This presentation discuss in brief the criteria, predictors and management approaches for treatment resistant psychosis.
The presentation is an overview for readers to search more regarding this important topic.
TREATMENT RESISTANT DEPRESSION IS A AREA THAT IS NOT EXPLORED MUCH, BUT IT REALLY NEEDS LOT OF ATTENTION AS IT IS ONE OF THE MOST COMMON OBSTACLE IN ACHIEVING COMPLETE REMISSION IN DEPRESSION
Since the discovery of the first effective antipsychotic medication (APM) in the mid 1950s, efforts to enhance their efficacy have been limited, despite improvements in tolerability. This stagnation is evident in effectiveness trials conducting in Europe and the United States. Several factors contribute to the failure to develop more effective APMs, including the absence of appropriate assessment tools for core symptoms domains in schizophrenia, reliance on the dopamenergic hypothesis, and the prolifration of “me too” drugs. The classification of APMs is also convoluted, grouping together second-generation, partial agonists, and multimodel APMs despite significant differences in their mechanism of action. Chllenges such as inadequate sample sizes, lack of statistical measures correlating with clinical significanse, and the high cost of newer APMs further hinder drug development. Additionally, there is lack of early predictors of antipsychotic response and tools to optimize APM efficacy. Suboptimal APM use by mental health providers, including excessive maintenance doses and irrational polypharmacy, exacerbates effectivness and medication adherence issues. Despite these challenges,there have been advancaments in APM tolerability and the development of long-acting injectables to address medication nonadherence. This critical review examines 70 years of antipsychotic development, identifies reasons for the failure to develop more effective APMs , and suggestes future directions in this field.
The recognition of bipolar disorder in primary careNick Stafford
Bipolar disorder and the complexities of screening and diagnosis in primary care. How more accurate detection and an integrated care pathway with secondary care can improve the diagnosis and outcome of the treatment of the disorder.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
2. Objectives
• Definition and criteria
• Predictors of resistance
• Pharmacological management
• Psychotherapy in TRP
• ECT in TRP
Sutherland Hospital 01/07/20Shokry
3. Definition and criteria
• The definition and criteria vary according to the guideline
describing them.
• It can be linked with higher risk of a clinical deterioration,
chronicity, neurotoxic effects of relapse, suicide, aggressive
conducts, poor quality of life and low level of functioning.(1)
• 3 keys for the definition of treatment resistant psychosis:
1. Confirmed diagnosis
2. Adequate pharmacological treatment
3. Persistence of significant symptoms despite this treatment.
Sutherland Hospital 01/07/20Shokry
4. guidelines Minimum
number of
failed APs
Specified AP Adeqaute treatment
episode duration
Dose Severity of illness others
APA 2 At least one of which is a
second- generation AP
≥6 weeks Therapeutic dose A clinically
inadequate
response” “and for
patients with
persistent suicidal
ideation or
behaviour that has
not responded to
other treatments
-
RANZCP 2 Recommends both first and
second trial to be of an
atypical
6-8 weeks Specified dosages Poor response If poor adherence,
or persistent suicide
risk, positively offer
trial of clozapine
NICE 2 One of the drugs should be a
non- clozapine second-
generation AP
≥4 weeks Adequate Inadequate response 2 trials should be
given “sequentially”
MAUDSLEY 2 Consider use of either first
generation or second-
generation AP
2-3 weeks for trial of
first AP in FEP. 6-
week trial for
subsequent 2nd AP
before clozapine.
At least minimum
effective dose, then
titrated to response
Not specified -
Sutherland Hospital 01/07/20
Shokry
5. • Poor responders (8.2%), the majority of patients have a
moderate response (76.4%), and only 15.4% can be
considered rapid responders with the greatest magnitude of
response. (2)
• In FEP 25% of patients’ symptoms of psychosis persist with a
worse long-term course of illness. (3)
• Temporal development:
Resistance can be present from the illness onset and can be
developed later after initial response.(4)
Sutherland Hospital 01/07/20Shokry
6. • Duration:
Each AP trial should last at least 6 weeks.
• Dose:
In first episode psychosis, minimum therapeutic dose which equals 600 mg of
chlorpromazine daily.
• Number of past treatment episodes:
At least 2 adequate treatment episodes.
Incomplete episodes due to non-compliance (adherence: ≥80% of prescribed
doses for ≥12 weeks) developed side effects should be excluded.
Shokry
Sutherland Hospital 01/07/20
7. Patient related predictors (cont.)
• Premobid functioning:
Lower premorbid functioning is one of the most important factors related to
poor or no response to antipsychotic medications (5)
• Yonger age at the onset of disorder and living in a less urban area:
few studies support this and results were controversial with other studies. (6)
• Lower education level:
La Salvia et al. (5), Verma et al. (7) and Diaz et al. (8) found a relationship
between lower educational level and treatment resistance.
