Long-Term Treatment of Patients with Recurrent Unipolar Major Depression: Evidence to Clinical Practice

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S15) ◽  
pp. 4-5 ◽  
Author(s):  
Martin B. Keller
Keyword(s):  
Treatment Strategies ◽  
Patient Characteristics ◽  
Evidence Base ◽  
Term Treatment ◽  
Recurrent Depression ◽  
Long Term Treatment ◽  
Risk Factors For Recurrence ◽  
The Individual ◽  
Term Management

Major depressive disorder (MDD) is almost exclusively recurrent. The vast majority of patients who experience one episode of MDD will eventually experience at least one more episode during their lifetime. The recurrent nature of MDD increases the burden to both the individual and society. Hence, it is imperative that treatment strategies focus on achieving remission acutely, as well as maintaining of remission and preventing recurrence. The articles in this supplement are based on presentations and a dialogue among a group of experts who convened for a roundtable discussion on improving long-term outcomes with antidepressant therapy.Improving long-term treatment of MDD begins with understanding the clinical course of recurrent depression and the ability to recognize those patients who are at greatest risk for recurrence. James H. Kocsis, MD, reviews the course of recurrent depression, emphasizing the tendency for it to progressively worsen. He also discusses patient characteristics and other risk factors for recurrence as well as current recommendations for long-term management of recurrent depression.Although long-term antidepressant maintenance treatment studies are somewhat limited in number, they provide the evidence base that shapes existing guidelines for long-term management of recurrent depression. Michael E. Thase, MD, examines this evidence for the different classes of antidepressants. In addition, Thase reviews evidence for the efficacy of psychotherapy and discusses its potentially important role in long-term depression management.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Atypical femoral fractures: risks and benefits of long-term treatment of osteoporosis with anti-resorptive therapy

2018 ◽  
Vol 178 (3) ◽  
pp. R81-R87 ◽  
Author(s):  
Robert A Adler
Keyword(s):  
Osteoporotic Fracture ◽  
Femoral Fractures ◽  
Osteoporosis Treatment ◽  
Term Treatment ◽  
Atypical Femoral Fractures ◽  
Treatment Of Osteoporosis ◽  
Endocrine Disease ◽  
Long Term Treatment ◽  
Term Management

Modern osteoporosis treatment began in the mid-1990s with the approval of amino-bisphosphonates, anti-resorptive agents that have been shown to decrease osteoporotic fracture risk by about half. In 2005, the first cases of atypical femoral fractures (AFF), occurring in the shaft of the femur, were reported. Since then, more cases have been found, leading to great concern among patients and a dramatic decrease in bisphosphonate prescribing. The pathogenesis and incidence of AFF are reviewed herein. Management and an approach to prevention or early detection of AFF are also provided. Denosumab, a more recently approved anti-resorptive medication has also been associated with AFF. Long-term management of osteoporosis and prevention of fracture are challenging in light of this serious but uncommon side effect, yet with an aging population osteoporotic fracture is destined to increase in frequency.

scholarly journals Behaviour of Factors II, VII, IX and X in Bleeding Complications During Long-Term Treatment with Coumarin

1963 ◽  
Vol 10 (02) ◽  
pp. 278-281 ◽  
Author(s):  
E. A Loeliger ◽  
A Hensen ◽  
Mieke J. Mattern ◽  
H. C Hemker
Keyword(s):  
Term Treatment ◽  
Bleeding Complications ◽  
Factor Activity ◽  
Normal Individuals ◽  
Individual Variations ◽  
Long Term Treatment ◽  
Average Factor ◽  
Average Activity ◽  
The Individual

SummaryIn 20 patients suffering from bleeding complications during long-term treatment with phenprocoumon, the depression of the activity of Factors II, VII, IX and X, on the average, was found to be stronger than in so-called adequately treated patients, whereas no statistically significant differences could be demonstrated between the average activity of the 4 factors. The individual variations between the 4 factors were higher than those found in normal individuals and adequately treated patients.Thrombotest activity appeared to be considerably lower than the average factor activity. This discrepancy is mainly caused by the action of the recently discovered circulating anticoagulant occurring in coumarin-treated or vitamin K-deficient patients.

Patient Characteristics Associated With the Need for Long-Term Treatment in a Child Psychiatry Hospital After the Earthquake in Mexico City

2020 ◽  
pp. 1-3
Author(s):  
Rosa-Elena Ulloa ◽  
Emmanuel Sarmiento
Keyword(s):  
Mexico City ◽  
Child Psychiatry ◽  
Clinical Characteristics ◽  
Patient Characteristics ◽  
Term Treatment ◽  
Health Programs ◽  
Baseline Assessment ◽  
Long Term Treatment ◽  
Mental Health Programs

ABSTRACT Objective: The aim of this study is to determine the demographic and clinical characteristics associated with the need for long-term treatment in a child psychiatry facility. Method: Demographic characteristics, diagnosis, source of referral, time elapsed between the earthquake and the request for care, and the treatment prescribed in the baseline assessment were compared between a group of subjects that required long-term treatment (LTT) and a group that was discharged after a brief intervention (D). Results: A total of 171 patients were seen, and 27% of the subjects required LTT. In general, these subjects were younger, referred from highly affected areas, presented a delay in seeking care, and were mainly diagnosed with anxiety and stress-related disorders. Conclusions: These findings suggest the need for research regarding the design of mental health programs for the early detection of psychopathology after natural disasters in children and adolescents.

