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PubMed2006

The right hippocampus participates in short-term memory maintenance of object-location associations.

Doubts have been cast on the strict dissociation between short- and long-term memory systems. Specifically, several neuroimaging studies have shown that the medial temporal lobe, a region almost invariably associated with long-term memory, is involved in active short-term memory maintenance. Furthermore, a recent study in hippocampally lesioned patients has shown that the hippocampus is critically involved in associating objects and their locations, even when the delay period lasts only 8 s. However, the critical feature that causes the medial temporal lobe, and in particular the hippocampus, to participate in active maintenance is still unknown. This study was designed in order to explore hippocampal involvement in active maintenance of spatial and non-spatial associations. Eighteen participants performed a delayed-match-to-sample task in which they had to maintain either object-location associations, color-number association, single colors, or single locations. Whole-brain activity was measured using event-related functional magnetic resonance imaging and analyzed using a random effects model. Right lateralized hippocampal activity was evident when participants had to maintain object-location associations, but not when they had to maintain object-color associations or single items. The present results suggest a hippocampal involvement in active maintenance when feature combinations that include spatial information have to be maintained online.

Adult↗
PubMed2004

Valgancyclovir as maintenance therapy for cytomegalovirus retinitis in a lung transplant patient--a case report.

UNLABELLED: The purpose of this article is to report the use of valgancyclovir as maintenance therapy for cytomegalovirus (CMV) retinitis in a lung transplanted patient. RESULT: A 30-year-old woman with underlying pulmonary lymphangioleiomyomatosis received a lung transplant 1 year ago. CMV retinitis developed 4 months later but subsided after intravenous ganciclovir treatment. Unfortunately, the CMV retinitis recurred three times in 1 year while on oral ganciclovir maintenance therapy. To treat the latest relapse, valgancyclovir 900 mg once daily was used as maintenance therapy after intravenous gancyclovir induction. With a 6-month follow-up, the fundoscopic examination revealed old atrophic scar and no active CMV retinits. The patient was able to maintain best-corrected visual acuity of 20/20 in both eyes. In conclusion, Valganciclovir may be used as maintenance therapy in CMV retinitis.

Adult↗
PubMed1998

A randomized trial of buprenorphine maintenance for heroin dependence in a primary care clinic for substance users versus a methadone clinic.

PURPOSE: Buprenorphine is an alternative to methadone for the maintenance treatment of heroine dependence and may be effective on a thrice weekly basis. Our objective was to evaluate the effect of thrice weekly buprenorphine maintenance for the treatment of heroin dependence in a primary care clinic on retention in treatment and illicit opioid use. SUBJECTS AND METHODS: Opioid-dependent patients were randomly assigned to receive thrice weekly buprenorphine maintenance in a primary care clinic that was affiliated with a drug treatment program (n = 23) or in a traditional drug treatment program (n = 23) in a 12-week clinical trial. Primary outcomes were retention in treatment and urine toxicology for opioids; secondary outcomes were opioid withdrawal symptoms and toxicology for cocaine. RESULTS: Retention during the 12-week study was higher in the primary care setting (78%, 18 of 23) than in the drug treatment setting (52%, 12 of 23; P = 0.06). Patients admitted to primary care had lower rates of opioid use based on overall urine toxicology (63% versus 85%, P < 0.01) and were more likely to achieve 3 or more consecutive weeks of abstinence (43% versus 13%, P = 0.02). Cocaine use was similar in both settings. CONCLUSIONS: Buprenorphine maintenance is an effective treatment for heroin dependence in a primary care setting.

Adult↗
PubMed1995

Dose-related difference in progression rates of cytomegalovirus retinopathy during foscarnet maintenance therapy. AIDS Clinical Trials Group Protocol 915 Team.

