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The Maintain Your Brain trial (MYB) is one of the largest internet-delivered multidomain RCT designed to target modifiable risk factors for dementia. It comprises four intervention modules: physical activity, nutrition, mental health, and cognitive training. This paper explains the MYB Nutrition Module, which is a fully online intervention promoting the adoption of the ‘traditional’ Mediterranean Diet (MedDiet) pattern for those participants reporting dietary intake that does not indicate adherence to a Mediterranean-type cuisine or those who have chronic diseases/risk factors for dementia known to benefit from this type of diet. Participants who were eligible for the Nutrition Module were assigned to one of the three diet streams: Main, Malnutrition, and Alcohol group, according to their medical history and adherence to the MedDiet at baseline. A short dietary questionnaire was administered weekly during the first 10 weeks and then monthly during the 3-year follow-up to monitor whether participants adopted or maintained the MedDiet pattern during the intervention. As the Nutrition Module is a fully online intervention, resources that promoted self-efficacy, self-management, and process of change were important elements to be included in the module development. The Nutrition Module is unique in that it is able to individualize the dietary advice according to both the medical and dietary history of each participant; the results from this unique intervention will contribute substantively to the evidence that links the Mediterranean-type diet with cognitive function and the prevention of dementia and will increase our understanding of the benefits of a MedDiet in a Western country.
Regionalizing pre-colonial Africa aids in the collection and interpretation of primary sources as data for further analysis. This article includes a map with six broad regions and 34 sub-regions, which form a controlled vocabulary within which researchers may geographically organize and classify disparate pieces of information related to Africa’s past. In computational terms, the proposed African regions serve as data containers in order to consolidate, link, and disseminate research among a growing trend in digital humanities projects related to the history of the African diasporas before c. 1900. Our naming of regions aims to avoid terminologies derived from European slave traders, colonialism, and modern-day countries.
We conduct an asymptotic analysis to derive a macrotransport equation for the long-time transport of a chemotactic/diffusiophoretic colloidal species in a uniform circular tube under a steady, laminar, pressure-driven flow and transient solute gradient. The solute gradient drives a ‘log-sensing’ advective flux of the colloidal species, which competes with Taylor dispersion due to the hydrodynamic flow. We demonstrate excellent agreement between the macrotransport equation and direct numerical solution of the full advection–diffusion equation for the colloidal species transport. In addition to its accuracy, the macrotransport equation requires $O(10^3)$ times less computational runtime than direct numerical solution of the advection–diffusion equation. Via scaling arguments, we identify three regimes of the colloidal species macrotransport, which span from chemotactic/diffusiophoretic-dominated macrotransport to the familiar Taylor dispersion regime, where macrotransport is dominated by the hydrodynamic flow. Finally, we discuss generalization of the macrotransport equation to channels of arbitrary (but constant) cross-section and to incorporate more sophisticated models of chemotactic fluxes. The macrotransport framework developed here will broaden the scope of designing chemotactic/diffusiophoretic transport systems by elucidating the interplay of macrotransport due to chemotaxis/diffusiophoresis and hydrodynamic flow.
To describe a pilot project infection prevention and control (IPC) assessment conducted in skilled nursing facilities (SNFs) in New York State (NYS) during a pivotal 2-week period when the region became the nation’s epicenter for coronavirus disease 2019 (COVID-19).
A telephone and video assessment of IPC measures in SNFs at high risk or experiencing COVID-19 activity.
SNFs in 14 New York counties, including New York City.
A 3-component remote IPC assessment: (1) screening tool; (2) telephone IPC checklist; and (3) COVID-19 video IPC assessment (ie, “COVIDeo”).
In total, 92 SNFs completed the IPC screening tool and checklist: 52 (57%) were conducted as part COVID-19 investigations, and 40 (43%) were proactive prevention-based assessments. Among the 40 proactive assessments, 14 (35%) identified suspected or confirmed COVID-19 cases. COVIDeo was performed in 26 (28%) of 92 assessments and provided observations that other tools would have missed: personal protective equipment (PPE) that was not easily accessible, redundant, or improperly donned, doffed, or stored and specific challenges implementing IPC in specialty populations. The IPC assessments took ∼1 hour each and reached an estimated 4 times as many SNFs as on-site visits in a similar time frame.
Remote IPC assessments by telephone and video were timely and feasible methods of assessing the extent to which IPC interventions had been implemented in a vulnerable setting and to disseminate real-time recommendations. Remote assessments are now being implemented across New York State and in various healthcare facility types. Similar methods have been adapted nationally by the Centers for Disease Control and Prevention.
Realizing packaged state-of-the-art performance of monolithic microwave integrated circuits (MMICs) operating at millimeter wavelengths presents significant challenges in terms of electrical interface circuitry and physical construction. For instance, even with the aid of modern electromagnetic simulation tools, modeling the interaction between the MMIC and its package embedding circuit can lack the necessary precision to achieve optimum device performance. Physical implementation also introduces inaccuracies and requires iterative interface component substitution that can produce variable results, is invasive and risks damaging the MMIC. This paper describes a novel method for in situ optimization of packaged millimeter-wave devices using a pulsed ultraviolet laser to remove pre-selected areas of interface circuit metallization. The method was successfully demonstrated through the optimization of a 183 GHz low noise amplifier destined for use on the MetOp-SG meteorological satellite series. An improvement in amplifier output return loss from an average of 12.9 dB to 22.7 dB was achieved across an operational frequency range of 175–191 GHz and the improved circuit reproduced. We believe that our in situ tuning technique can be applied more widely to planar millimeter-wave interface circuits that are critical in achieving optimum device performance.
Assessing the impacts of invasive predators on the demography and distribution of native species is critical for understanding mechanisms of species persistence and informing the design of recovery programmes. On the oceanic island of Guam, the introduction of the predatory brown treesnake Boiga irregularis after World War II caused the near-total loss of the native forest avifauna. Localised snake control measures have been implemented since the early 1990s, yet it remains poorly understood how they have impacted Guam’s remaining native bird populations. To address this question, we combined intensive area searches of Andersen Air Force Base (AAFB) with island-wide transect surveys and opportunistic sightings to provide a comprehensive update on the distribution and abundance of Såli (Micronesian Starling, Aplonis opaca) – one of Guam’s last extant native bird species. Area searches of AAFB, where the largest remnant of the Såli population persists, revealed a 15-fold population increase since the last survey in the early 1990s, and transect surveys and opportunistic sightings indicate incipient recolonisation of other urbanised areas of northern and central Guam. We estimate the current island-wide population size at ~1,400 individuals. The population increase can likely be attributed to a combination of snake control measures and the Såli’s ability to exploit urban refugia for nesting and roosting. Although these trends demonstrate some population recovery, a skewed age ratio (>90% adults and subadults) at AAFB and a highly urbanised distribution and low abundance outside AAFB indicate that snake predation continues to strongly impact the population. More intensive snake suppression efforts, particularly in forested areas, may allow for the Såli population to attain its former distribution and abundance on Guam. More broadly, our findings reinforce the importance of urban areas as refugia for some threatened species.
During the late nineteenth and early twentieth centuries, arsenic was used as an embalming agent in the United States. In 1996, Konefes and McGee brought the potential danger of arsenic poisoning during excavation to the attention of archaeologists. They developed methodology that was later refined by the present authors. This article discusses the history of arsenic as an embalming agent, explores socioeconomic and demographic factors that might suggest the presence of arsenic in certain burials, and presents methods for testing arsenic in archaeological contexts. We also discuss environmental impact mitigation considerations and review examples of arsenic testing in archaeological contexts.
Firearm injuries are a significant public health problem. Prior studies have analyzed firearm death data or adult firearm injury data, but few studies have analyzed firearm injury data specifically among youth. To inform the current debate surrounding gun policy in the United States, this study aims to provide an estimate of the immense burden of youth firearm injury and its associated risk factors. Therefore, we performed a descriptive analysis of the Nationwide Emergency Department Sample (NEDS), the largest all-payer emergency department database in the United States, from January 2006 to September 2015. All patients age < 21 who presented with any diagnosis of firearm-related injuries were included.