Long-Term Management of Generalized Pustular Psoriasis with Infliximab: Case Series

2008 ◽  
Vol 12 (4) ◽  
pp. 184-188 ◽  
Author(s):  
Shannon B. Routhouska ◽  
Pranav B. Sheth ◽  
Neil J. Korman
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Term Treatment ◽  
Pustular Psoriasis ◽  
Short Term Treatment ◽  
Long Term Treatment ◽  
Generalized Pustular Psoriasis ◽  
Factor Α ◽  
Term Management

Background: Infliximab, a tumor necrosis factor α antagonist, has recently been shown to be successful for the short-term treatment of generalized pustular psoriasis (GPP) in multiple case reports. Objective: The goal of this case series was to assess the efficacy of the longer-term management of GPP with infliximab. Methods: Three patients with severe GPP were followed to assess the efficacy of long-term treatment with infliximab. Results: Infliximab therapy was more efficacious with infusion every 6 to 8 weeks in combination with methotrexate. Conclusion: Infliximab may be efficacious for some patients for the long-term management of GPP. Maintaining a strict infliximab infusion schedule and concomitant methotrexate therapy may decrease infusion reactions and increase efficacy.

scholarly journals Post-stroke Rehabilitation of Severe Upper Limb Paresis in Germany – Toward Long-Term Treatment With Brain-Computer Interfaces

2021 ◽  
Vol 12 ◽  
Author(s):  
Cornelius Angerhöfer ◽  
Annalisa Colucci ◽  
Mareike Vermehren ◽  
Volker Hömberg ◽  
Surjo R. Soekadar
Keyword(s):  
Upper Limb ◽  
Hand Function ◽  
Treatment Strategies ◽  
Term Treatment ◽  
Brain Computer Interfaces ◽  
Stroke Patients ◽  
Computer Interfaces ◽  
Long Term Treatment ◽  
Upper Limb Paresis

Severe upper limb paresis can represent an immense burden for stroke survivors. Given the rising prevalence of stroke, restoration of severe upper limb motor impairment remains a major challenge for rehabilitation medicine because effective treatment strategies are lacking. Commonly applied interventions in Germany, such as mirror therapy and impairment-oriented training, are limited in efficacy, demanding for new strategies to be found. By translating brain signals into control commands of external devices, brain-computer interfaces (BCIs) and brain-machine interfaces (BMIs) represent promising, neurotechnology-based alternatives for stroke patients with highly restricted arm and hand function. In this mini-review, we outline perspectives on how BCI-based therapy can be integrated into the different stages of neurorehabilitation in Germany to meet a long-term treatment approach: We found that it is most appropriate to start therapy with BCI-based neurofeedback immediately after early rehabilitation. BCI-driven functional electrical stimulation (FES) and BMI robotic therapy are well suited for subsequent post hospital curative treatment in the subacute stage. BCI-based hand exoskeleton training can be continued within outpatient occupational therapy to further improve hand function and address motivational issues in chronic stroke patients. Once the rehabilitation potential is exhausted, BCI technology can be used to drive assistive devices to compensate for impaired function. However, there are several challenges yet to overcome before such long-term treatment strategies can be implemented within broad clinical application: 1. developing reliable BCI systems with better usability; 2. conducting more research to improve BCI training paradigms and 3. establishing reliable methods to identify suitable patients.

scholarly journals Acute and long-term treatment of mania

2008 ◽  
Vol 10 (2) ◽  
pp. 165-179 ◽  
Keyword(s):  
Correct Diagnosis ◽  
Evidence Base ◽  
Term Treatment ◽  
Acute Mania ◽  
Compulsory Admission ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Treatment ◽  
Treatment Refractory

The treatment of mania starts with a correct diagnosis and elementary measures to prevent risks for the patient, relatives, and others. Sometimes, compulsory admission and treatment may be required for a few days. Patients with psychotic or mixed mania may be more difficult to treat. At the present time, there is solid evidence supporting the use of lithium, the anticonvulsants valproate and carbamazepine, and the antipsychotics chlorpromazine, haloperidol, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and asenapine in acute mania, and some evidence supporting the use of clozapine or electroconvulsive therapy in treatment-refractory cases. However, in clinical practice, combination therapy is the rule rather than the exception. The treatment of acute mania deserves a long-term view, and the evidence base for some treatments may be stronger than for others. When taking decisions about treatment, tolerability should also be a major concern, as differences in safety and tolerability may exceed differences in efficacy for most compounds. Psychoeducation of patients and caregivers is a powerful tool that should be used in combination with medication for optimal long-term outcome. Functional recovery should be the ultimate goal.

Long-Term Treatment of Depression

1994 ◽  
Vol 165 (S26) ◽  
pp. 31-36 ◽  
Author(s):  
Stuart A. Montgomery
Keyword(s):  
Acute Treatment ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Term Treatment ◽  
Recurrent Depression ◽  
Recurrence Prevention ◽  
Treatment Of Depression ◽  
Long Term Treatment ◽  
Effective Doses ◽  
Therapeutic Doses

Long-term treatment of depression encompasses two separate phases: relapse and recurrence prevention. Relapse prevention aims to consolidate the response to acute treatment. Some tricyclic antidepressants (TCAs) have been shown to be effective, possibly in lower than standard acute treatment doses. The selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective at the same minimum effective doses used to treat acute depression, or in a lower dose as with citalopram. Recurrence prevention aims to reduce the risk of onset of a new episode of depression in patients with recurrent depression. Imipramine has been thoroughly studied in unipolar depressed patients in full therapeutic doses for up to five years and is clearly effective. Other TCAs have not been adequately tested and may not all be equally effective. The SSRIs fluoxetine, paroxetine and sertraline have also been shown to be effective in reducing the risk of new episodes of depression.

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