scholarly journals Early augmentation by using neuromodulation in psychiatric disorder: a kaleidoscopic view

CNS Spectrums ◽  
2021 ◽  
pp. 1-3
Author(s):  
Sujita Kumar Kar ◽  
Vikas Menon
Keyword(s):  
Clinical Practice ◽  
Psychiatric Disorder ◽  
Psychiatric Disorders ◽  
Psychological Treatment ◽  
Treatment Resistant ◽  
Traditional Treatment ◽  
Early Symptom ◽  
Early Return ◽  
Augmentation Strategies ◽  
Augmentation Strategy

Abstract Early augmentation is a relatively newer concept in the management of psychiatric disorders. In managing psychiatric disorders, augmentation strategies are commonly used after failed attempts of optimization of a dose of the medications and then switching to another medication. Neuromodulation methods are recommended by traditional treatment recommendations as augmenting strategies (mostly) in managing treatment-resistant/refractory cases of psychiatric disorders. Late in the process of therapy, several of these techniques are applied to the patient. However, using different neuromodulation techniques, early augmentation of the ongoing pharmacological or psychological treatment may be achieved, resulting in early symptom reduction or remission and early return to work by resuming functionality. The length of the symptomatic cycle may be shortened by early augmentation. There are several potential challenges to adopting an early augmentation strategy in clinical practice. This article discusses the concept and evidence of early augmentation strategy in managing psychiatric disorder by using neuromodulation technique and potential challenges before it.

Augmentation Strategies for Clozapine-Resistant Patients with Schizophrenia

2020 ◽  
Vol 26 (2) ◽  
pp. 218-227
Author(s):  
Yi-Hang Chiu ◽  
Chia-Yueh Hsu ◽  
Mong-Liang Lu ◽  
Chun-Hsin Chen
Keyword(s):  
Sample Size ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Mood Stabilizers ◽  
Treatment Resistant ◽  
Double Blind ◽  
Beneficial Effects ◽  
Augmentation Strategies ◽  
Pubmed Database ◽  
Augmentation Strategy ◽  
Larger Sample

Background: Clozapine has been used in treatment-resistant patients with schizophrenia. However, only 40% of patients with treatment-resistant schizophrenia have response to clozapine. Many augmentation strategies have been proposed to treat those clozapine-resistant patients, but the results are inconclusive. In this review, we intended to review papers dealing with the augmentation strategies in the treatment of clozapineresistant patients with schizophrenia. Method: We reviewed randomized, double-blind, placebo- or sham-controlled trials (RCT) for clozapine-resistant patients with schizophrenia in Embase, PsycINFO, Cochrane, and PubMed database from January 1990 to June 2019. Results: Antipsychotics, antidepressants, mood stabilizers, brain stimulation, such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation, and other strategies, were used as an augmentation in clozapine-resistant patients with schizophrenia. Except for better evidence in memantine with 2 RCTs and cognitive behavior therapy in 2 studies to support its effectiveness, we found that all the other effective augmentations, including sulpiride, ziprasidone, duloxetine, mirtazapine, ECT, sodium benzoate, ginkgo biloba, and minocycline, had only one RCT with limited sample size. Conclusion: In this review, no definite effective augmentation strategy was found for clozapine-resistant patients. Some potential strategies with beneficial effects on psychopathology need further studies with a larger sample size to support their efficacy.

Pharmacologic Treatment of Body Dysmorphic Disorder: Review of the Evidence and a Recommended Treatment Approach

CNS Spectrums ◽  
2002 ◽  
Vol 7 (6) ◽  
pp. 453-463 ◽  
Author(s):  
Katharine A. Phillips
Keyword(s):  
Psychiatric Disorders ◽  
Serotonin Reuptake ◽  
Body Dysmorphic Disorder ◽  
Treatment Approach ◽  
Serotonin Reuptake Inhibitors ◽  
Empirical Literature ◽  
Pharmacologic Treatment ◽  
Treatment Resistant ◽  
Recommended Treatment ◽  
Augmentation Strategies

