical activity and gym membership/use, and the degree to which their haemophilia impacts on both.
Ten participants were interviewed. Preferred activities were variable, with five participants describing themselves as very physically active, three moderately active, and two reporting little physical activity; four described themselves as ‘not gym-confident’. Seven participants described themselves as highly or moderately motivated to undertake physical activity, with motivations including weight loss and getting fit for summer holidays. However, there was some anxiety around weight-bearing exercise due to the fear of pain or injury. All participants had been exposed to personal trainers (PTs) and recognised the importance of being properly introduced to training equipment but felt that PTs were too expensive for them. The majority of participants reported sports-related injuries and self-perceived limitations on activity due to their personal/individual experience of living with haemophlia. Physiotherapists were often the first point of contact for advice and support on safe physical activity. All participants recognised the benefits of physical activity and had been encouraged in this by their physiotherapists.
Young men with haemophilia are keen to use the gym as part of their personal fitness regimens. The ongoing safety concerns of health care professionals warrants further research.
Adherence to treatment recommendations in patients with chronic disease is complex and is influenced by numerous factors. Haemophilia is a chronic disease with reported levels of adherence ranging from 17–82%.
Based on the theoretical foundation of the World Health Organization Multidimensional Adherence Model, the objective of this study was to identify the best combination of the variables infusion frequency, annualised bleed rate, age, distance to haemophilia treatment centre (HTC) and Haemophilia Joint Health Score (HJHS), to predict adherence to treatment recommendations in patients with haemophilia A and B on home infusion prophylaxis in Canada.
A one-year retrospective cohort study investigated adherence to treatment recommendations using two measures: 1) subjective report via home infusion diaries, and 2) objective report of inventory ordered from Canadian Blood Services. Stepwise regression was performed for both measures.
Eighty-seven patients with haemophilia A and B, median age 21 years, were included. Adherence for both measures was 81% and 93% respectively. The sample consisted largely of patients performing an infusion frequency of every other day (34%). Median scores on the HJHS was 10.5; annualised bleed rate was two. Distance to the HTC was 51km. Analysis of the objective measure weakly supported greater infusion frequency as a treatment-related factor for the prediction of lower adherence, however the strength of this relationship was not clinically relevant (R2=0.048). For the subjective measure, none of the explanatory variables were significant.
Adherence is a multifaceted construct. Despite the use of theory, most of the variance in adherence to treatment recommendations in this sample of patients with haemophilia remains unknown. Further research on other potential predictors of adherence, and possible variables and relationships within factors of the MAM is required.
Introduction: The purpose of this article is to analyse the phenomenon of “body cult” as well as psychological and social factors conditioning its occurrence among young women. Particular attention was paid to the role of social media and an attempt was made to indicate possible preventive measures to promote health-popularising behaviour towards the body among high school students.
Materials and methods: On the basis of the review of the available literature, developmental conditions of the adolescence period and research results on the subject were presented.
Results: The paper presents the role of social media in the context of shaping behaviours related to “body cult”.
Conclusions: The content presented on blogs and social networks put pressure on young women to cultivate the physical characteristics of a person. In this perspective, excessive focus on striving for the perfect figure can lead to the development of anti-health behaviour. Further research is definitely needed.
Introduction: Workaholism as a psychological and social phenomenon is the object of only a few empirical studies. Despite the fact that the phenomenon of addiction to work was not specified in the ICD-10 or DSM-5 Classifications, the authors of this paper have decided that it is worth considering its preconditions.
Materials and method: Based on the review of the available literature, the topic of work addiction was discussed and the main determinants of workaholism and the so-called workaholic personality were presented.
Results: The paper presents the author’s theoretical proposition of workaholism notion which postulates the existence of a form of addiction to work, which has its source in personality and motivation.
Conclusions: Undoubtedly, workaholism is addictive, but only obsessive-compulsive components may not be sufficient to determine its nature. Workaholism adopts a three-dimensional structure including behavioral, cognitive and affective aspects. Further research on this issue is needed.
Haemophilia is a rare hereditary haemorrhagic disease caused by coagulation factor VIII (haemophilia A) or IX (haemophilia B) deficiency. Very few data exist on this disease in Congo. This survey aims to describe the epidemiological and clinical aspects of the children affected.
