Treatment-resistant schizophrenia during life span : Epidemiology, outcomes and innovative M-Health treatments within M-RESIST Project

2016 ◽  
Vol 33 (S1) ◽  
pp. S35-S35
Author(s):  
K. Rubinstein
Keyword(s):  
Psychotic Disorders ◽  
Clinical Importance ◽  
Treatment Resistance ◽  
The European Union ◽  
Treatment Resistant ◽  
Time Data ◽  
Information And Communication ◽  
Competing Interest ◽  
Definition Of ◽  
Psychosocial Approaches

Treatment-resistant symptoms of schizophrenia (TRS) complicate the clinical course of the illness, and a large proportion of patients do not reach functional recovery (Englisch and Zink, 2012). Out of the estimated 5 million people (0.2–2.6 %) suffering from psychotic disorders in the European Union, 30-50 % can be considered resistant to treatment, and 10–20 % ultra-resistant (Essock et al., 1996 ; Juarez-Reyes et al., 1995). The complexity of standard intervention within this population, along with the presence of persistent positive symptomatology, extensive periods of hospital care and greater risk of multi-morbidity, lead to a high degrees of suffering for the patients, family and social environment, and a high proportion of costs to the healthcare system (Kennedy et al., 2014).At present, a uniform definition of treatment resistance in the pharmacotherapy of schizophrenia is not available (Suzuki et al., 2011), as well as generally recommendable evidence-based treatment methods (Dold and Leucht, 2014).A recent systematic review on the topic showed that TRS is poorly a studied and understood condition, contrasted to its high prevalence, clinical importance and poor prognosis. There is lack of studies on epidemiology and risk factors of this disorder, as well as on outcomes and longitudinal course. Most of the available literature focuses on medication treatments, while very few examine efficacy of adjunctive therapeutic options (Seppala et al., in preparation).Treatments based on information and communication technology (ICT) present novel possibilities to improve the outcomes of schizophrenia. Previous studies have indicated suitability and promising results of such intervention techniques (Granholm et al., 2012 ; Ben-Zeev et al., 2013). m-RESIST is an innovative project aimed to empower patients with resistant schizophrenia, to personalize treatment by integrating pharmacological and psychosocial approaches, and to further develop knowledge related to the illness using predictive models designed to exploit historical and real-time data based on environmental factors and treatment outcomes.Disclosure of interestThe author has not supplied his declaration of competing interest.

Autism-plus spectrum disorders: Interfaces with psychosis

2016 ◽  
Vol 33 (S1) ◽  
pp. S356-S356
Author(s):  
I. Peixoto ◽  
R. Velasco Rodrigues ◽  
C. Marques
Keyword(s):  
Autism Spectrum Disorder ◽  
Differential Diagnosis ◽  
Clinical Case ◽  
Psychotic Disorders ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Case Vignette ◽  
The Face ◽  
Competing Interest ◽  
Definition Of

IntroductionDespite categorical differentiation, autistic and psychotic disorders are historically related diagnostic entities and there is still much controversy regarding their limits and developmental course. Particularly in children, the presence of idiosyncratic fears, difficulties in the social sphere and thought disorder are important factors in the differential diagnosis. There are some research-derived clinical constructs that operationalize symptomatology aiming to highlight the interfaces and the overlap between such disorders. Their clinical implications can be extremely relevant in the face of the limits of current nosology.ObjetivesTo phenomenologically describe differentiating parameters and high-risk clinical profiles for the development of psychosis in children with autism spectrum disorder.MethodsSelective review of the literature in PubMed (MEDLINE). Illustration with a clinical case vignette.ResultsThe clinical case reflects well the difficulties posed in the differential diagnosis due to the multiple interfaces between autism and psychosis. Constructs such as “multiple complex developmental disorder” or “multidimensionally impaired syndrome” allow a clearer and more practice-friendly characterization of such individuals.ConclusionThe constelation of symptoms identified in these criteria may become useful through the definition of subgroups of autism spectrum disorder individuals with complex psychopathology. Studies in this regard are still scarce, but the validation and reproduction of the positive results observed in the near future can help optimize the clinical approaches in these children.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Identifying Service and Care Needs from the Users’ Perspective in Treatment-Resistant Schizophrenia

