This document discusses key terms used to describe outcomes in antidepressant treatment research and clinical practice, specifically response, remission, recurrence, and recovery. It notes that while remission is now considered the optimal treatment goal, implying wellness, definitions of remission have varied inconsistently across studies. True wellness should be determined by a lack of symptoms, good functional status, and reduced pathophysiology. The document calls for clinical trials to better reflect the treatment goal of sustained wellness through longer durations, larger sample sizes, and assessment of functional outcomes.
Background: Behavioral health conditions are prevalent among patients in inpatient medical settings and when not adequately treated contribute to diminished treatment outcomes and quality of life. Substantial evidence has demonstrated the effectiveness of psychological interventions in addressing behavioral health conditions in a range of settings but, to a lesser extent with psychologically-based interventions delivered in inpatient medical settings. Purpose: The purpose of this paper is to increase attention on psychological interventions being delivered to patients across a broad spectrum of medical specialties in inpatient medical settings to support the implementation of interventions to address increasing patient needs. Methods: This selected, brief review of the literature sought to describe published psychologically-based interventions delivered in inpatient medical settings. A search for studies catalogued on PubMed from 2007 to 2016 was examined and studies were included in the review if they were delivered within inpatient medical settings. Two reviewers independently assessed relevant studies for criteria. Results: A total of ten articles met the inclusion criteria with interventions targeting outcomes across four primary domains: 1) pain and fatigue; 2) cognition; 3) affective/emotional and; 4) self-harm. Several articles support interventions grounded in Cognitive-Behavioral Therapy and brief psychological interventions. Most studies reported favorable outcomes for the interventions relative to controls. Conclusions: Psychologically-based interventions, especially those that integrate components of cognitive-behavioral therapy and a multidisciplinary approach, can be implemented in inpatient medical settings and may promote improved patient outcomes. However, the quality of this evidence requires formal assessment, requiring more comprehensive reviews are needed to replicate findings and clarify effectiveness of interventions.
The 2012 AHS/AAN Guidelines for Prevention of Episodic Migraine: A Summary an...Utai Sukviwatsirikul
The 2012 AHS/AAN Guidelines for Prevention of Episodic Migraine: A Summary and Comparison With Other Recent Clinical Practice Guidelineshead_2185 930..945
Elizabeth Loder, MD, MPH; Rebecca Burch, MD; Paul Rizzoli, MD
Background: Behavioral health conditions are prevalent among patients in inpatient medical settings and when not adequately treated contribute to diminished treatment outcomes and quality of life. Substantial evidence has demonstrated the effectiveness of psychological interventions in addressing behavioral health conditions in a range of settings but, to a lesser extent with psychologically-based interventions delivered in inpatient medical settings. Purpose: The purpose of this paper is to increase attention on psychological interventions being delivered to patients across a broad spectrum of medical specialties in inpatient medical settings to support the implementation of interventions to address increasing patient needs. Methods: This selected, brief review of the literature sought to describe published psychologically-based interventions delivered in inpatient medical settings. A search for studies catalogued on PubMed from 2007 to 2016 was examined and studies were included in the review if they were delivered within inpatient medical settings. Two reviewers independently assessed relevant studies for criteria. Results: A total of ten articles met the inclusion criteria with interventions targeting outcomes across four primary domains: 1) pain and fatigue; 2) cognition; 3) affective/emotional and; 4) self-harm. Several articles support interventions grounded in Cognitive-Behavioral Therapy and brief psychological interventions. Most studies reported favorable outcomes for the interventions relative to controls. Conclusions: Psychologically-based interventions, especially those that integrate components of cognitive-behavioral therapy and a multidisciplinary approach, can be implemented in inpatient medical settings and may promote improved patient outcomes. However, the quality of this evidence requires formal assessment, requiring more comprehensive reviews are needed to replicate findings and clarify effectiveness of interventions.
The 2012 AHS/AAN Guidelines for Prevention of Episodic Migraine: A Summary an...Utai Sukviwatsirikul
The 2012 AHS/AAN Guidelines for Prevention of Episodic Migraine: A Summary and Comparison With Other Recent Clinical Practice Guidelineshead_2185 930..945
Elizabeth Loder, MD, MPH; Rebecca Burch, MD; Paul Rizzoli, MD
We all know that individuals with fasd fulfil the requirements for DSM mental health diagnoses, usually receiving multiple DSM diagnoses.
So, it is not surprising that the more the behavioural mental health diagnoses are explored, beyond their own behavioural criteria, the more commonalities are found: in this case “delay discounting”.