Sutherland Hospital 01/07/20Shokry
8. Patient related predictors (cont.)
• Gender:
Male gender was found as a predictor of worse response, poor
outcome and higher risk of relapse after discontinuation of
antipsychotic.
Also, Lally et al.(12) for FEP in patients with schizophrenia concluded
that treatment resistance was strictly connected with male sex.
• Marital status:
Controversial findings of relation between single marital status and
treatment resistance as this factor is changeable.
Sutherland Hospital 01/07/20Shokry
9. Disorder related factors (cont.)
• Type of symptoms:
Some studies found theat patients with high levels of both positive
and negative symptoms have poor outcomes. (13)
Patients with negative symptoms at the onset of disorder and
resistant in nature have higher rates of treatment resistance.(14,15)
Cognitive and disorganized symptoms are predictors of treatment
resistance. (16, 17, 18)
Sutherland Hospital 01/07/20Shokry
10. Disorder related factors (cont.)
• Diagnosis of schizophrenia was found significantly related to
treatment resistance. (6)
• Comorbidity:
40% of patients with schizophrenia meet criteria of alcohol
use disorder and 30% for substance use disorder especially
cannabis which was considered as a predominant factor of
treatment resistance. (19)
Sutherland Hospital 01/07/20Shokry
11. Neurobiological Predictors
• Decreased plasma level of dopamine metabolites.(20)
• Decreased level of dopamine syntesis in striatum.
• Greater decrease of myelination in substantia nigra.(21) ??!!
Greater decrease of myelination of substantia nigra was
observed in cases with schizophrenia with poor response
• Cortisol and inflammatory markers:
Blunted cortisol awakening response and increased
proinflammatory cytokines were predictors of resistance in
the early phases of psychosis . (22)
Sutherland Hospital 01/07/20Shokry
12. Neurobiological Predictors (cont.)
• Pituitary volume:
It has inverse relation with decrease of symptoms severity. (23)
• Decreased volume of grey matter:
Hypogyria in bilateral insular regions, left frontal area and
right temporal area.
Sutherland Hospital 01/07/20Shokry
13. Treatment related predictors
• Adherence:
Higher level of adherence since FEP predicted response and
remission of the illness. (24)
LAI can be considered in patients with risk factors of relapse.(3)
• Early response:
Samara et al. (25) showed association between lack of
symptoms improvement at week 2 and later non-response.
Sutherland Hospital 01/07/20Shokry
14. Treatment related predictors (cont.)
• Duration of untreated psychosis (DUP)
A more prolonged DUP has been related to a longer time of
response to treatment in patients who presented a first-
episode of psychosis and to an impaired course of the disorder
such as higher levels of positive, negative symptoms and lower
global functioning. (26)
Sutherland Hospital 01/07/20Shokry
15. Changeable factors Unchangeable factors
• Lower educational level
• Single marital status
• Negative symptoms
• Substance use disorder
• Non-adherence
• Early non-response (within
week 2)
• Duration of untreated
psychosis
• Poor premorbid functioning
• Male gender
• Younger age at onset
• Diagnosis of schizophrenia
• Neurobiological factors
Sutherland Hospital 01/07/20Shokry
16. Management of resistant psychosis
Clozapine:
• It is the first line medication in TRP
• Not tolerable by many patients with sometimes serious side
effects
• Some patients are resistant to clozapine as well
• Pharmacological augmentation:
Mainly to reduce clozapine side effects such as weigh gain and
dyslipidemia and decrease used doses of clozapine; however,
it can increase the burden of side effects.(cont.)
Sutherland Hospital 01/07/20Shokry
17. Management of resistant psychosis (cont.)
• Amisulpride, Sertindole, Pimozide and ziprasidone may increase
cardiac side effects.(27)
• Aripiprazole has limited therapeutic evidence but decrease weight
and LDL cholesterol.(28)
• 2 RCTs support use of MEMANTINE.(29,30)
• Haloperidol has a modest effect.
• Lamotrigine has moderate effect and may reduce alcohol
consumption.
• Risperidone effect is controversial.
Sutherland Hospital 01/07/20Shokry
18. Management of resistant psychosis (cont.)
ECT:
• A study showed that 50% of the patient received bilateral ECT
as augmentation to clozapine had 40% or more reduction of
symptoms.(31)
• ECT augmentation is a safe and efficacious in TRS
• Adverse effects such as transient memory impairment(32),
headache, increased blood pressure after ECT and prolonged
seizures. (33)
Sutherland Hospital 01/07/20Shokry
19. Management of resistant psychosis (cont.)
CBT:
• Cognitive behavioral psychotherapy is very effective particularly in the
treatment of positive symptoms in TRS and/or TRP patients. (34)
• The same efficacy was not found in the treatment of negative symptoms
while it was only partial in achieving an improvement in the total scores of
patients evaluated in the PANSS.
• CBT in augmentation with the usual treatment (TAU) works well in the
initial stages and then gradually loses effectiveness.(35)
Sutherland Hospital 01/07/20Shokry
20. References
1. Demjaha A, Leppin JM, Stahl D, Patel MX, MacCabe JH, Howes OD, et al. Antipsychotic treatment resistance
in first-episode psychosis: prevalence, subtypes and predictors. Psychol Med. (2017) 47:1981-9.
2. Murray R, Correll CU, Reynolds GP, Taylor D. Atypical antipsychotics: recent research findings and
applications to clinical practice: proceedings of a symposium presented at the 29th Annual European College of
Neuropsychopharmacology Congress, 19 September 2016, Vienna, Austria. Ther Adv Psychopharmacol. (2017)
7:1–14.
3. Fusar-Poli P, McGorry PD, Kane JM. Improving outcomes of first- episode psychosis: an overview. World
Psychiatry (2017) 16:251–65.
4. Agid O, Arenovich T, Sajeev G, Zipursky RB, Kapur S, Foussias G, Remington G. An algorithm- based approach
to first-episode schizophrenia: Response rates over 3 prospective antipsychotic trials with a retrospective data
analysis. J Clin Psychiatry. 2011; 72:1439–1444.
5. Lasalvia A, Bonetto C, Lenzi J, Rucci P, Iozzino L, Cellini M, et al. Predictors and moderators of treatment
outcome in patients receiving multi- element psychosocial intervention for early psychosis: results from the
GET UP pragmatic cluster randomised controlled trial. Br J Psychiatry (2017)
Sutherland Hospital 01/07/20Shokry
21. 6. Wimberley T, Støvring H, Sørensen HJ, Horsdal HT, MacCabe JH, Gasse C. Predictors of treatment resistance in patients
with schizophrenia: a population-based cohort study. Lancet Psychiatry (2016) 3:358–66.
7. Verma S, Subramaniam M, Abdin E, Poon LY, Chong SA. Symptomatic and functional remission in patients with first-
episode psychosis. Acta Psychiatr Scand. (2012) 126:282–9.
8. Díaz I, Pelayo-Terán JM, Pérez-Iglesias R. Predictors of clinical remission following a first episode of non-affective
psychosis: sociodemographics, premorbid and clinical variables. Psychiatry Res. (2013) 206:181–7.
9. Di Capite S, Upthegrove R, Mallikarjun P. The relapse rate and predictors of relapse in patients with first-episode
psychosis following discontinuation of antipsychotic medication. Early Interv Psychiatry (2016) 12:893–9.
10. Selten JP, Veen ND, Hoek HW. Early course of schizophrenia in a representative Dutch incidence cohort. Schizophr
Res. (2007) 97:79–87.
11. Derks EM, Fleischhacker WW, Boter H, Peuskens J, Kahn RS. EUFEST Study Group. Antipsychotic drug treatment in
first-episode psychosis: should patients be switched to a different antipsychotic drug after 2, 4, or 6 weeks of
nonresponse? J Clin Psychopharmacol. (2010) 30:176–80.
12. Lally J, Ajnakina O, Di Forti M, Trotta A, Demjaha A, Kolliakou A, et al. Two distinct patterns of treatment resistance:
clinical predictors of treatment resistance in first-episode schizophrenia spectrum psychoses. Psychol Med. (2016)
46:3231–40.
13. Addington J, Addington D. Symptom remission in first episode patients. Schizophr Res. (2008) 106:281–5
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22. 14. Strauss GP, Harrow M, Grossman LS, Rosen C. Periods of recovery in deficit syndrome schizophrenia: a 20-year multi-
follow-up longitudinal study. Schizophr Bull. (2010) 36:788–99.
15. Ventura J, Subotnik KL, Gitlin M, Gretchen-Doorly D, Ered A, Villa KF, et al. Negative symptoms and functioning during
the first year after a recent onset of schizophrenia and 8 years later. Schizophr Res. (2015) 161:407–13.
16. Chiliza B, Asmal L, Kilian S, Phahladira L, Emsley R. Rate and predictors of non-response to first-line antipsychotic
treatment in first-episode schizophrenia. Hum Psychopharmacol. (2015) 30:173–82.
17. Levine SZ, Rabinowitz J. Trajectories and antecedents of treatment response over time in early-episode psychosis.
Schizophr Bull. (2010) 36:624–32.
18. Iasevoli F, Giordano S, Balletta R, Latte G, Formato MV, Prinzivalli E, et al. Treatment resistant schizophrenia is
associated with the worst community functioning among severely-ill highly-disabling psychiatric conditions and is the
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