2017 ◽  
Vol 41 (S1) ◽  
pp. S68-S68
Author(s):  
K. Rubinstein
Keyword(s):  
Psychosocial Functioning ◽  
Treatment Resistant ◽  
Time Data ◽  
General Will ◽  
Care Needs ◽  
Individual Interviews ◽  
Advantages And Disadvantages ◽  
Technological Developments ◽  
Competing Interest ◽  
Informal Carers

Exploring service and care needs of patients with treatment-resistant schizophrenia is necessary for a better understanding of their psychosocial functioning, in order to develop rehabilitation goals as well as to provide them with better care.m-RESIST is an innovative project aimed to empower patients with resistant schizophrenia, to personalize treatment by integrating pharmacological and psycho-social approaches, and to develop knowledge related to the illness using predictive models designed to exploit historical and real-time data, based on environmental factors and treatment outcomes.m-RESIST is a system based on computer and cellular applications and wearable computing devices. The system will serve patients, caregivers and clinicians, and include the following functions: Information, Assessment, Monitoring, Communication, and Intervention.The first step in the development process included definition of the end user needs and preferences, in order to involve users in the design of the system. Outpatients with treatment-resistant schizophrenia, informal carers (relatives), and clinicians were included in the sample. There were a total of 9 focus groups, 3 in each pilot country. Each group was composed of one of the participant profiles. Additionally, 35 individual interviews were performed, which were unevenly distributed throughout the 3 institutions.The current workshop section will present the outcomes of this process: perceived advantages and disadvantages of the technological solution, as well as conclusions for further development. In addition, methodological issues, future challenges, relevant for the evolution of the m-RESIST project, in particular, as well as technological developments in the field of mental health, in general, will be discussed.1Disclosure of interestThe author has not supplied his declaration of competing interest.

Prescription profile of antipsychotics in inpatients with psychotic disorders

2016 ◽  
Vol 33 (S1) ◽  
pp. S612-S612
Author(s):  
M.D.C. García Mahía ◽  
Á. Fernández Quintana ◽  
M. Vidal Millares
Keyword(s):  
Psychotic Disorders ◽  
Treatment Resistance ◽  
Psychiatric Inpatients ◽  
Total Sample ◽  
Response To Treatment ◽  
Typical Antipsychotic ◽  
Concurrent Use ◽  
Significant Difference ◽  
Schizophrenic Patients ◽  
Competing Interest

IntroductionPrevious studies of prescribing in psychiatric services have identified the relatively frequent use of combined antipsychotics in schizophrenia.Aims– To analyze the proportion of patients treated with more than one antipsychotic;– to study clinical as sociodemographic variables associated with types of prescription.MethodsRetrospective descriptive study of treatment prescribed to psychiatric inpatients treated in an acute care unit of Psychiatry Service in a large teaching hospital during a period of 3 years. Consecutively admitted inpatients receiving concurrent antipsychotics were compared with those treated with a single antipsychotic. Prescription drug records at discharging were revised, n = 263.ResultsFrom the total sample, 61% received more than one antipsychotic. The most common types of combinations were atypical plus a typical antipsychotic followed by two atypical antipsychotics, being less frequent combination of three or more antipsychotics. There were 19 different drug combinations. Concurrent antipsychotics were most frequently prescribed in schizophrenia and schizoaffective disorder. Patients with more previous episodes of illness received more frequently concurrent antipsychotics than patients with low number of previous episodes of illness (P < 0.03). Patients with longer time of hospitalization, and age between 30 and 50 years were treated more frequently with several antipsychotics. Analysis with other variables is presented in the study.ConclusionsThere is a significant difference in the strategies of treatment with antipsychotics depending on diagnosis and number of previous episodes of illness. The concurrent use of multiple antipsychotics in psychiatric inpatients appears to be a response to treatment resistance and is frequent in schizophrenic patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The CINP Guidelines on the Definition and Evidence-Based Interventions for Treatment-Resistant Bipolar Disorder

