Unipolar mania: identification and characterisation of cases in France and the United Kingdom

Background: Unipolar mania is a putative subtype of bipolar disorder (BD) in which individuals experience recurrent manic but not major depressive episodes. Few studies of unipolar mania have been conducted in developed countries and none in the UK. This study aimed to identify and characterise people with unipolar mania in the UK and France. Methods: People with unipolar mania were ascertained using a South London UK electronic case register and a French BD case series. Each unipolar mania group was compared to a matched group of people with BD who have experienced depressive episodes. Results: 17 people with unipolar mania were identified in South London and 13 in France. The frequency of unipolar mania as a percentage of the BD clinical population was 1.2% for the South London cohort and 3.3% for the French cohort. In both cohorts, people with unipolar mania experienced more manic episodes than people with BD, and in the French cohort were more likely to experience a psychotic illness onset and more psychiatric admissions. Treatment characteristics of people with unipolar mania were similar to people with BD except that the unipolar mania group was less likely to be treated with antidepressants. Limitations: The relatively small number of people with unipolar mania identified by this study limits its power to detect differences in clinical variables. Conclusions: People with unipolar mania can be identified in France and the UK, and they may experience a higher frequency of manic episodes but have similar treatment characteristics to people with BD

Home-based initiatives for acute management of COVID-19 patients needing oxygen: differences across The Netherlands

Objective: During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands. Methods: Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an ‘early hospital discharge’ program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used. Results: Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff’s qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option. Conclusions: We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care

FIRST-TRIMESTER MATERNAL SERUM IMMUNOREACTIVE INHIBIN IN CHROMOSOMALLY NORMAL AND ABNORMAL PREGNANCIES

Objective: To investigate the maternal serum immunoreactive inhibin level in chromosomally normal and abnormal pregnancies in the first trimester. Methods: This was a retrospective study under the auspices of the Dutch Working Party on Prenatal Diagnosis. Maternal serum samples were taken before prenatal diagnosis. Forty-eight maternal serum samples from chromosomally abnormal pregnancies, including 23 with Down syndrome, were available for analysis; 284 samples from chromosomally normal pregnancies were used to establish reference ranges. Results: The median value of maternal serum immunoreactive inhibin in the 23 Down syndrome pregnancies was 1.3 multiples of the normal median (95% confidence interval 0.8-2.1). No significant difference was found between the distributions of the inhibin concentrations in the normal and the Down syndrome pregnancies or in the normal and the other chromosomally abnormal pregnancies. Conclusion: In contrast to the second trimester of pregnancy, the level of maternal serum immunoreactive inhibin in the first trimester is not related to fetal chromosomal abnormalities and therefore is not useful as a biochemical screening index