PURPOSE: A previous dose-ranging study of foscarnet maintenance therapy for cytomegalovirus retinopathy showed a positive relationship between dose and survival but could not confirm a relationship between dose and time to first progression. This retrospective analysis of data from that study was undertaken to determine whether there was a relationship between dose and progression rates, which reflects the amount of retina destroyed when progression occurs. METHODS: Patients were randomly given one of two foscarnet maintenance therapy doses (90 mg/kg of body weight/day [FOS-90 group] or 120 mg/kg of body weight/day [FOS-120 group] after induction therapy. Using baseline and follow-up photographs and pre-established definitions and methodology in a masked analysis, posterior progression rates and foveal proximity rates for individual lesions, selected by prospectively defined criteria, were calculated in each patient. Rates were compared between groups. RESULTS: The following median rates were greater for the FOS-90 group (N = 8) than for the FOS-120 group (N = 10): greatest maximum rate at which lesions enlarged in a posterior direction (43.5 vs 12.5 microns/day; P = .002); posterior progression rate for lesions closest to the fovea (42.8 vs 5.5 microns/day; P = .010); and maximum foveal proximity rate for either eye (32.3 vs 3.4 microns/day; P = .031). CONCLUSION: Patients receiving higher doses of foscarnet have slower rates of progression and therefore less retinal tissue damage during maintenance therapy. A foscarnet maintenance therapy dose of 120 mg/kg of body weight/day instead of 90 mg/kg of body weight/day may help to preserve vision in patients with cytomegalovirus retinopathy.

AIDS-Related Opportunistic Infections↗
PubMed2000

Placebo effect in randomized, controlled maintenance studies of patients with bipolar disorder.

The prevention of mood episodes is an important goal of the maintenance treatment of patients with bipolar disorder. The rate of relapse on placebo compared with that on active treatment is an important issue in the design of future clinical trials of maintenance treatment. We examine the range and time course of placebo relapse rates in studies of patients with bipolar I disorder. In addition, we address the potential variables associated with placebo response, strategies to minimize placebo response, the optimum duration of placebo-controlled maintenance trials, possible alternatives to placebo control groups, and the impact of these considerations in maintenance studies of children, adolescents, and older adults with bipolar disorder.

Acute Disease↗
PubMed2000

Nucleus accumbens cell firing during maintenance, extinction, and reinstatement of cocaine self-administration behavior in rats.

Electrophysiological recording procedures were used to examine nucleus accumbens (Acb) cell firing in rats (N=13) during cocaine self-administration sessions consisting of three phases. In phase one (maintenance), each lever press resulted in an intravenous cocaine infusion (0.33 mg, 6 s) paired with a tone-houselight stimulus (20 s). Of 144 Acb cells recorded during maintenance, 39 neurons (27%) exhibited phasic firing relative to the cocaine-reinforced response [4-8]. Briefly, Acb neurons showed increases in firing rate within seconds preceding the reinforced response and/or changes (increases or decreases) in activity within seconds following response completion. In phase two (extinction), saline was substituted for cocaine in the task. Results indicated that cells displaying exclusively anticipatory discharges during maintenance exhibited similar phasic activity during extinction. However, neurons that displayed post-response activity during the maintenance phase typically showed significant attenuation of phasic firing rates during extinction. After 30 min of no responding, animals were 'primed' with an intravenous infusion of cocaine, and self-administration was reestablished during phase three (reinstatement). Results showed that pre-response discharge patterns remained relatively intact while post-response cells typically exhibited a partial recovery of phasic activity. Similar findings were observed during other extinction experiments in which the stimulus only was removed (CS extinction). These findings support the notion that specific factors operating within the self-administration context differentially control pre- versus post-response discharge patterns of Acb neurons.

Action Potentials↗
PubMed2002

Telomere maintenance in telomerase-positive human ovarian SKOV-3 cells cannot be retarded by complete inhibition of telomerase.

The two known mechanisms for telomere maintenance in eukaryocytes are telomerase in telomerase-positive cells and alternative lengthening of telomeres (ALT) in telomerase-negative cells. We report here that telomere maintenance in the telomerase-positive human ovarian SKOV-3 cells was not affected by inhibition of telomerase. For comparison, the effect of telomerase inhibitors on telomere maintenance in another telomerase-positive cell line (i.e. human pharynx FaDu cells) and the telomerase-negative human osteosarcoma Saos-2 cells was examined. Telomerase activity was measured using a modified telomeric repeat amplification protocol and telomere length was measured using a solution hybridization-based method and fluorescence in situ hybridization. A reverse transcriptase inhibitor (3'-azido-deoxythymidine or AZT) and an antisense against a component of human telomerase RNA (antisense hTR) were used to inhibit telomerase. FaDu and SKOV-3 cells showed comparable baseline telomerase activity. Telomerase activity in both cells was inhibited about equally by AZT (maximal inhibition of approximately 80%) and by expression of antisense hTR (complete inhibition in SKOV-3 cells and maximal inhibition of approximately 80% in FaDu cells). However, treatment with telomerase inhibitors resulted in approximately 50% telomere shortening in FaDu cells but had no effect on SKOV-3 nor Saos-2 cells. SKOV-3 cells did not show the characteristic features of ALT (i.e. heterogeneous telomere length and promyelocytic leukemia bodies), whereas these ALT features were observed in Saos-2 cells. Collectively, these results suggest the existence of a telomerase-independent mechanism of telomere maintenance in the telomerase-positive SKOV-3 cells.