However, there is already a term that is being used, Stuck In Set Perseveration.
See, The Lens by Which Those Afflicted with FASD Interpret their Relationship and Environment. XXXIVth International Congress on Law and Mental Health. Vienna, 2015.
Summary of current research on routine outcome measurement, feedback, the validity, reliability, and effectiveness of the ORS and SRS (or PCOMS Outcome Management System)
Efficacy of Mindfulness-Based Cognitive Therapy in Relation to Prior History ...Tejas Shah
Mindfulness-based cognitive therapy reduces residual depressive symptoms irrespective of the number of previous episodes of major depression.
Presented by Tejas Shah (www.healingstudio.in)
Homeopathy for Depression - DEP-HOM: study protocol for a randomized, partial...home
Homeopathy is often sought by patients with depression. In classical homeopathy, the treatment
consists of two main elements: the case history and the prescription of an individually selected homeopathic
remedy. Previous data suggest that individualized homeopathic Q-potencies were not inferior to the antidepressant
fluoxetine in a sample of patients with moderate to severe depression. However, the question remains whether
individualized homeopathic Q-potencies and/or the type of the homeopathic case history have a specific
therapeutical effect in acute depression as this has not yet been investigated. The study aims to assess the two
components of individualized homeopathic treatment for acute depression, i.e., to investigate the specific effect of
individualized Q-potencies versus placebo and to investigate the effect of different approaches to the homeopathic
case history.
We all know that individuals with fasd fulfil the requirements for DSM mental health diagnoses, usually receiving multiple DSM diagnoses.
So, it is not surprising that the more the behavioural mental health diagnoses are explored, beyond their own behavioural criteria, the more commonalities are found: in this case “delay discounting”.
However, there is already a term that is being used, Stuck In Set Perseveration.
See, The Lens by Which Those Afflicted with FASD Interpret their Relationship and Environment. XXXIVth International Congress on Law and Mental Health. Vienna, 2015.
Summary of current research on routine outcome measurement, feedback, the validity, reliability, and effectiveness of the ORS and SRS (or PCOMS Outcome Management System)
Efficacy of Mindfulness-Based Cognitive Therapy in Relation to Prior History ...Tejas Shah
Mindfulness-based cognitive therapy reduces residual depressive symptoms irrespective of the number of previous episodes of major depression.
Presented by Tejas Shah (www.healingstudio.in)
Homeopathy for Depression - DEP-HOM: study protocol for a randomized, partial...home
Homeopathy is often sought by patients with depression. In classical homeopathy, the treatment
consists of two main elements: the case history and the prescription of an individually selected homeopathic
remedy. Previous data suggest that individualized homeopathic Q-potencies were not inferior to the antidepressant
fluoxetine in a sample of patients with moderate to severe depression. However, the question remains whether
individualized homeopathic Q-potencies and/or the type of the homeopathic case history have a specific
therapeutical effect in acute depression as this has not yet been investigated. The study aims to assess the two
components of individualized homeopathic treatment for acute depression, i.e., to investigate the specific effect of
individualized Q-potencies versus placebo and to investigate the effect of different approaches to the homeopathic
case history.
Efficacy of individualized homeopathic treatment and fluoxetine for moderate ...home
his study is the first trial of classical homeopathy that will evaluate the efficacy of homeopathic
individualized treatment using C-potencies versus placebo or fluoxetine in peri- and postmenopausal women with
moderate to severe depression. It is an attempt to deal with the obstacles of homeopathic research due to the
need for individual prescriptions in one of the most common psychiatric diseases.
This topic is very essential for Pharm.D students. It includes application, benefits, limitations of EBM. It also includes EBM history and background which helps you for examinations. EBM is very important topic in Pharmacotherapeutics-III so you may find this needful.
All the best!!!
C H A P T E R 1
Clinical reasoning, evidencebased
practice, and symptom analysis
Basic health assessment involves the application of the practitioner’s knowledge and skills to identify and
distinguish normal from abnormal findings. Basic assessment often moves from a general survey of a body
system to specific observations or tests of function. Such an approach to assessment and clinical decision
making uses a deductive process of reasoning. For example, a specialist examining a patient with known
hyperthyroidism would conduct a physical examination to test for deep tendon reflexes. Brisk or hyperreflexic
reflexes would lead the practitioner to conclude that a hyperthyroid state is a likely cause of these findings. This
would greatly narrow the choices of diagnostic tests and treatment decisions.
