Safe and effective use of lithium

Lithium has proven efficacy in the treatment of bipolar disorder, both for acute mania and long-term mood stabilisation and prophylaxis. It is also useful in combating treatment-resistant depression. Compared to other mood stabilisers, lithium has a favourable efficacy-tolerability balance. Lithium is underused due to active marketing of alternatives and concerns regarding adverse effects, tolerability, and the perception that regular monitoring is difficult

Examining The Psychological Wellbeing Of Stepparents: Utilising Social Identity Theory And System Justification Theory To Investigate The Impact Of Perceived Discrimination

Stepfamilies are an increasingly common family form, however, little is known about the psychological wellbeing of this population. Stepfamily researchers have theorised that stigma and unfavourable stereotypes contribute to the difficulties associated with the stepparent role, particularly for stepmothers. However, these relationships have not yet been empirically examined. This study therefore aimed to examine several facets of stepparent wellbeing using a comparison group of biological parents. Further, it tested a series of hypotheses derived from socio-cultural theories: Social Identity Theory and System Justification Theory. An online survey was conducted with biological parents (n = 180) and stepparents (n = 145). Contrary to predictions, stepparents did not report higher levels of negative emotion or poorer relationship satisfaction compared to biological parents. As hypothesised, stepparents reported lower life satisfaction compared to biological parents. This finding was accounted for by higher levels of child psychopathology and behaviour problems in stepfamilies. Moreover, as predicted, stepparents, and in particular stepmothers, perceived higher levels of discrimination compared to biological parents and displayed a lower sense of self-worth as a group. As hypothesised, perceived discrimination was associated with lower wellbeing via adoption and internalisation of negative societal perceptions amongst stepparents. Further, stepparents who tended to subjugate their own needs for the wellbeing of others were more likely to experience higher levels of negative emotion. In contrast to predictions, higher self-sacrifice was associated with increased spousal relationship satisfaction among stepparents. Finally, stepparents exhibited more ambivalent attitudes toward their group than biological parents. This finding suggests that stepparents may partially accept and legitimise their lowered social status, supporting assertions of System Justification Theory

A randomized trial of planned cesarean or vaginal delivery for twin pregnancy

Background: Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy.\ud \ud Methods: We randomly assigned women between 32 weeks 0 days and 38 weeks 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison.\ud \ud Results: A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P = 0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P = 0.49).\ud \ud Conclusion: In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery