Posted by Ron Hill on August 25, 2009, at 7:02:04
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Special Report August 2009
Treatment Resistance Special Report August 2009Despite advances in the understanding of neurobiology and psychopharmacology, treatment resistance continues to be a problem across all age groups and diagnoses. In depression alone, it has been estimated that only 50% to 75% of patients respond successfully to treatment; that leaves a considerably large portion of the population untreated. To make matters worse, experts agree that a better, more standardized definition of treatment resistance is needed, as some current definitions fail to take into account those patients who only minimally respond to treatment.
What can be done? This Special Report explores strategies to help overcome treatment resistance across several psychiatric disorders. Under the guidance of Dr Eric Plakun of the Austen Riggs Center, the authors provide valuable insights into this phenomenon and provide clinical suggestions to better help patients achieve treatment success.
Introduction: Underlying Causes and Implications
It's not good enough to better care for patients with treatment resistance, argues Special Report Chair Dr Eric Plakun, director of admissions and professional relations at the Austen Riggs Center; psychiatry should aim to best serve patients. To truly understand what constitutes treatment resistance and better respond to it, Dr Plakun suggests that the field consider more than the biological and pharmacological aspects.Chronic Eating Disorders: A Different Approach to Treatment Resistance
Anorexia nervosa (AN) is associated with a mortality rate higher than any other psychiatric disorder, and in one study, researchers found that more than 30% of patients had AN that was refractory to treatment. Dr Allan S. Kaplan, the Loretta Anne Rogers Chair in Eating Disorders at Toronto General Hospital and professor of psychiatry at the University of Toronto, and Dr Kate Strasburg, a resident in psychiatry at the University of Toronto, discuss a client-centered, assertive community-based treatment approach that has proven to be effective in bettering outcomes for these patients.Borderline Personality Disorder and Resistance to Treatment: The Primary Sources of Resistance
Patients with borderline personality disorder can experience psychological resistance to treatment, an idea originally put forth by Freud, as well biological resistance where symptoms simply do not respond to treatment. Dr Lois W. Choi-Kain, instructor in psychiatry at Harvard Medical School, and Dr John G. Gunderson, professor of psychiatry at Harvard Medical School, use clinical vignettes to explore the issues complicating treatment.Treatment-Resistant Bipolar Disorder: A Review of Psychotherapeutic Approaches
Almost half of patients with bipolar disorder experience symptom recurrence in two years despite standard care regimens, notes Dr James C-Y Chou, associate professor of psychiatry at the Mount Sinai School of Medicine in New York and attending psychiatrist at the James J. Peters VA Medical Center in the Bronx. By optimizing phase-specific, evidence-based treatments (including novel treatments and combination strategies), positive outcomes can be achieved.Psychodynamic Psychopharmacology: Addressing the Underlying Causes of Treatment Resistance
When psychiatry moved from a psychodynamic framework to a more biological approach, did it lose some of its potent tools for working with troubled patients? Dr David Mintz, director of residency training and continuing medical education at the Austen Riggs Center in Stockbridge in Mass., explores the psychodynamic aspects of psychopharmacology and provides suggestions for using those tools in the treatment of patients experiencing resistance.Strategies for Recognizing Schizophrenia and Treating to Remission
What's the difference between apparent treatment resistance and true treatment resistance in schizophrenia? How can clinicians be sure patients have received an adequate trial of pharmacological, psychological and psychosocial treatments? Dr Seong S Shim, assistant professor in the department of psychiatry at Case Western Reserve University School of Medicine, sheds light on treatment resistance in schizophrenia.Treatment-Resistant Depression: Management Strategies
According to Dr James G Barbee, the George C. Dunn, MD, professor of psychiatry and professor of neurology and pharmacology at the Louisiana State University Medical Center in New Orleans, switching and combination strategies may be key weapons in overcoming treatment resistant depression. Since there are differing levels of efficacy data and clinical trials are still needed to better support some strategies, Dr Barbee works on making sense of the many options available.Related Content
Treatment-Resistant Depression: Advances in Assessment
The μ-Opioid System and Antidepressant Response: How the Opioid System Affects Response to Psychopharmacology
Theoretical Models of Health Behavior: Understanding Treatment Adherence in Children With Attention-Deficit/Hyperactivity Disorder
Achieving Remission in Generalized Anxiety Disorder: What Are the Treatment Options?
poster:Ron Hill
thread:913969
URL: http://www.dr-bob.org/babble/20090818/msgs/913969.html