Cells, Cultured↗
PubMedDate not supplied

Addressing generalization and maintenance of stuttering treatment in the schools: a critical look.

UNLABELLED: Generalization and maintenance are a widely recognized challenge for stuttering treatment. There are many reasons why this is the case. First, there is no accepted model of recovery, though self-efficacy may be a helpful construct and, secondly, the client's age, stuttering severity, and negative attitudes may be complicating factors. Three strategies for promoting generalization and maintenance in school settings are suggested based on current research evidence. They include probing and training for generalization, incorporating real-life elements into therapy, and training clients to self-regulate their behavior. These strategies appear to be viable and practical, but further research is needed to fully evaluate their effectiveness for school settings. LEARNING OUTCOMES: Readers will learn about (1) typical approaches to managing stuttering in the school setting, (2) barriers to generalization and maintenance of stuttering treatment gains, and (3) three strategies for promoting generalization and maintenance.

Adolescent↗
PubMed1992

Sodium restriction versus daily maintenance replacement in very low birth weight premature neonates: a randomized, blind therapeutic trial.

To test the hypothesis that restriction of sodium intake during the first 3 to 5 days of life will prevent the occurrence of hypernatremia and the need for administration of large fluid volumes, we prospectively and randomly assigned 17 babies (mean +/- SD: 850 +/- 120 gm; 27 +/- 1 weeks of gestation) to receive in blind fashion either daily maintenance sodium or salt restriction with physician-prescribed parenteral fluid intake. Maintenance-group infants received 3 to 4 mEq of sodium per kilogram per day; restricted infants received no sodium supplement other than with such treatments as transfusion. Sodium balance studies conducted for 5 days demonstrated that maintenance salt intake resulted in a daily sodium balance near zero, whereas sodium-restricted infants continued to excrete urinary sodium at a high rate, which promoted a more negative balance (average daily sodium balance -0.30 +/- 1.78 SD in maintenance group vs -3.71 +/- 1.47 mEq/kg per day in restriction group; p less than 0.001). Care givers tended to prescribe daily increases in parenteral fluids for the salt-supplemented infants, perhaps because serum sodium concentrations were elevated in these infants after the first day of the study (p less than 0.001). Hypernatremia developed in two sodium-supplemented infants (greater than 150 mEq/L), and hyponatremia developed in two sodium-restricted infants (less than 130 mEq/L); however, the restricted infants were more likely to have normal serum osmolality (p less than 0.05). Both groups of infants produced urine that was neither concentrated nor dilute, with a high fractional excretion of sodium; renal failure was not observed. The mortality rate was not affected, but the incidence of bronchopulmonary dysplasia was significantly less in the sodium-restricted babies (p less than 0.02). We conclude that in tiny premature infants, a fluid regimen that restricts sodium may simplify parenteral fluid therapy targeted to prevent hypernatremia and excessive administration of parenteral fluids.

Fluid Therapy↗
PubMed2002

Psychological aspects of weight maintenance and relapse in obesity.

Studies have shown that, among formerly obese individuals, the continued practice of the behavioural strategies adopted during weight loss is associated with the successful maintenance of a new lower weight. Much less attention has been focused on the psychological factors that motivate the continued use or abandonment of these critical weight maintenance behaviours. This paper reviews studies that have attempted to identify psychological characteristics that may be associated with weight maintenance and relapse in obesity. This is important because a better understanding of these factors may lead to the development of improved psychological treatments for obesity. The results of the studies suggest that a number psychological factors, such as having unrealistic weight goals, poor coping or problem-solving skills and low self-efficacy, may have an important effect on the behaviours involved in weight maintenance and relapse in obesity, and further research in this area is warranted.

Adaptation, Psychological↗
PubMed1991

Maintenance therapy in peptic ulcer disease.