There were an estimated 198,839 incidents of firearm-related emergency department visits for patients age < 21 from 2006 through 2015. After presenting to the ED, an estimated 11,909 cases resulted in death. The population adjusted rate of firearm-related emergency department visits was highest in the South and Midwest. This study demonstrates the significant burden of firearm injury among youth. Having a reliable estimate of the number of children harmed by firearms each year is a critical tool for policymakers — and may make common-sense gun safety measures more politically possible.
This essay seeks to get beyond the narrow debate between two candidate grounds for indexing advantage in accounts of justice: the Rawlsian primary goods of income and wealth and capability or capabilities. Rawls is more deeply committed to multidimensionality than this debate has tended to recognize. Commitment to multidimensionality is shallow if each of the multiple dimensions is seen as contributory to something sought only for its own sake that can be adequately represented along a single dimension, such as welfare or well-being as they are sometimes conceived. To avoid treating multidimensionality shallowly — whether within the domain of justice or outside it — defenders of appealing to capabilities would do well to follow Rawls in recognizing a division of moral labour among multiple principles, with the different principles serving different social values and addressing different sets of social institutions. This approach offers an attractive and flexible alternative to single-principle outcome-ranking approaches. Along the way, in reference to the older debates, it is shown that there is, for Rawls, no single currency of justice and that he has serious reasons, grounded in respect for the fact of pluralism, to avoid resting too much theoretical weight on the idea of well-being.
Emergency Medical Services (EMS) systems have developed protocols for prehospital activation of the cardiac catheterization laboratory for patients with suspected ST-elevation myocardial infarction (STEMI) to decrease first-medical-contact-to-balloon time (FMC2B). The rate of “false positive” prehospital activations is high. In order to decrease this rate and expedite care for patients with true STEMI, the American Heart Association (AHA; Dallas, Texas USA) developed the Mission Lifeline PreAct STEMI algorithm, which was implemented in Los Angeles County (LAC; California USA) in 2015. The hypothesis of this study was that implementation of the PreAct algorithm would increase the positive predictive value (PPV) of prehospital activation.
This is an observational pre-/post-study of the effect of the implementation of the PreAct algorithm for patients with suspected STEMI transported to one of five STEMI Receiving Centers (SRCs) within the LAC Regional System. The primary outcome was the PPV of cardiac catheterization laboratory activation for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The secondary outcome was FMC2B.
A total of 1,877 patients were analyzed for the primary outcome in the pre-intervention period and 405 patients in the post-intervention period. There was an overall decrease in cardiac catheterization laboratory activations, from 67% in the pre-intervention period to 49% in the post-intervention period (95% CI for the difference, -14% to -22%). The overall rate of cardiac catheterization declined in post-intervention period as compared the pre-intervention period, from 34% to 30% (95% CI, for the difference -7.6% to 0.4%), but actually increased for subjects who had activation (48% versus 58%; 95% CI, 4.6%-15.0%). Implementation of the PreAct algorithm was associated with an increase in the PPV of activation for PCI or CABG from 37.9% to 48.6%. The overall odds ratio (OR) associated with the intervention was 1.4 (95% CI, 1.1-1.8). The effect of the intervention was to decrease variability between medical centers. There was no associated change in average FMC2B.
The implementation of the PreAct algorithm in the LAC EMS system was associated with an overall increase in the PPV of cardiac catheterization laboratory activation.
Schizophrenia is a chronic disease. Several etiopathogenic aetiologies have been posed, among them the existence of cerebral inflammation. S100B is a calcium-binding protein, mainly produced and secreted by astrocytes, that mediates the interaction among glial cells and between glial cells and neurons. Serum S100B levels have been proposed as a peripheral marker of brain inflammation.
The aim of this research is to study if the serum level of the protein S100B has relationship with positive psychopathology.
31 paranoid schizophrenic inpatients (22 male and 9 female, 36.7±10.3 years) meeting DSM-IV criteria participated in the study. Blood was sampled by venipuncture at 12:00 and 24:00 hours. Blood extractions were carried out during the first 48 hours after hospital admission. Psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS). Serum S100B levels were measured by sandwich ELISA techniques.