ABSTRACTResearch on effective pharmacotherapy for body dysmorphic disorder (BDD) has rapidly increased in recent years, with emerging data consistently indicating that serotonin reuptake inhibitors (SRIs) are often efficacious for this disorder. Although data are limited, it appears that higher SRI doses and longer treatment trials than those used for many other psychiatric disorders are often needed to treat BDD effectively. Approaches to treatment-resistant BDD have received little investigation, but available data indicate that switching to another SRI and several SRI-augmentation strategies may be helpful. This article reviews the empirical literature on BDD and offers a recommended approach to the pharmacotherapy of this distressing and often disabling disorder.

Does Psychological Treatment Help Only Those Patients with Severe Irritable Bowel Syndrome Who Also Have a Concurrent Psychiatric Disorder?

2005 ◽  
Vol 39 (9) ◽  
pp. 807-815 ◽  
Author(s):  
Francis Creed ◽  
Elspeth Guthrie ◽  
Joy Ratcliffe ◽  
Lakshmi Fernandes ◽  
Christine Rigby ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Irritable Bowel Syndrome ◽  
Treatment Group ◽  
Psychiatric Disorder ◽  
Psychological Treatment ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Irritable Bowel

Objective: We have previously reported improved health-related quality of life in patients with severe irritable bowel syndrome (IBS) following psychological treatments. In this paper, we examine whether this improvement was associated with improvement in psychological symptoms and was confined to those patients who had concurrent psychiatric disorder. Method: Two hundred and fifty-seven patients with severe IBS entering a psychological treatment trial were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. At entry to the trial and 15 months later, patients were also assessed using the Hamilton Depression Rating Scale, Symptom Cheecklist-90 (SCL-90) and Short Form-36 (SF36) physical component summary score as the main outcome measure. Partial correlation was used to compare changes in SF36 score and changes in psychological scores while controlling for possible confounders, treatment group and baseline scores. Multiple regression analysis was used to examine whether changes in psychological scores, changes in pain and a history of abuse could account for most of the variance of change in SF36 physical component score. Results: Of 257 patients with severe IBS, 107 (42%) had a depressive, panic or generalized anxiety disorder at trial entry. There were moderate but significant correlations (0.21–0.47) between change in the psychological scores and the change in SF36 physical component scores. The correlation coefficients were similar in the groups with and without psychiatric disorder. The superiority of psychotherapy and antidepressant groups over treatment as usual was similar in those with and without psychiatric disorder. Multiple regression found significant independent effects of change in depression, anxiety, somatization and abdominal pain but there was still variance explained by treatment group. Conclusions: In severe IBS improvement in health-related quality of life following psychotherapy or antidepressants is correlated with, but not explained fully by reduction of psychological scores. A more complete understanding of how these treatments help patients with medically unexplained symptoms will enable us to refine them further.

Emotion Dysregulation: A Review of the Concept and Implications for Clinical Practice

2016 ◽  
Vol 33 (S1) ◽  
pp. S528-S529
Author(s):  
A. D’Agostino ◽  
S. Covanti ◽  
M. Rossi Monti ◽  
V. Starcevic
Keyword(s):  
Clinical Practice ◽  
Psychiatric Disorders ◽  
Emotion Dysregulation ◽  
Emotional Reactivity ◽  
Emotional Awareness ◽  
Future Research ◽  
Competing Interest ◽  
Expression Of Emotions ◽  
Psychology Literature ◽  
Definition Of

IntroductionOver the past decade, emotion dysregulation has become a very popular term in the psychiatric and clinical psychology literature and it has been described as a key component in a range of mental disorders. For this reason, it has been recently called the “hallmark of psychopathology” (Beauchaine et al., 2007). However, many issues make this concept controversial.ObjectivesTo explore emotion dysregulation, focusing on problems related to its definition, meanings and role in many psychiatric disorders.AimsTo clarify the psychopathological core of emotion dysregulation and to discuss potential implications for clinical practice.MethodsA literature review was carried out by examining articles published in English between January 2003 and June 2015. A search of the databases PubMed, PsycINFO, Science Direct, Medline, EMBASE and Google Scholar was performed to identify the relevant papers.ResultsAlthough, there is no agreement about the definition of emotion dysregulation, the following five overlapping, not mutually exclusive dimensions were identified: decreased emotional awareness, inadequate emotional reactivity, intense experience and expression of emotions, emotional rigidity and cognitive reappraisal difficulty. These dimensions characterise a number of psychiatric disorders in different proportions, with borderline personality disorder and eating disorders seemingly more affected than other conditions.ConclusionsThis review highlights a discrepancy between the widespread clinical use of emotion dysregulation and inadequate conceptual status of this construct. Better understanding of the various dimensions of emotion dysregulation has implications for treatment. Future research needs to address emotion dysregulation in all its multifaceted complexity.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Novel Neurostimulation Therapeutic Approaches for Treatment-Resistant Psychiatric Disorders

2018 ◽  
pp. 325-347
Author(s):  
Ralph J. Koek ◽  
Janine Roach ◽  
Nicholas Athanasiou ◽  
Arkady Korotinsky
Keyword(s):  
Psychiatric Disorders ◽  
Therapeutic Approaches ◽  
Treatment Resistant

scholarly journals Mood disorders and violence: a new focus

2009 ◽  
Vol 15 (4) ◽  
pp. 263-270 ◽  
Author(s):  
Clare Oakley ◽  
Fiona Hynes ◽  
Tom Clark
Keyword(s):  
Mental Illness ◽  
Clinical Practice ◽  
Psychiatric Disorder ◽  
Mood Disorders ◽  
Good Evidence ◽  
Public Concern ◽  
Violent Behaviour ◽  
People With Mental Illness

SummaryViolent behaviour in people with a psychiatric disorder causes great public concern and leads to stigma for people with mental illness. There is good evidence for a correlation between schizophrenia and increased rates of violence but any association between mood disorders and violence has been comparatively overlooked. It appears that there may be more evidence relating mood disorders and violence than many clinicians realise. This article highlights the difficulties in assessing this, summarises what is known and discusses what this means for clinical practice.

Augmentation strategies in the treatment of major depressive disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S407-S407
Author(s):  
S. Bise ◽  
B. Kurtovic ◽  
D. Begic ◽  
O. Cemalovic
Keyword(s):  
Major Depressive Disorder ◽  
Combination Therapy ◽  
Depressive Disorder ◽  
Mood Stabilizers ◽  
Augmentation Therapy ◽  
Major Depressive ◽  
Augmentation Strategies ◽  
Significant Difference ◽  
Augmentation Strategy ◽  
Competing Interest

Augmentation strategies for the treatment of Major depressive disorder (MDD) are needed when patients with MDD have a partial, or not responded to antidepressant monotherapy. The focus of augmentation therapy has been combining an antidepressant (AD) medication with another AD. Atypical antipsychotics (AAP) are becoming commonly used to augment antidepressants. Beyond AD and AAP, alternative augmentation strategies include mood stabilizers (MS).AimTo analyze the characteristics of therapy in patients with diagnosis of MDD and to investigate the frequency of augmentation therapy.MethodStudy included 28 patients hospitalized during one year with MDD diagnosis. Statistical analysis was performed with x2 and t-test.ResultAmong patients with MDD there were 18 (64.28%) women with an average age 57.5 and 10 (35.71%) men with an average age 53.5. Of the 28 patients with MDD, 25 (89.28%) were treated with a combination therapy, and monotherapy in the remaining 3 patients (10.71%). Of 25 patients with augmentation strategy treatment, 22 (88%) used two medications and the remaining 3 (12%) tree psychotropic medications (AAP, AD, MS). The most frequent combinations were a combination of AD and AAP (17 patients, 68%). Beyond that frequent combination were AD and MS (6 patients, 24%). Two patients used combination two AAP, and one patient with two AD and one patients used AAP and MS.ConclusionAugmentation strategy is often used in patients with MDD. There is no significant difference in the use combination therapy based on gender and age.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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