2019 ◽  
Vol 23 (4) ◽  
pp. 230-256 ◽  
Author(s):  
Konstantinos N Fountoulakis ◽  
Lakshmi N Yatham ◽  
Heinz Grunze ◽  
Eduard Vieta ◽  
Allan H Young ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Treatment Options ◽  
Treatment Resistance ◽  
Maintenance Phase ◽  
Evidence Based ◽  
Treatment Resistant ◽  
Evidence Based Treatment ◽  
Significant Disability ◽  
Definition Of

Abstract Background Resistant bipolar disorder is a major mental health problem related to significant disability and overall cost. The aim of the current study was to perform a systematic review of the literature concerning (1) the definition of treatment resistance in bipolar disorder, (2) its clinical and (3) neurobiological correlates, and (4) the evidence-based treatment options for treatment-resistant bipolar disorder and for eventually developing guidelines for the treatment of this condition Materials and Methods The PRISMA method was used to identify all published papers relevant to the definition of treatment resistance in bipolar disorder and the associated evidence-based treatment options. The MEDLINE was searched to April 22, 2018. Results Criteria were developed for the identification of resistance in bipolar disorder concerning all phases. The search of the literature identified all published studies concerning treatment options. The data were classified according to strength, and separate guidelines regarding resistant acute mania, acute bipolar depression, and the maintenance phase were developed. Discussion The definition of resistance in bipolar disorder is by itself difficult due to the complexity of the clinical picture, course, and treatment options. The current guidelines are the first, to our knowledge, developed specifically for the treatment of resistant bipolar disorder patients, and they also include an operationalized definition of treatment resistance. They were based on a thorough and deep search of the literature and utilize as much as possible an evidence-based approach.

scholarly journals Prevalence of treatment resistance and clozapine use in early intervention services

BJPsych Open ◽  
2020 ◽  
Vol 6 (5) ◽  
Author(s):  
Imogen Stokes ◽  
Siân Lowri Griffiths ◽  
Rowena Jones ◽  
Linda Everard ◽  
Peter B. Jones ◽  
...  
Keyword(s):  
Early Intervention ◽  
Treatment Resistance ◽  
Prescribing Patterns ◽  
Positive Symptoms ◽  
Treatment Resistant ◽  
Medication History ◽  
Early Intervention Services ◽  
Intervention Services ◽  
Definition Of ◽  
Early Intervention In Psychosis

Background Treatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics. Aims This paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services. Method Data were taken from the National Evaluation of the Development and Impact of Early Intervention Services study (N = 1027) and included demographics, medication history and psychosis symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, 6 months and 12 months. Prescribing patterns and pathways to clozapine were examined. We adopted a strict criterion for treatment resistance, defined as persistent elevated positive symptoms (a PANSS positive score ≥16, equating to at least two items of at least moderate severity), across three time points. Results A total of 143 (18.1%) participants met the definition of treatment resistance of having continuous positive symptoms over 12 months, despite treatment in EIP services. Sixty-one (7.7%) participants were treatment resistant and eligible for clozapine, having had two trials of standard antipsychotics; however, only 25 (2.4%) were prescribed clozapine over the 12-month study period. Treatment-resistant participants were more likely to be prescribed additional antipsychotic medication and polypharmacy, instead of clozapine. Conclusions Prevalent treatment resistance was observed in UK EIP services, but prescription of polypharmacy was much more common than clozapine. Significant delays in the commencement of clozapine may reflect a missed opportunity to promote recovery in this critical period.

Eosinophilia associated with clozapine – A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S750-S751 ◽  
Author(s):  
T. Abreu ◽  
A. Carvalho ◽  
O. Von Doellinger
Keyword(s):  
Skin Rash ◽  
Clinical Case ◽  
Psychotic Disorders ◽  
Spontaneous Resolution ◽  
Close Monitoring ◽  
Anti Psychotic ◽  
Treatment Resistant ◽  
Hematologic Disorders ◽  
Medicine Service ◽  
Competing Interest