Correlations between serum levels of S100B protein and PANSS positive scores are shown in the following table. The first figure corresponds to the Pearson's correlation coefficient, while the figure in brackets corresponds to its statistical significance.
Total Positive Score
Serum levels of S100B protein may be used as a biological marker of positive psychopathology in paranoid schizophrenia.Acknowledgement
We present the case of a schizophrenic patient with severe insomnia that had a partial response to high doses of benzodiazepines and sedating antipsychotics. Treatment with agomelatine allowed to suspend benzodiazepine treatment and restore quality of sleep.
Mr. Y is a 36 year old male patient diagnosed with simple schizophrenia that has complained of insomnia since the age of sixteen. During the last three years the treatment that the patient was following was stable and consisted of 100 mg of diazepam, 300 mg of levomepromazine and 120 mg of clotiapine every night. During the last year 60 mg of duloxetine were added to treat a moderate depression. His mood improved with the prescribed treatment, but eleven months later it worsened. In an attempt to simultaneously treat the mood and the sleep disorder, during a period of 4 days, a dosis of 12.5 mg of aglomelatin at dinner was introduced while the morning dose of duloxetine was reduced to 30mg. On the fifth day, agomelatine was increased to 25 mg at dinner while duloxetine was suspended. The antipsychotic treatment was kept stable while the patient was instructed to reduce 10 mg of diazepam every week until next appointment one month later. In the next appointment the patient had completely suspended diazepam one week before the appointment. The patient referred improved sleep quality and no rebound insomnia.
Agomelatine may be a valid treatment of insomnia in schizophrenia.
Mefloquine is being used as malaria prevention by Plasmodium Falciparum in chloroquine-resistant zones. We describe a woman who developed a manic episode with psychotic symptoms during mefloquine treatment.
Methods and results
A 26-year-old Spanish woman had been working in Mali for the last six months and had started antimalarial prevention with mefloquine. In Mali, the clinical picture had a sudden debut and she related: excessive happiness, incapacity to sleep, and megalomania (she believed to have special powers and to be the mother of all the children). She was admitted in a hospital in Mali for seven days and received treatment with haloperidol and chlorpromazine. Then, she was repatriated to Spain without treatment and she continued suffering the same symptoms. After 15 days, she went to our hospital and she was admitted. Treatment started with risperidone (up to 6 mg/day) and clonazepam (up to 1.5 mg/day). At admission Young Mania Rating Scale (YMRS) was 25 points. Physical examination and complementary tests were normal, and was orientated as a manic episode with psychotic symptoms secondary to mefloquine. She had a quick symptomatic improvement (after 7 days of treatment YMRS was 5 points) and was discharged after 15 days.
Mefloquine more frequent adverse neuropsychiatric effects are: dizziness, vivid dreams and insomnia. Others are confusion, and auditory hallucinations. Side effects are dose dependent. Psychotic symptoms are frequently auto-limited when mefloquine is suppressed but treatment with atypical antipsychotics is often needed. MDR1/ABCB1 polymorphisms may play a role in neuropsychiatric side effects
Stress and trauma have been reported as leading contributing factors in schizophrenia. And certainly child abuse (neglect, emotional, physical and sexual abuse among others) has a lasting negative impact, which is well established in literature.
To consider the presence of infant trauma and its relationship with psychopathology in paranoid schizophrenics.Methods. 37 patients (mean age 29±6.3; years from onset 9.20±4.7), meeting DSM IV paranoid schizophrenia criteria, undergoing treatment in a university hospital are studied. The PANSS is administered in order to rate psychopathology.
27 patients had infant trauma (55.8%). Main traumas are: sexual abuse (12.8%), child abuse (7.7%), both sexual and child abuse (5.18%), parental separation (7.7%), extra-rigid parents (2.6%), alcoholic parents (18.2%), child abuse and mother's death in childhood (2.6%). Infant trauma and psychopathology showed a significant relationship concerning Hostility (No 1.75±1.209, Yes 2.26±1.759), Unnatural Movements and Posture (No 1.55±0.945, Yes 1.16±0.545), Depression (No 1.25±0.550, Yes 1.74±1.284) and Preoccupation (No 2.75±1.410, Yes 3.26±1.996).
