scholarly journals Introduction—Treatment Resistance: Concepts and Management in Mood and Anxiety Disorders

CNS Spectrums ◽  
2002 ◽  
Vol 9 (S14) ◽  
pp. 5-5
Author(s):  
Mark H. Rapaport
Keyword(s):  
Anxiety Disorders ◽  
Stress Disorder ◽  
Behavioral Therapy ◽  
Combined Treatment ◽  
Treatment Resistance ◽  
Rational Approach ◽  
Individual Treatment ◽  
Therapeutic Approaches ◽  
Important Data ◽  
Mood And Anxiety Disorders

This supplement to CNS Spectrums focuses on exciting emerging data on therapeutic approaches that can help the clinician with difficult-to-treat patients. Over the last decade, there have been tremendous advances in our conceptualization of difficult-to-treat patients, including diagnostic, psychotherapeutic, pharmacotherapeutic, and somatic approaches. A series of articles addressing these advances in the field are presented in this supplement.Edna B. Foa, PhD, has been a leading expert in cognitive-behavioral therapy (CBT) for anxiety disorders for many years. Foa and colleagues provide a thoughtful analysis of the particular components of CBT that may be responsible for its efficacy in anxiety disorders. This article goes beyond simple trials looking at the efficacy of CBT or combined treatment with pharmacotherapy and CBT. Foa and colleagues identify individual treatment and patient factors as well as the interaction between the two, that may influence treatment response. Treatment of posttraumatic stress disorder is used as a model for helping us understand this exciting work.Next, Waguih William IsHak, MD, presents important data about the use of practical and pragmatic treatment paradigms in patients with mood and anxiety disorders. Dr. IsHak emphasizes the importance of standardized structured approaches to facilitate understanding of the breadth of psychopathology present in the patient. The model Dr. IsHak proposes for the evaluation and conceptualization of the patient facilitates the integration of biological factors, psychological factors, and psychosocial variables. His algorithms go beyond merely a technique for assessment and present a rational approach to therapy for patients. These algorithms are limited by existing data, but the steps elaborated within the algorithm are powerful and useful for the clinician. This article serves as a useful guide for both trainees and clinicians with many years in practice.

Pharmacological Adjuncts and Evidence-Supported Treatments for Trauma

2016 ◽  
Author(s):  
Nina N. Karpova
Keyword(s):  
Anxiety Disorders ◽  
Stress Disorder ◽  
Traumatic Event ◽  
Behavioral Therapy ◽  
Combined Treatment ◽  
Treatment Strategies ◽  
Neural Circuitry ◽  
Therapeutic Interventions ◽  
Pharmacological Agents ◽  
Evidence Supported Treatments

A large proportion of humans experienced a traumatic event in their lifetime, with more than 10% developing posttraumatic stress disorder (PTSD), panic disorder, phobias, and other fear/anxiety disorders. The neural circuitry of fear responses is highly conserved in humans as well as rodents, and this allows for translational research using animal models of fear. Fear/anxiety disorders in humans are most efficiently treated by exposure-based psychotherapy (i.e., cognitive behavioral therapy; CBT), the main aspects of which are closely modeled by extinction training in Pavlovian fear conditioning and extinction paradigms in rodents. To improve the efficacy of psychotherapy, pharmacological agents potent for enhancing learning and memory consolidation processing should be developed to combine with exposure-based therapy. The purpose of these adjunctive pharmacological agents is to promote fear memory erasure and the consolidation of extinction memories, thus providing a combined treatment of increased effectiveness. This review discusses established pharmacological adjuncts to behavioral therapeutic interventions for fear/anxiety disorders. The mechanisms of action of these adjuncts, as well as the evidence for and against the pharmacological treatment strategies and their limitations are discussed.

scholarly journals Diverse mechanisms and treatment strategies to confront fatigue in multiple sclerosis: A systematic review

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 563
Author(s):  
Sumanth Khadke ◽  
tehmina siddique
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Reviews ◽  
Observational Studies ◽  
Behavioral Therapy ◽  
Combined Treatment ◽  
Cochrane Review ◽  
Treatment Strategies ◽  
Individual Treatment ◽  
Positive Effects ◽  
Positive Effect

Background: Firm conclusions about the applicability of treatment methods other than pharmacotherapy in treating fatigue in multiple sclerosis (MS) remain elusive. Our objective is to synthesize and review the epidemiological literature systematically and find an effective therapeutic plan for fatigue. The effect of individual treatment and combined treatment strategies are studied. Methods: An electronic database search included EBSCO, PubMed, SCIENCE DIRECT and Scopus from January 1, 2013, to September 30, 2018. Search terms used are “Fatigue AND Multiple sclerosis AND therapy”. The articles included in the study are open access, published in last five years, not restricted to region and language. The search included randomized controlled trials (RCTs), observational studies, and systematic reviews. Results: We included 13 systematic reviews, 10 RCTs and 7 observational studies. A Cochrane review on 3206 patients showed exercise therapy to have a positive effect on fatigue in RRMS patients. The EPOC trial showed switching interferon therapy or glatiramer to fingolimod showed improved fatigue levels. The FACETS trial showed incorporating behavioral therapy to ongoing recommended therapy is beneficial. Few observational studies demonstrated that fatigue is influenced by pain, mood problems, and depression. Conclusions: The diverse pathology of fatigue related to MS is important in understanding and quantifying the role of each causal factor. Evidence reveals a positive effect on fatigue levels of RRMS patients with regular CBT and exercise-based combination therapy. Progressive forms of the disease have the worst prognosis. Individually aerobic exercises, behavioral therapy and pharmacotherapy have positive effects. A modified amalgamation of the same is a better hope for MS patients.

scholarly journals New Psychotherapies for Mood and Anxiety Disorders

2010 ◽  
Vol 55 (4) ◽  
pp. 193-201 ◽  
Author(s):  
Shannon Wiltsey Stirman ◽  
Katherine Toder ◽  
Paul Crits-Christoph
Keyword(s):  
Anxiety Disorders ◽  
Stress Disorder ◽  
Empirical Support ◽  
Current Level ◽  
Depression And Anxiety ◽  
The Past ◽  
Efficacy Trials ◽  
Mood And Anxiety Disorders ◽  
Cognitive Behavioural ◽  
Initial Results

Objective: To discuss psychotherapies for depression and anxiety that have emerged in recent years and to evaluate their current level of empirical support. Method: An electronic and a manual literature search of psychotherapies for mood and anxiety disorders were conducted. Results: Five new therapies for mood disorders and 3 interventions for posttraumatic stress disorder with co-occurring substance abuse met criteria for inclusion in this review. Fewer psychotherapies have been developed for other anxiety disorders. Although research for some of the psychotherapies has demonstrated superiority to usual care, none have firmly established efficacy or specific benefits over other established psychotherapies. Conclusions: A plurality of the new psychotherapies introduced and established in the past 5 years have been different assimilations of previously established cognitive-behavioural, interpersonal, or psychodynamic models. While initial results are promising for some, more rigorous efficacy trials and replications are necessary before conclusions can be drawn regarding their relative benefits.

scholarly journals The German Guidelines for the treatment of anxiety disorders: first revision

2021 ◽  
Author(s):  
Borwin Bandelow ◽  
Antonia M. Werner ◽  
Ina Kopp ◽  
Sebastian Rudolf ◽  
Jörg Wiltink ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Psychological Treatment ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Individual Treatment ◽  
Level Of Evidence ◽  
Randomized Controlled Studies ◽  
Noradrenaline Reuptake ◽  
Virtual Reality Exposure

AbstractStarting in 2019, the 2014 German Guidelines for Anxiety Disorders (Bandelow et al. Eur Arch Psychiatry Clin Neurosci 265:363–373, 2015) have been revised by a consensus group consisting of 35 experts representing the 29 leading German specialist societies and patient self-help organizations. While the first version of the guideline was based on 403 randomized controlled studies (RCTs), 92 additional RCTs have been included in this revision. According to the consensus committee, anxiety disorders should be treated with psychotherapy, pharmacological drugs, or their combination. Cognitive behavioral therapy (CBT) was regarded as the psychological treatment with the highest level of evidence. Psychodynamic therapy (PDT) was recommended when CBT was not effective or unavailable or when PDT was preferred by the patient informed about more effective alternatives. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are recommended as first-line drugs for anxiety disorders. Medications should be continued for 6–12 months after remission. When either medications or psychotherapy were not effective, treatment should be switched to the other approach or to their combination. For patients non-responsive to standard treatments, a number of alternative strategies have been suggested. An individual treatment plan should consider efficacy, side effects, costs and the preference of the patient. Changes in the revision include recommendations regarding virtual reality exposure therapy, Internet interventions and systemic therapy. The recommendations are not only applicable for Germany but may also be helpful for developing treatment plans in all other countries.

Efficacy of Combined Pharmacotherapy and Psychotherapy Versus Monotherapy in the Treatment of Anxiety Disorders

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S12) ◽  
pp. 29-33 ◽  
Author(s):  
Donald W. Black
Keyword(s):  
Anxiety Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Randomized Clinical Trials ◽  
Behavioral Therapy ◽  
Combined Therapy ◽  
Combined Treatment ◽  
Empirical Support ◽  
The United States ◽  
Compulsive Disorder ◽  
Review Criteria

AbstractAnxiety disorders in the United States are prevalent, widespread, and disabling. These illnesses may account for almost one third of the $148 billion total mental health bill each year. Pharmacologic options include tricyclic antidepressants, monoamine oxidase inhibitors, serotonin norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, and anxiolytics. Psychological treatments include cognitive-behavioral therapy (CBT), cognitive therapy, exposure, and ritual prevention therapies. Despite insufficient evidence, many experts recommend combined treatment, generally medication with CBT. A literature review was conducted to examine studies with random assignment, adequate methods and sample sizes, blind assessments, sufficient dosages and durations of treatment, and satisfactory reporting of data, to determine whether combined treatment was superior to monotherapy. Twenty-six randomized clinical trials were identified; nine met review criteria. A review of relevant studies could not confirm the superiority of combined treatment over monotherapy. In one of four studies of obsessive-compulsive disorder, combined treatment produced better results than monotherapy.  There was no evidence of superiority for combined therapy over monotherapy for the treatment of social phobia or generalized anxiety disorder. There were no studies that met review criteria for either specific phobia or posttraumatic stress disorder (PTSD). With panic disorder, there was evidence that combined treatment might actually lead to worse outcome. Combined treatment is commonly recommended, but empirical support is limited. More research is needed. There are few well-designed studies, and little data regarding PTSD and specific phobias.

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