The maxim "once an ulcer, always an ulcer" is still an appropriate description for the chronic nature of peptic ulcer disease. The goals for treating patients with ulcer disease are to relieve symptoms, heal the acute ulcer, reduce the risk of ulcer recurrence and complications, and decrease the economic impact of this chronic disease while maintaining the patient's quality of life. Patients with documented peptic ulcer disease should be carefully evaluated and a treatment plan devised that takes into account the possible need for maintenance therapy. Risk factors that seem to reflect a high likelihood of ulcer recurrence should be identified early in all ulcer patients and attempts made to minimize or correct them in the future. Assuming that a diagnosis of peptic ulcer disease has been firmly established and an adequate period of drug treatment makes complete ulcer healing likely, a reasonable way to proceed is outlined in Figure 4. If the patient is young and generally healthy, has an uncomplicated ulcer and few risk factors favoring ulcer relapse, either no treatment or symptomatic selfcare would be reasonable. If one chooses the latter course, the patient can be given a prescription for 3 to 6 months of medication and told to take full therapy for any recurrent symptoms, continuing the treatment until symptoms are relieved. The failure of such treatment to relieve symptoms after 2 to 3 weeks, the onset of alarming symptoms such as intense pain, vomiting, or melena, or possibly the exhaustion of the 6-month supply of medication with continued mild symptoms should lead to reevaluation. Alternatively, such a patient could be managed with no therapy and seen again if ulcer symptoms recur and reevaluated for further diagnosis and treatment. Obviously, patients who are candidates for these approaches to postulcer healing management are those with a low risk for ulcer recurrence and who are likely to be compliant with follow-up advice. Accordingly, careful patient selection seems most important in prescribing symptomatic self-care or intermittent full-dose maintenance treatment. On the other hand, if the patient has had a complicated course of ulcer disease, such as bleeding, or has a significant number of risk factors that would make early ulcer relapse highly likely, it would be prudent to institute continuous maintenance therapy while working to reduce or eliminate the adverse risk factors. Any relapse of symptomatic ulcer disease during noncontinuous maintenance therapy should indicate the need for return to a continuous dosing program.(ABSTRACT TRUNCATED AT 400 WORDS)

Histamine H2 Antagonists↗
PubMed1991

Hospital and other influences on the uptake and maintenance of breast feeding: the development of infant feeding policy in a district.

Hospital practices in the post-natal period are now recognised as one of a wide range of influences affecting the success of breast feeding. A study of 48 non-medical maternity unit staff and 250 recently delivered mothers at a District General Hospital was carried out in order to identify obstacles and sources of support in the establishment and maintenance of breast feeding. This study formed part of an evaluation of local policy development which included the appointment of a Baby Feeding Adviser. Eighty-two percent of mothers (95% confidence interval; 87.0-96.4) began breast feeding, and this fell to 57.4% (50.6-64.2) at 6 weeks. A majority of mothers reported that advice was at least partly conflicting, and of those who began breast feeding 92.7% had used supplements within 2 days. In multivariate analysis, factors significantly associated with a lower rate of initial breast feeding were: non-attendance at antenatal classes, Caucasian ethnicity, social class and religious denomination. Social factors were much less important in the maintenance of breast feeding, but mothers who had undergone Caesarian section were more likely to give up breast feeding by 6 weeks. The reported quality of advice and support from the hospital and community were not associated with the maintenance of breast feeding. Many of the maternity unit midwifery staff reported inadequate time for discussion of feeding with mothers. Although two-thirds of the staff felt that there should be an infant feeding policy or were not sure, most of those favouring a policy felt that it should not actively promote breast feeding. Their main reason for this view was the fear of inducing guilt in bottle-feeding mothers. The social and service-related factors associated with the initiation and maintenance of breast feeding may be useful for targeting additional support for some mothers. The ambivalence and concerns among maternity unit midwifery staff about promoting breast feeding must be addressed if successful policy implementation is to be achieved. Plans for implementing change and evaluation are described.

Adult↗
PubMed1988

Does maintenance therapy keep duodenal ulcers healed?