ObjectivesClozapine is an atypical anti-psychotic used in the treatment of schizophrenia and other psychotic disorders. It is associated with several side effects, namely, hematologic disorders, the more common being agranulocytosis. Some cases of eosinophilia have been described. This work describes a case of transient eosinophilia caused by clozapine.MethodsDescription of a clinical case.ResultsA 22-year-old female patient, with a treatment resistant psychotic disorder initiated clozapine in a slow titration to 300 mg. Ten days after initiating clozapine, the patient presented with eosinophilia (started with 6.6 × 108/L and peaked at 10.0 × 108/L). Two weeks later, the patient presented with a skin rash in the arms and legs. The case was discussed with internal medicine service and other causes of eosinophilia were excluded. Since the eosinophilia was mild, the rash was not severe and the patient did not present any other symptoms or signs, it was not considered necessary to stop clozapine. During the next three months, with close monitoring, the eosinophilia and the skin rash slowly resolved.ConclusionsThis is a case of a patient who presented mild eosinophilia and skin rash, associated to clozapine, with spontaneous resolution. We draw attention to the need of close monitorization and exclusion of other causes of eosiniphilia and rash. Furthermore, other hematologic disorders should be considered besides agranulocytosis, namely eosinophilia, when prescribing clozapine.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Current perspectives in the management of treatment-resistant depression

2004 ◽  
Vol 6 (1) ◽  
pp. 53-60
Keyword(s):  
Depressive Disorders ◽  
Antidepressant Treatment ◽  
Behavioral Therapy ◽  
Treatment Resistance ◽  
Care Utilization ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Combination Strategies ◽  
Resistant Depression ◽  
Definition Of

Depressive disorders are a leading cause of disability worldwide and greatly impact morbidity, health care utilization, and medical costs. Major depression that does not resolve with adequate antidepressant treatment is termed treatment-resistant depression (TRD), There is no universally accepted definition of TRD and several criteria have been suggested to define it. Multiple factors can contribute to treatment resistance, including unrecognized comorbid medical or psychiatric illness, the use of concomitant medications, noncompliance, and psychosocial stressors. TRD is associated with extensive use of depression-related and general medical services, and poses a substantial economic burden. Current approaches to its management include the use of antidepressant strategies, such as increasing the dose of the antidepressant, augmentation strategies, combination strategies, and switching strategies, electroconvulsive therapy, and cognitive behavioral therapy. Although no definite algorithm exists for treating TRD, research in this area has advanced considerably in recent years. One approach to this is a clinical trial called STAR*D (Sequenced Treatment Alternatives to Relieve Depression). This has the potential to increase our understanding about the diagnostic and therapeutic aspects of TRD, to substantially reduce disability, and to enhance the quality of life in individuals with this condition.

scholarly journals CYBERTERRORISM: AN ATTEMPT OF PHILOSOPHICAL AND LEGAL UNDERSTANDING

2021 ◽  
Vol 2 (49) ◽  
Author(s):  
Volodymyr Trofymenko ◽  
Anastasiia Mishanchuk
Keyword(s):  
Information And Communication Technologies ◽  
Digital Literacy ◽  
Rapid Development ◽  
General Term ◽  
Modern World ◽  
Main Body ◽  
The European Union ◽  
Information And Communication ◽  
True Knowledge ◽  
Definition Of

Problem setting. Ukraine continues its integration processes with the international community, in particular, with the European Union and NATO. But comprehensive integration leads to the fact that Ukraine is forced to integrate into the negative processes from which the modern world suffers and with which it tries to fight. With the rapid development of the Internet, its use with criminal intent is probably developing at the same rate. Novelty, level of danger, volumes of received and future possible losses of this type of crime contributed to the formation of such a dangerous phenomenon as cyberterrorism. Accordingly, there is a new task  for world scientists – to understand the essence of the concept of cyberterrorism most accurately and generally, to explore its deep aspects, to develop a single conceptual apparatus and to propose a system of preventive measures. Recent research and publications analysis. The topic of information terrorism within the Ukrainian cyberspace, as well as its inseparable interaction with the world wide web, theoretical aspects of this phenomenon, disclosure of concepts related to cybercrime are covered in the publications of such domestic researchers as S. Hnatyuk, О. Gerashchenko, V. Ostroukhov, M. Prysyazhnyuk, I. Diorditsa, O. Trofimenko, Yu. Prokop, I. Aristova, V. Tsymbalyuka, O. Zadereiko, O. Bogdanov, O. Drozhchan, M. Gutsalyuk and others. A number of well-known foreign scientists and philosophers have devoted their works to the study of the phenomenon of terrorism in the context of globalization and the rapid development of information and communication technologies, in particular E. Toffler, B. Hoffman, A. Schmid, D. Bell, J. Baudrillard, E. Giddens, F. Fukuyama and others. Paper objective. This article aims to formulate a generalized definition of "cyberterrorism", its key elements, sources, features of implementation, specificity and classification through the method of deduction (derivation of true knowledge from the general term "terrorism" to specific - "cyberterrorism"). Paper main body. The opinion of domestic and foreign scientists on the concept of cyberterrorism is analyzed. Based on the considered opinions, the authors try to show the peculiarities of cyberterrorism and reveal its danger to society as a whole and individuals. Finally, the authors turn to the analysis of Ukrainian legislation on cyberterrorism. Conclusions of the research. Taking into account all the mentioned above, the state should introduce appropriate training systems for integrated skills and abilities that are necessary to support the goals of cybersecurity in secondary and higher schools, conduct cybersecurity briefings, increase digital literacy and the culture of safe behavior in cyberspace, as well as timely report about new threats and ways to avoid them.