Infant trauma is common in paranoid schizophrenia and our findings give some evidence to a relationship with psychopathology, especially with dimensions as Hostility, Unnatural Movements and Posture, Depression and Preoccupation. Despite sample size, a high proportion (55.8%) of the patients presented infant trauma and future research is needed in order to open new avenues in this field, particularly studies concerning infant trauma and symptomatology specificity will be greatly appreciated as well as the plausible link to personality traits and personality disorders.
There is a significant incidence of psychiatric symptoms in patients with multiple sclerosis, the most common after receiving the diagnosis. We describe a man who was admitted for a first episode psychosis and a diagnosis of multiple sclerosis was made moreover.
A 24-year-old man was admitted with a paranoid delusion, auditory hallucinations with emotional response and the believe that their thoughts were being interfered. Blood test and cranial CT were normal. Risperidone was started. He developed ataxia and sensitive disturbances on the right arm. A cranial and spinal cord MRI revealed multiple T2 and FLAIR hyperintense lesions located in supra and infratentorial white matter, lesions in C3, and one lesion in right basal ganglia that enhanced with gadolinium. CSF analysis showed oligoclonals bands. Three years ago the patient had had transient sensitive symtoms. A diagnosis of relapsing-remitting multiple sclerosis was made and was started methyl-prednisolone intravenously. Risperidone was changed for amisulpride 800 mg/day because lack of response. He was discharged after 25 days. Six months later he has attenuated psychotic symptoms without news lesions in MRI. Glatiramer acetate has been started.
Results and conclusions
The most frequent disorder associated to multiple sclerosis is depression (prevalence of 20%). Psychosis is unusual, transient, sometimes as the onset relapse followed by remission. There's evidence of correlation between psychosis in multiple sclerosis and multiple lesions in temporal periventricular area. We suggest that in our case these two disorders are two separated entities since the enhanced lesion does not correpond with clinical findings.
Mefloquine is being used as malaria prevention by Plasmodium Falciparum in chloroquine-resistant zones. We describe a woman who developed a manic episode with psychotic symptoms during mefloquine treatment.
Methods and results
The case describes a 26-year-old Spanish woman who had been working in Mali for the last six months and had started antimalarial prevention with mefloquine. In Mali, the clinical picture had a sudden debut and she related: excessive happiness, incapacity to sleep, and megalomania (she believed to have special powers and to be the mother of all the children). She was admitted in a hospital in Mali for seven days and received treatment with haloperidol and chlorpromazine. Then, she was repatriated to Spain without treatment and she continued suffering the same symptoms. After 15 days, she went to our hospital and she was admitted. Treatment started with risperidone (up to 6 mg/day) and clonazepam (up to 1.5 mg/day). At admission Young Mania Rating Scale (YMRS) was 25 points. Physical examination and complementary tests were normal, and was orientated as a manic episode with psychotic symptoms secondary to mefloquine. She had a quick symptomatic improvement (after 7 days of treatment YMRS was 5 points) and was discharged after 15 days.
Mefloquine more frequent adverse neuropsychiatric effects are: dizziness, vivid dreams and insomnia. Others are confusion, and auditory hallucinations. Side effects are dose dependent. Psychotic symptoms are frequently auto-limited when mefloquine is suppressed but treatment with atypical antipsychotics is often needed. MDR1/ABCB1 polymorphisms may play a role in neuropsychiatric side effects.
Group-based trajectory modeling (GBTM) is a statistical method created to explore the heterogeneity of clinical groups based on their longitudinal outcomes by identifying distinct trajectories of change. This model can be applied to assess heterogeneity in responses to treatment. This pilot study explored the relevance of the GBTM associated with the dimensional evaluation of mood (MATHYS) to define trajectory of recovery in acute bipolar mood episodes on a short period of time during a naturalistic study.
The sample consisted in 118 bipolar patients and all patients were recruited during an acute phase: 56% had a major depressive episode, 26% a manic or hypomanic episode, and 18% a mixed state using the DSM-IV criteria. Patients were assessed four times with MATHYS during a three weeks follow-up period. It is an observational study and treatment was prescribed as usual. We applied the GBTM method and MATHYS total score to define trajectories of recovery.