34 patients were endoscopically reexamined once a month while receiving ranitidine 150 mg at night to sustain remission of a duodenal ulcer. The cumulative recurrence rate after 1 year of maintenance treatment was 48%. 71% of recurrences were painless when first detected. The monthly percentage probabilities for asymptomatic ulcers rehealing, remaining unchanged, and causing pain were 33%, 63%, and 4%, respectively. Because painless ulcers may reheal, the number of ulcer recurrences detected during maintenance trials depends on the frequency of endoscopic reexamination of symptomless patients. Endoscopic examination of symptomless patients every 6 months would have failed to detect nearly half of all recurrences in this study. Thus an accurate assessment of the true incidence of asymptomatic (and, therefore, total) recurrences requires frequent endoscopic re-examination of symptomless patients. The clinical value of maintenance treatment should be judged by prevention of symptoms and complications, since it is not possible--either practically or mathematically--to determine the true incidence of ulcer recurrence, and because asymptomatic recurrences are irrelevant, provided maintenance treatment is continued.

Actuarial Analysis↗
PubMed2006

Patient benefits of maintenance immunotherapy.

Rituximab maintenance therapy after effective induction has been shown to prolong progression-free and even overall survival, compared with no further treatment until relapse, in randomized, prospective phase III clinical trials in follicular lymphoma. In addition, the use of rituximab maintenance therapy is likely to have an important psychological and emotional impact for many patients. Currently, all patients are expected to relapse eventually following induction treatment: the knowledge that they are being actively treated to delay relapse for as long as possible may provide significant reassurance and emotional support. Similarly, the experience of relapse itself is also likely to be a traumatic event for patients: reducing the frequency of relapse with rituximab maintenance may thus spare patients some of this trauma. Overall, therefore, rituximab maintenance therapy might be expected to improve quality of life for patients with follicular lymphoma over and above the observed clinical benefits in progression-free and overall survival. At present, however, this can only be speculated from observations and experience. Formal quality-of-life and patient preference assessments will be required to demonstrate this conclusively.

Antibodies, Monoclonal↗
PubMed2001

Cost-minimization analysis of simvastatin versus atorvastatin for maintenance therapy in patients with coronary or peripheral vascular disease.

BACKGROUND: Previous health economic studies have demonstrated the cost-effectiveness of simvastatin in the treatment of coronary heart disease (CHD) based on clinical results of the Scandinavian Simvastatin Survival Study. A prior analysis evaluated the "cost of getting to goal," but ignored all costs after titration. However, when evaluating the cost-effectiveness of long-term therapies, it is important to consider the maintenance costs as well. OBJECTIVE: The purpose of this study was to evaluate the maintenance costs of treatment with simvastatin versus that of treatment with another more recently available statin, atorvastatin, in a European context. METHODS: We assessed the long-term maintenance cost of simvastatin versus atorvastatin in terms of the cost of reducing low-density lipoprotein cholesterol (LDL-C) levels to the recommended goals based on a previously published clinical trial in patients with CHD. The analysis focused on the patients in the original clinical trial who were randomized to treatment with simvastatin or atorvastatin. Patients began therapy with 10 mg of simvastatin or atorvastatin; the dose of study drug was titrated every 12 weeks up to 40 mg simvastatin or 80 mg atorvastatin, with the addition of up to 8 g/d of cholestyramine until a modified European Atherosclerosis Society LDL-C goal (<2.84 mmol/L) was reached. As there was no significant difference between the 2 groups in resource utilization for adverse events, only drug costs were included. The calculated average annual maintenance cost was based on the distribution of the final daily dosing regimens and the public drug prices for each regimen. Individual country analyses were conducted using each local currency. RESULTS: There was no significant difference between groups in the percentage of patients reaching their LDL-C goal over the study period (80% for simvastatin-treated pa- tients vs 89% for atorvastatin-treated patients, P = 0.135). However, the cost of maintaining a similar percentage of patients at their appropriate LDL-C levels was significantly lower in the simvastatin group compared with the atorvastatin group in 13 of the 17 countries assessed. In the remaining 4 countries, there was a cost advantage for simvastatin, but it did not reach statistical significance. CONCLUSIONS: Across Europe there was a significant reduction in the cost of maintaining patients at their appropriate LDL-C levels with simvastatin versus atorvastatin. The results of this analysis, along with the proven clinical benefits of simvastatin, support the use of this drug as the treatment of choice in the secondary prevention of CHD.

Anticholesteremic Agents↗
PubMedDate not supplied

Effectiveness of ranitidine 150 mg at bedtime as maintenance therapy for healed gastric ulcers.

