China
Africa
Explore chapters and articles related to this topic
Clinical indications for ECT: adults
Published in Alan Weiss, The Electroconvulsive Therapy Workbook, 2018
The Texas Medication Algorithm Project was a statewide quality assurance programme that developed and prospectively evaluated consensus-based medication algorithms for the treatment of individuals with severe and persistent mental illness with the aim of providing appropriate treatment recommendations to improve clinical outcomes (Crismon et al., 1999). The work is now extensive with algorithms covering major depressive disorder (Crismon et al., 1999), schizophrenia (Moore et al., 2007), bipolar disorder (Suppes et al., 2001), mania (Suppes et al., 2003) and mental illness in children (Pliszka et al., 2000). ECT is recommended as Stage 4 treatment of major depressive disorder if there has not been a response to medication trials and Stage 3 treatment for major depressive disorder with psychosis (Suehs, Bendele, Crismon, Madhukar, Trivedi and Kurian, 2008).
Long-acting antipsychotics in the treatment of schizophrenia: opportunities and challenges
Published in Expert Opinion on Pharmacotherapy, 2023
Peter M. Haddad, Christoph U. Correll
A systematic review of 17 schizophrenia clinical practice guidelines (CPGs) showed marked variation in recommendations on how long antipsychotic treatment should be continued after a first psychotic episode and during maintenance treatment [6]. Just over half (9 out of 17) provided a specific recommendation on the duration of antipsychotic treatment following successful treatment of the first psychotic episode [6]. Recommendations ranged from 9 to 12 months in the New Jersey Division of Mental Health Services (NJDMHS) guidelines [17] to indefinitely in the Texas Medication Algorithm Project [18] guidelines. Altogether 6 of the 17 CPGs specified a duration of maintenance treatment ranging from 2 to 6 years, another 10 recommended the duration was individualized to the patient and 1 guideline made no mention of maintenance treatment [6]. This variation reflects the lack of a clear boundary between acute and maintenance treatment and the limited evidence regarding the duration of maintenance treatment, given that most placebo-controlled RCTs are 1 year long. However, observational studies show that discontinuing antipsychotics at any point, including 5 or more years after the first episode of schizophrenia, is associated with an increased risk of relapse over antipsychotic continuation [19]. A recent meta-analysis supported the use of at least the minimum antipsychotic dose licensed for acute treatment during the maintenance phase, as reducing the dose below this threshold significantly increased the risk of relapse [20].
A clinical approach to treatment resistance in depressed patients: What to do when the usual treatments don’t work well enough?
Published in The World Journal of Biological Psychiatry, 2021
Seetal Dodd, Michael Bauer, Andre F. Carvalho, Harris Eyre, Maurizio Fava, Siegfried Kasper, Sidney H. Kennedy, Jon-Paul Khoo, Carlos Lopez Jaramillo, Gin S. Malhi, Roger S. McIntyre, Philip B. Mitchell, Angela Marianne Paredes Castro, Aswin Ratheesh, Emanuel Severus, Trisha Suppes, Madhukar H. Trivedi, Michael E. Thase, Lakshmi N. Yatham, Allan H. Young, Michael Berk
There are several current treatment guidelines for depression, including the WFSBP guidelines (Bauer et al. 2002a, 2002b; Bauer 2007; Bauer et al. 2007, 2013, 2015, 2017), Texas Medication Algorithm Project (TMAP) (Suehs et al. 2008), CANMAT guidelines (Kennedy et al. 2009; Lam, Kennedy, et al. 2009; Kennedy et al. 2016; Lam, Kennedy, et al. 2016; Lam, McIntosh, et al. 2016; MacQueen et al. 2016; Milev et al. 2016; Parikh et al. 2016; Ravindran et al. 2016), RANZCP (Ellis 2004; Malhi et al. 2015) and NICE guidelines (NICE Guidance 2018). Complex depression, comorbidities and other factors that contribute to depression are often covered in these guidelines. These treatment guidelines provide a wealth of expert information, are evidence based and are broad in their scope. It is not the intention of this current work to expand on these guidelines or suggest any modifications. When treatment resistance is encountered, the key to reversing resistance lies in factors associated with depression in an individual patient. A structured approach to identifying factors underlying the non-response to treatment has been described elsewhere (Ellison and Harney 2000). Once identified, these factors can be addressed in tandem with existing evidence-based guidelines.
Predictors of poor 6-week outcome in a cohort of major depressive disorder patients treated with antidepressant medication: the role of entrapment
Published in Nordic Journal of Psychiatry, 2021
Serafim Carvalho, Filipa Caetano, José Pinto-Gouveia, Jorge Mota-Pereira, Dulce Maia, Paulo Pimentel, Cátia Priscila, Paul Gilbert
At the eligibility consultation, the patients were evaluated by a trained psychologist using four instruments: the Structured Clinical Interview for DSM-IV, Clinical Version (SCID-CV), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID- II), the Child Experience of Care and Abuse Questionnaire (CECA.Q) and the Life Events and Difficulties Schedule (LEDS). At this appointment, the severity of the depressive symptoms was assessed with the Beck Depression Inventory (BDI). Patients with BDI ≥ 20 were referred to the first treatment session (EV1) [36]. At EV1, researchers filled out the study form with the following information: socio-demographic data, current episode duration, detailed medical comorbidities, medication use, history of treatment discontinuation and parental history of mental disorders. The BDI, Entrapment Scale (ES), Defeat Scale (DS), Social Comparison Scale (SCS), Submissive Behavior Scale (SBS) and Other as Shamer Scale (OAS) were applied. At this point, pharmacological treatment was chosen according to the MDD treatment algorithm of the Texas Medication Algorithm Project (TMAP) [37–39].