Sachs M, Madaan V Electroconvulsive therapy in children and adolescents: brief overview and ethical issues. Published online 1—9. Freeman B Pathway to electroconvulsive treatment for minors.
Expert Rev Neurother 11 1 — Benson NM, Seiner SJ Electroconvulsive therapy in children and adolescents: clinical indications and special considerations. Harv Rev Psychiatry 27 6 — Curr Psychiatry Rev — Published online. Am J Psychiatry 5 — Ann Gen Psychiatry 12 1 :1—8. PLOS Med 6 7 :e Oxford University Press. Book Google Scholar. Taylor EH Advances in the diagnosis and treatment of children with serious mental illness.
Child Welf 77 3 — CAS Google Scholar. Published online JBI Evid Synth 18 10 — Aspects M, Reading F Weighted arithmetic mean. In: The concise encyclopedia of statistics. Springer New York, pp — J Clin Psychiatry. Indian J Psychol Med 43 2 — Google Scholar. Findings from a whole-population study. J ECT 19 2 — J ECT 36 1 — Shilton T, Enoch-Levy A, Giron Y et al A retrospective case series of electroconvulsive therapy in the management of comorbid depression and anorexia nervosa.
Int J Eat Disord 53 2 — A retrospective study. J ECT 34 2 — J Child Adolesc Psychopharmacol 26 7 — J ECT 31 4 — J Affect Disord 82 3 — J ECT 29 2 — J Child Adolesc Psychopharmacol 10 4 — Strober M, Rao U, DeAntonio M et al Effects of electroconvulsive therapy in adolescents with severe endogenous depression resistant to pharmacotherapy.
Biol Psychiatry 43 5 — J Child Adolesc Psychopharmacol 6 4 — Eur Psychiatry 17 4 — During the electro-diagnostic test the pulse lasting less than 3 months.
The second light a possible bradycardia. The prior to VNS implant, 2 long-lasting MDEs not consid- generator was switched off for two weeks postoperatively ering the current one. He spent, during the last two to allow postsurgical edema to resolve. No hypomanic episodes were re- age for categorical variables. A repeated measures corded in the last two years. Two patients withdrew from the study: one Results subject Figure 3 , whose depression slightly improved One hundred-fifty-nine subjects were interviewed HDRS 14 , withdrew after 18 months because of through telephone in order to assess eligibility criteria side effects judged by the patient as intolerable hoarse- for inclusion into the study; of them, 39 were asked to ness, sore throat and neck pain , and had the VNS gen- present for a face-to-face clinical interview.
Thirty-three erator switched off. One additional from the study. Figures 1, 2, 3, 4 A total of five patients met the inclusion criteria and and 5 show individual scores for each patient and stimula- had the VNS generator implanted.
At 2 years, the three pa- after VNS implant and during the follow-up period. With regard to tolerability, patients reported common Two of the three patients who were followed-up for 5 years side effects traditionally observed in previous clinical had one depressive recurrence during the 4th year and the studies. The only side effect related to the surgical pro- third subject showed no recurrences for the whole period. Only in one case the pain persisted up to month controlled and uncontrolled clinical trials: the 1-year re- Our alteration of voice, and described as mild to moderate.
In response rate at 1 year is comparable to the Findings from our case series indicate a progres- off definitely. Pulse-width was not reduced, although this sive symptom reduction over the first year, although strategy is commonly used to improve tolerability. No statistical analyses were not significant; moreover, the hypo manic episodes, a rare but yet documented adverse analysis of individual rating scales scores over time event potentially occurring with VNS, were observed dur- shows that VNS, when effective not in all patients , is ing the 60 months of stimulation.
Preliminary evi- Caution has to be used in interpreting our results, as dence suggests that adjunctive VNS has two principal ef- we observed no statistically significant changes in HDRS fects: first, it reduces depressive symptoms in a small or MADRS scores nor in SF scores in the first but significant proportion of patients who otherwise 12 months of treatment see Table 2 ; moreover, two pa- would be unresponsive to standard treatments, and, sec- tients dropped out by 12—18 months.
This long-term effect, how- to be mitigated on the basis of these limitations. Moreover, the majority of pa- may be then of interest to clinicians. A careful screening of subjects with TRD is then indicated, with particular attention not Table 3 Side effects of Vagus Nerve Stimulation only to the history of resistant depression number of Side effects Sample previous failed antidepressant trials, compliance, etc. Despite several efforts by the et al. Am J Psychiatry.
Al- 7. Berlim MT, Turecki G. Definition, assessment, and staging of treatment-resistant though it is unusual for someone to consent to having a refractory major depression: a review of current concepts and methods.
Can J Psychiatry. The Maudsley Staging up, he did so and told the psychiatrist that he was will- Method for treatment-resistant depression: prediction of longer-term outcome ing to try transcranial magnetic stimulation at another and persistence of symptoms.
J Clin Psychiatry. Treatment-resistant depression. J Clin University hospital. This case underlines, to our opinion, Psychiatry. Wijeratne C, Sachdev P. Treatment-resistant depression: critique of current mood disorders is compulsory before implementing neuro- approaches. Aust N Z J Psychiatry. Deep brain stimulation for treatment-resistant depression: follow-up tions to attend complex and expensive procedures such as after 3 to 6 years.
VNS implantation. We have uploaded these PDF and EPUB files to our online file repository so that you can enjoy a safe and blazing-fast downloading experience. Treatment-resistant major depression and bipolar disorder are highly prevalent and disabling conditions associated with substantial morbidity and mortality. The assessment and management of refractory patients with mood disorders is a major clinical challenge for mental health providers. Part of the Oxford Psychiatry Library OPL series, this pocketbook provides a concise view of the current definitions, assessment and evidence-based management of treatment-resistant mood disorders and reviews novel therapeutic targets for mood disorders, which may enhance the therapeutic armamentarium of clinicians in the near future.
The pocketbook serves as a useful guide for mental health practitioners, including psychiatrists, clinical psychologists, trainees, and interested primary care physicians. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.
The majority of depressed patients fail to respond to an appropriate antidepressant drug trial or show a partial response, with substantial residual symptomatology and increased risk of relapse. A staging method for assessing resistance may provide important clues for long-term management. Assessment should encompass treatment history, psychiatric, and medical comorbidity, with particular regard to the longitudinal development of co-occurring mental disorders and their hierarchical organization using macro- and micro-analysis.
There is evidence to support the use of psychosocial approaches such as cognitive-behavioural therapy CBT , and some indications for interpersonal psychotherapy IPT and family interventions. The sequential administration of pharmacotherapy and psychotherapy according to the stages of the disorder is a viable strategy for preventing relapse and recurrence. The clinical approach, especially in the case of drug resistance or partial remission, should be filtered by clinical judgment taking into consideration a number of variables.
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