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Schizophrenia is often associated with an inadequate response to pharmacological and non-pharmacological treatments. How to treat patients who have an unsatisfactory response to anti-psychotics, including clozapine - which is unequivocally the most powerful antipsychotic medication for this recalcitrant population - remains a clinical conundrum. A range of adjunctive medications have been tried with mixed results; there has also been renewed interest in the role of neuromodulatory strategies, electroconvulsive therapy, and cognitive and vocational approaches. Perhaps a bright spot for the future lies in the evolution of pharmacogenetic approaches for individualized care. In this book, leading experts from Europe, Australia and the Americas provide a timely appraisal of treatments for the most severely ill schizophrenia patients. This clinically focused book is informed by the latest research on the neurobiology and treatment of schizophrenia. It is comprehensive in scope, covering current treatment options, various add-on approaches, and a range of psychosocial treatments. The contributors are respected experts who have combined their clinical experience with cutting-edge research to provide readers with authoritative information on fundamental aspects of clinical care for schizophrenia.
This manual attempts to provide simple, adequate and evidence-based information to health care professionals in primary health care especially in low- and middle-income countries to be able to provide pharmacological treatment to persons with mental disorders. The manual contains basic principles of prescribing followed by chapters on medicines used in psychotic disorders; depressive disorders; bipolar disorders; generalized anxiety and sleep disorders; obsessive compulsive disorders and panic attacks; and alcohol and opioid dependence. The annexes provide information on evidence retrieval, assessment and synthesis and the peer view process.
This book provides clear and concise guidance for clinicians when they encounter a patient with psychosis, starting with the medical work-up to arrive at a diagnosis and ending with the comprehensive care for patients with established schizophrenia. It covers the optimal use of medications (emphasizing safe use) but also addresses other treatment approaches (psychological treatments, rehabilitation) and the larger societal context of care, including how to work effectively in complex systems. It uniquely condenses the literature into teaching points without simplifying too much, effectively serving as a learning tool for trainees and professionals. For this second edition, the book was extensively updated and its content expanded, with new figures as well. Each chapter begins with an initial summary and includes Tips and Key Points in text boxes. Each chapter also includes links to external websites and additional readings. The book contains clinical and practical wisdom for clinicians who are treating real patients at the front lines, setting it apart from all other texts. Psychotic Disorders is an excellent resource for medical students, early career professionals such as trainees and fellows, and related clinicians seeking additional training and resources, including those in psychiatry, psychology, neurology, and all others.
The new edition of this popular handbook has been thoroughly updated to include the latest data concerning treatment of first-episode patients. Drawing from their experience, the authors discuss the presentation and assessment of the first psychotic episode and review the appropriate use of antipsychotic agents and psychosocial approaches in effective management.
The introduction of chlorpromazine in 1953, and haloperidol in 1958, into clinical practice dramatically altered the therapy of schizophrenic patients. Although representing by no means a cure for this severe psychiatric ill ness, it allowed, for the first time, to adequately control the severe hallu cinations and delusional beliefs which prevent these patients from leading a more or less independent life. Indeed these antipsychotics (and the many congeners that were to follow) significantly reduced the number ofchronic schizophrenic inpatients in psychiatric clinics all over the world. However soon after their introduction it became clear that, like all other available drugs, antipsychotics were by no means miracle drugs. In fact, two major problems appeared. First, the antipsychotics had very little effect on the so-called negative or defect symptoms, like social isolation, apathy and anhedonia, and secondly virtually all antipsychotics produced a number of side-effects, of which the neurological (often called extra pyramidal) side-effects were the most troublesome. Especially the tardive dyskinesia, which occurred in about 15 to 20% of the patients after pro longed treatment, represented a major problem in the treatment of schizo phrenic patients.
Real-world and clinical trial data support that clozapine is the only effective antipsychotic for treatment resistant schizophrenia and other severe mental illnesses. Clozapine also reduces rates of suicidality, psychiatric hospitalization and all-cause mortality. However, clozapine is underutilized for two reasons: misunderstandings of its efficacy benefits and misapprehension of, limited knowledge or misinformation about the management of treatment related risks and adverse effects. In response to worldwide efforts to promote clozapine use, this user-friendly Handbook provides clinicians with evidence-based approaches for patient management, as well as logical approaches to the management of clinical situations and adverse effects. It outlines clearly the rationale for specific management decisions and prioritises the options based on this logic. This Handbook is designed for use by clinicians worldwide and is essential reading for all mental health care professionals.
The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.
Since the development of pharmacoconvulsive therapy in 1934 and of electroconvulsive therapy (ECT) in 1938, ECT has proven far more valuable than just the intervention of last resort. In comparison with psychotropic medications, we now know that ECT can act more effectively and more rapidly, with substantial clinical improvement that is often seen after only a few treatments. This is especially true for severely ill patients -- those with severe major depression with psychotic features, acute mania with psychotic features, or catatonia. For patients who are physically debilitated, elderly, or pregnant, ECT is also safer than psychotropic medications. The findings of the American Psychiatric Association (APA) Task Force on ECT were published by the APA in 1990 as the first edition of The Practice of Electroconvulsive Therapy, inaugurating the development of ECT guidelines by groups both within the United States and internationally. Since then, advances in the use of this technically demanding treatment prompted the APA to mandate a second edition. The updated format of this second edition presents background information followed by a summary of applicable recommendations for each chapter. This close integration of the recommendations with their justifications makes the material easy to read, understand, and use. To further enhance usability, recommendations critical to the safe, effective delivery of treatment are marked with the designation "should" to distinguish them from recommendations that are advisable but nonessential (with the designations "encouraged," "suggested," "considered"). The updated content of this second edition, which spans indication for use of ECT, patient evaluation, side effects, concurrent medications, consent procedures (with sample consent forms and patient information booklet), staffing, treatment administration, monitoring of outcome, management of patients following ECT, and documentation, as well as education, and clinical privileging. This volume reflects not only the wide expertise of its contributors, but also involved solicitation of input from a variety of other sources, including applicable medical professional organizations, individual experts in relevant fields, regulatory bodies, and major lay mental health organizations. In addition, the bibliography of this second edition is based upon an exhaustive search of the clinical ECT literature over the past decade and contains more than four times the original number of citations. Complemented by extensive annotations and useful appendixes, this remarkably comprehensive yet practical overview will prove an invaluable resource for practitioners and trainees in psychiatry and related disciplines.
This book offers a new approach to understanding and treating psychotic symptoms using Cognitive Behavioural Therapy (CBT). CBT for Psychosis shows how this approach clears the way for a shift away from a biological understanding and towards a psychological understanding of psychosis. Stressing the important connection between mental illness and mental health, further topics of discussion include: the assessment and formulation of psychotic symptoms how to treat psychotic symptoms using CBT CBT for specific and co-morbid conditions CBT of bipolar disorders. This book brings together international experts from different aspects of this fast developing field and will be of great interest to all mental health professionals working with people suffering from psychotic symptoms.