Advanced assessment builds on basic health assessment yet is performed more often using an inductive or
inferential process, that is, moving from a specific physical finding or patient concern to a more general
diagnosis or possible diagnoses based on history, physical findings, and the results of laboratory and diagnostic
tests. The practitioner gathers further evidence and analyzes this evidence to arrive at a hypothesis that will lead
to a further narrowing of possibilities. This is known as the process of diagnostic reasoning.
Diagnostic reasoning
Diagnostic reasoning is a scientific process in which the practitioner suspects the cause of a patient’s symptoms
and signs based on previous knowledge. The practitioner gathers relevant information, selects necessary tests,
makes an accurate diagnosis, and recommends therapy. The difference between an average and an excellent
practitioner is the speed and focus used to arrive at the correct conclusion and initiate the best course of
evidencebased treatment with minimum harm, cost, inconvenience, and delay. This expertise of the
practitioner is acquired through knowledge and a skill set developed through experience in clinical practice.
Repeated practice with real cases helps to develop memory schemes for relating clinical problems and store
them in longterm memory.
By using diagnostic reasoning, the practitioner is able to accomplish the following:
• Determines and focuses on what needs to be asked, what data need to be obtained, and what needs to
be examined
• Performs examinations and diagnostic tests accurately
• Clusters all pertinent findings
• Analyzes and interprets the findings
• Develops a list of likely or differential diagnoses
The diagnostic process
The primary care context
The process of assessment in the primary care setting begins with the patient or caregiver stating a reason for
the visit or a chief concern. Most visits to primary care providers involve concerns or symptoms presented by
the patient, such as an earache, vomiting, or fatigue. The initial evidence is collected through a patient history.
Demographic information, such as gend ...
REVIEW Open AccessWhat happens after treatment Asystema.docxmichael591
REVIEW Open Access
What happens after treatment? A
systematic review of relapse, remission, and
recovery in anorexia nervosa
Sahib S. Khalsa1,2*, Larissa C. Portnoff3, Danyale McCurdy-McKinnon4 and Jamie D. Feusner5
Abstract
Background: Relapse after treatment for anorexia nervosa (AN) is a significant clinical problem. Given the level of
chronicity, morbidity, and mortality experienced by this population, it is imperative to understand the driving forces
behind apparently high relapse rates. However, there is a lack of consensus in the field on an operational definition
of relapse, which hinders precise and reliable estimates of the severity of this issue. The primary goal of this paper
was to review prior studies of AN addressing definitions of relapse, as well as relapse rates.
Methods: Data sources included PubMed and PsychINFO through March 19th, 2016. A systematic review was
performed following the PRISMA guidelines. A total of (N = 27) peer-reviewed English language studies addressing
relapse, remission, and recovery in AN were included.
Results: Definitions of relapse in AN as well as definitions of remission or recovery, on which relapse is predicated,
varied substantially in the literature. Reported relapse rates ranged between 9 and 52%, and tended to increase
with increasing duration of follow-up. There was consensus that risk for relapse in persons with AN is especially
high within the first year following treatment.
Discussion: Standardized definitions of relapse, as well as remission and recovery, are needed in AN to accelerate
clinical and research progress. This should improve the ability of future longitudinal studies to identify clinical,
demographic, and biological characteristics in AN that predict relapse versus resilience, and to comparatively
evaluate relapse prevention strategies. We propose standardized criteria for relapse, remission, and recovery, for
further consideration.
Keywords: Anorexia nervosa, Treatment, Outcome, Relapse, Remission, Recovery, Prevention, Eating disorder,
Bulimia nervosa
Plain English Summary
Relapse occurs frequently in individuals receiving treat-
ment for anorexia nervosa. However, there is no com-
mon agreement on how to define relapse. In this study,
we reviewed previous studies of relapse, remission, and
recovery following treatment for anorexia nervosa. We
found that there were many different definitions for
these terms, which resulted in different estimates of re-
lapse rate. To understand what drives relapse it is
important to have a consistent definition across studies.
To help this discussion we propose common criteria for
relapse, remission, and recovery from anorexia nervosa.
Background
Anorexia nervosa (AN) is a serious psychiatric illness
with amongst the highest mortality rates of any mental
disorder—up to 18% in long-term follow-up studies [1–
3]. Most cases emerge during adolescence, and tend to-
wards a protracted and chronic course [4, 5]. In females,
AN has a p.
"..The proposed definition, therefore, is not intended to be prescriptive but represents a working framework. Clinicians and researchers should exercise their judgment in interpreting the principles described in this report when applying the definition to diverse settings.."
-- Kwan P, et al, 2017