As many as 89% of gastric ulcer patients experience ulcer recurrences within 1 year of successful healing with conventional antiulcer therapies. Because ranitidine is effective in the healing of gastric and duodenal ulcers and the maintenance of healed duodenal ulcers, we hypothesized that ranitidine would also be effective in the maintenance of healed gastric ulcers. A 48-week, placebo-controlled, randomized, double-blind, multicenter trial was conducted to compare ranitidine 150 mg administered at bedtime with placebo for the maintenance of healed gastric ulcers. Endoscopies were performed at baseline and repeated after 12, 24, 36, and 48 weeks of treatment. Gastric ulcer recurrence rates at each scheduled endoscopy were significantly lower in patients receiving ranitidine (5%, 13%, 16%, and 19%, respectively) compared with those receiving placebo (20%, 30%, 40%, and 50%, respectively). Compared with placebo, ranitidine was more effective in maintaining healed gastric ulcers regardless of previous gastric ulcer history, smoking status, age (< 65 vs > or = 65 years), or sex. There were no significant differences between the two treatment groups in the number of patients experiencing adverse events or laboratory abnormalities. Ranitidine 150 mg administered at bedtime provides safe and effective treatment for the maintenance of healed gastric ulcers.

Administration, Oral↗
PubMed2000

Maintenance therapies for classic and other forms of bipolar disorder.

The progressive, episodic and chronic nature of bipolar disorder dictates the need for lifelong pharmacological maintenance treatment in the majority of patients. Prophylaxis should be considered after a single episode of severe mania or after more than one episode of hypomania in bipolar II disorder, although some clinicians now consider an episode of either sufficient to warrant maintenance therapy. Lithium is efficacious as maintenance therapy, but is not as highly effective as early studies initially suggested (abrupt discontinuation of lithium probably increased placebo relapse figures). Rates of premature discontinuation of lithium are high. Divalproex sodium is used frequently in the USA and Canada for long-term treatment for bipolar disorder but an insufficient number of controlled trials have been published to assess adequately its role. Carbamazepine is also employed in maintenance treatment. Randomized studies indicate it is superior to placebo but somewhat less effective than lithium. Augmentation of any of these drugs with another mood stabilizer, an antipsychotic, or electroconvulsive therapy appears to be effective, although there are few controlled studies. Design issues that need consideration in order to achieve meaningful data are discussed. A severe manifestation of bipolar disorder is rapid cycling. It is often induced by antidepressants, although this association frequently goes unrecognized. Patients with a rapid cycling course of illness are difficult to treat effectively. Although rapid cycling is often associated with poor response to lithium, there have been no randomized, controlled treatment studies. Based on open studies and expert panel recommendations, the International Exchange on Bipolar Disorder (IEBD) recommended initial treatment with divalproex sodium, with subsequent addition of other mood stabilizers, antipsychotics or thyroid supplementation as necessary. Combination treatments are frequently required for optimal response in these patients.

Antidepressive Agents↗
PubMed1998

Suicide mortality in patients on lithium maintenance therapy.

Mood disorders are frequently recurrent and it has been shown that maintenance treatment can reduce long-term morbidity in this condition. It has also been shown that mood disorders carry an increased risk of suicide and that a significant proportion of individuals who commit suicide suffer from a mood disorder. This paper reports the results of a long term follow-up of a cohort of patients attending a specialist mood disorder clinic over a period of 18 years. Sixty-seven suffered from unipolar depression and 36 had bipolar or schizo-affective disorders In order to qualify for entry to the cohort the unipolar patients had to have had at least three episodes of depression and those with bipolar disorders had to have had at least three episodes - with at least one manic episode and one depressive episode. All patients were treated with lithium. The initial treatment refusal rate and drop our rates were low. The mortality from suicide in this group was compared with that reported in five recent studies - all of which involved patients who had not been given maintenance therapy. The standardised mortality ratio (SMR) for all causes for the whole group was 0.93. There were two suicides. In one case the patient had continued treatment with lithium until death and in the other the patient had discontinued treatment 12 months before death. The overall suicide rate was 1.3 per 1000 patient years. Amongst similar groups of patients who had not been given maintenance therapy suicide rates of about 5.5 per 1000 patient years have been reported. It is concluded that maintenance treatment of mood disorders reduces the suicide rate in this vulnerable group of patients.

Cohort Studies↗