This method allows identifying 4 trajectories of recovery. At Baseline, two of them started with a score of inhibition but with quite different evolutive profiles (stable inhibition versus improvement). The two others trajectories started with a score of activation (mild versus moderate) and showed a linear improvement of symptoms but with a more rapid recovery for the patients with the higher activation at baseline.
When considering the diagnosis of patients belonging in each trajectory, there model seems particular relevant to explore the high heterogeneity in response to treatment in bipolar patients during an acute depressive episode.
Objective. As some temperament profiles may be markers of genetic vulnerability traits, we aimed to compare sensation seeking in euthymic bipolar patients and in controls. Methods. One hundred ninety-four patients fulfilling DSM-IV diagnostic criteria for bipolar disorders (BP), 81% of whom presented type I BP, and 95 controls were included in this study. Euthymia was assessed using both the MADRS and Bech mania scales. Subjects were evaluated using the French abbreviated form of Zuckerman’s Sensation Seeking Scale (SSS), which provide a total score (TS) and four subscores: Thrill and Adventure Seeking (TAS), Experience Seeking (ES), Disinhibition (Dis), and Boredom Susceptibility (BS). Results. SSS total score differed significantly between men (17.2 ± 0.5) and women (15.3 ± 0.6) (P = 0.02) and all the subscores were negatively correlated with age. On adjustement for sex and age, we found that bipolar patients had a high Dis score (P = 0.003). However, if the same analysis was performed with a lifetime history of alcohol abuse or dependence as a covariable, no such difference was found (P = 0.436). The SSS demonstrated a high degree of test-retest reliability (ICC = 0.91). Conclusion. These results suggest that sensation seeking assessed with the SSS is not a temperament characteristic associated with bipolar disorders but is instead linked to a tendency towards alcohol abuse.
Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.
The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.
There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.
These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.
Face aux difficultés persistantes pour traiter efficacement la dépression bipolaire et à la complexité des guidelines, il est indispensable d’identifier des prédicteurs de réponse aux traitements médicamenteux afin d’améliorer le pronostic fonctionnel des patients. Des études cliniques avec une approche dimensionnelle ont montré que les dépressions bipolaires pouvaient être caractérisées par la réactivité émotionnelle , celle-ci pouvant constituer un marqueur d’intérêt de réponse aux traitements pharmacologiques. Dans cette perspective, l’utilisation de modèles statistiques de trajectoire pour différencier des profils cliniques de réponses aux traitements a permis de montrer que l’hyperréactivité émotionnelle serait un facteur prédictif d’une bonne réponse aux antipsychotiques atypiques. Cependant, certaines dépressions bipolaires avec une hyporéactivité émotionnelle semblent résister aux traitements classiques. De ce fait, plusieurs études ont testé l’intérêt de thérapeutiques moins conventionnelles dans le traitement des dépressions bipolaires résistantes aux traitements habituels . Le pramipexole est un agoniste dopaminergique dont la particularité est d’avoir une affinité sélective pour les récepteurs D3 de la voie mésolimbique. Les données actuelles concernant l’efficacité antidépressive de ce traitement dans les dépressions bipolaires résistantes semblent en faveur de taux de réponses et de rémission significativement plus importants et plus précoces (dès la 3e semaine) en comparaison à des antidépresseurs classiques ou d’un placebo, et d’une bonne tolérance . Une série d’observations cliniques chez 64 patients souffrant de dépression (uni ou bipolaire) suivis en ambulatoire a montré une efficacité du pramipexole sur les symptômes de dépression dans un délai de 3 à 17 jours à des doses moyennes de 1,4 mg/j. L’hyporéactivité émotionnelle pourrait être un indicateur d’une meilleure efficacité du traitement. Nous proposons dans ce symposium de mettre en perspective les caractéristiques cliniques des dépressions bipolaires qui pourraient orienter le choix du clinicien entre antipsychotiques atypiques, antidépresseurs et thérapeutiques innovantes.