Materials and methods
A descriptive cross-sectional study was carried out in the haematology department of the Brazzaville University Hospital over a period of two years. Children (under 18 years of age) with haemophilia and with a factor VIII or IX level less than or equal to 30% were identified. The parameters analysed included age, diagnostic delay, type and severity of haemophilia, type and frequency of bleeding manifestations, complications and history of transfusion.
Nineteen patients were identified with an average age at diagnosis of four years. The average time to diagnosis was six years, and the most frequent first known bleeding episode was haemorrhage during circumcision. Family history was found in 14 cases. There were 13 cases of haemophilia A and six cases of haemophilia B. Fourteen cases were severe haemophilia; no mild cases were identified. Haemorrhagic manifestations included haemarthrosis, haematomas and mucocutaneous haemorrhages. The average number of haemorrhagic episodes per year was 12. Haemophilic arthropathy was present at diagnosis in seven cases, with the main location being the knee. The average number of hospitalisations before diagnosis was two. Sixteen patients had been transfused at least once.
Although circumcision is the most frequent first known haemorrhagic manifestation of haemophilia in Congo, patients are often diagnosed late, sometimes with severe osteoarticular complications. Further measures are needed to help ensure early diagnosis and improve care.
Management of haemophilia A requires administration of factor VIII therapy which, for those with severe haemophilia A in the UK, is predominantly self-administered at home in a prophylactic regimen to prevent or minimise bleeding. The UK undertakes a national tendering process every three years to ensure access to current and new therapies at a cost-effective price, through contracting for large volumes from individual suppliers. This means that some products may no longer be available and that new products can enter the UK market at any tendering stage.
In the latest tendering round, in 2018, more than one product was withdrawn from the UK market and a new product (NovoEight®; Novo Nordisk) was added to the prescribing list. This meant people with haemophilia having to change products. The experience of 77 people with haemophilia or their carers who changed treatment products during this process was captured by questionnaires administered by haemophilia nurses from 12 treatment centres. Overall, although people with haemophilia felt that they had little influence in decision making about changing to NovoEight, they were confident with their new treatment including packaging and accessories for administration. This was seen more in those who switched from plasma-derived products where ease of infusion was rated highly. Users’ views of haemophilia treatment should be collected at times of change to identify facilitators and barriers experienced in self-management
Haemophilia is an X-linked congenital bleeding disorder due to deficiency of coagulation factor VIII (in haemophilia A) or factor IX (in haemophilia B) caused by mutations of the respective clotting factor genes. Treatment involves the administration of an appropriate dose of factor concentrate, as soon as possible, in the event of any bleeding episode. In low-resource settings, such as Northeast India, where factor concentrates are not widely available, people with haemophilia (PwH) may bleed profusely even from trivial external injuries, warranting transfusion of blood or blood products. We previously reported on the use of a low cost, foam-based haemostatic patch to treat an external bleed in a single patient. In this study, we investigated its use to treat a range of external injuries in PwH presenting at Assam Medical College and Hospital.
Over 24 months, eligible PwH with external injuries attending our haemophilia clinic were treated with a topical haemostatic patch (VELSEAL-T) at the target bleeding site. The time to cessation of bleeding was recorded and the wound sites evaluated after haemostasis to monitor efficacy and safety.
Out of 72 individuals with bleeding disorders who volunteered to participate, 59 cases of external bleeding in 48 PwH were eligible for inclusion in the study. Nine (15.3%) had aberration wounds, 24 (40.7%) cut wounds, 21 (35.6%) tooth and/or gum bleeding and five (8.4%) bleeding from puncture wounds. The average time required for achievement of haemostasis was 9.9 (±4.7) minutes. Aberration wounds required the least amount of time for haemostasis at 7.3 (±4.4) minutes. Cut wounds required a mean time of 8.5 (±2.9) minutes; puncture wounds required 9.0 (±3.1) minutes; gum bleeding required the longest time to achieve haemostasis with a mean of 12.7 (±5.6) minutes.
The use of this topical haemostatic patch has been shown to be beneficial in the treatment of external injuries in PwH, and provides a good treatment option in resource-constrained areas. A larger controlled study would be helpful to further investigate its efficacy and safety.