Atypical psychosis – historical and current perspective

2016 ◽  
Vol 33 (S1) ◽  
pp. S362-S362
Author(s):  
M.A. Aleixo ◽  
C.A. Moreira ◽  
G. Sobreira ◽  
J. Oliveira ◽  
L. Carvalhão Gil
Keyword(s):  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Case Identification ◽  
Current Perspective ◽  
Pubmed Database ◽  
Brief Psychotic Disorder ◽  
Icd 10 ◽  
History Of ◽  
Competing Interest ◽  
Definition Of

IntroductionClinical concepts regarding atypical psychosis such as the French bouffeé délirante, the German cycloid psychosis, and the Scandinavian reactive and schizophreniform psychoses are now under the category of F23 ‘Acute and transient psychotic disorders’ (ATPD) of the tenth revision of the International Classification of Mental and Behavioural Disorders (ICD-10).AimsThe authors’ aim is to highlight the clinical and scientific relevance of atypical psychosis from the historical concepts to the current perspective.MethodsA Pubmed database search using as keywords “atypical psychosis”, “acute and transient psychotic disorders”, and “brief psychotic disorder” and retrieved papers were selected according to their relevance.ResultsDifferent psychiatric schools, often of a regional or national character, have provided concepts for transient psychotic states. The acute and transient psychotic disorders of ICD-10 and the brief psychotic disorder of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reflect the diversity of the history of such concepts. The available evidence suggests that case identification and follow-up is difficult in ATPD due to the heterogeneous and infrequent nature of this clinical phenomenon. Furthermore ATPD has a low diagnostic stability and there are few studies focused on brief psychotic disorders.ConclusionsThe present definition of acute and transient psychotic disorders and brief psychotic disorder, while taking into account the history of the concepts involved, leave many questions open to further studies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

E-health developments in the system of health services in Hungary and the European Union

2014 ◽  
Vol 155 (21) ◽  
pp. 822-827
Author(s):  
Ágnes Váradi
Keyword(s):  
Health Care ◽  
European Union ◽  
Public Discourse ◽  
Action Plan ◽  
Fundamental Rights ◽  
Public Health Care ◽  
The European Union ◽  
Contemporary Issue ◽  
Definition Of ◽  
Basic Features

The question of electronic solutions in public health care has become a contemporary issue at the European Union level since the action plan of the Commission on the e-health developments of the period between 2012 and 2020 has been published. In Hungary this issue has been placed into the centre of attention after a draft on modifications of regulations in health-care has been released for public discourse, which – if accepted – would lay down the basics of an electronic heath-service system. The aim of this paper is to review the basic features of e-health solutions in Hungary and the European Union with the help of the most important pieces of legislation, documents of the European Union institutions and sources from secondary literature. When examining the definition of the basic goals and instruments of the development, differences between the European Union and national approaches can be detected. Examination of recent developmental programs and existing models seem to reveal difficulties in creating interoperability and financing such projects. Finally, the review is completed by the aspects of jurisdiction and fundamental rights. It is concluded that these issues are mandatory to delineate the legislative, economic and technological framework for the development of the e-health systems. Orv. Hetil., 2014, 155(21), 822–827.

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