Acute phase treatment

The first decision when beginning acute phase treatment is choosing the primary treatment modality psychotherapy, medication, or both. Several short-term therapies including CBT, IPT, brief psychodynamic therapy, and marital therapy are effective treatments in mild-to-moderate cases of depression without added antidepressant treatment. This is a viable alternative that many patients may prefer. 

Sleep is another concern during maintenance therapy. As we noted in the discussion of acute phase treatment, sleep deprivation can destabilize mood and is often the first sign of an impending episode of illness. Therefore, it remains imperative that the patient sleeps well. It is common practice for patients to keep a small supply of a hypnotic agent such as zolpidem or a benzodiazepine to use as needed in the event of sleep disturbance. Furthermore, patients should routinely be advised to notify their physician should they have two or more consecutive nights of poor sleep so that more aggressive measures can be taken to circumvent the possible development of an illness episode. 

Acute Phase Treatment. The short-term objective when treating panic disorder is to optimize symptom relief. This primarily consists of reducing the severity and frequency of panic attacks but also includes the anticipatory anxiety and secondary... 

Acute Phase Treatment. There is considerable-evidence that cognitive-behavioral therapy (CBT) is effective in the treatment of OCD. Some studies have even suggested that CBT may provide enduring prophylactic benefit against OCD... 

Specific Sociai Anxiety Disorder, Acute Phase Treatment. Different strategies have evolved for treating specific social anxiety disorder versus generalized social anxiety disorder. Less complicated is the management of the specific subtype. Exposure-based psychotherapy is a mainstay of treatment, and as-needed medication doses prior to scheduled performances are also widely used. Preferred agents for performance anxiety are alprazolam or propranolol. 

Generalized Sociai Anxiety Disorder, Acute Phase Treatment. CBT is... 

Acute Phase Treatment. Hypnotic medications are useful for short-term treatment of insomnia, but they should always be accompanied by behavioral and psychoeducational treatments, including a review of good sleep hygiene practices. It may also include more aggressive measures such as relaxation training, sleep restriction therapy, and stimulus control therapy. 

The subject of intense research, nitrocytoprotectors (piracetam, gingko biloba, almitrine/raubasine) are searching for their role in acute phase treatment. In certain countries, available drugs have been used in the functional rehabilitation phase (cognitive benefit). BN 80933 is an anti-free radical and anti-NO synthetase molecule which appears to have a powerful curative effect in animals. 

HCV infection is rarefy diagnosed in the acute phase, as most acutely infected individuals are asymptomatic. Between 50% and 90% of patients develop chronic infection, however, and this warrants early therapy. After occupational exposure with a known date, treatment should not be started before the acute episode characterized by alanine aminotransferase elevation, but it should always be started within 24 weeks after the onset of symptoms. The optimal treatment schedule for acute hepatitis C is controversial. Pegylated IFN-a monotherapy at the standard dose for 24 weeks yielded SVR rates close to 100% in symptomatic patients referred to tertiary care centers (De Rosa et al. 2006 Jaeckel et al. 2001 Santantonio et al. 2005 Wiegand et al. 2006). Shorter therapy may be envisaged (Calleri et al. 2007). Combination with ribavirin is recommended if a first course of pegylated IFN-a monotherapy fails to eradicate the infection. Viral elimination appears to be independent of the HCV genotype and the HCV RNA level (Calleri et al. 2007 De Rosa et al. 2006 Jaeckel et al. 2001). 

Ticlopidine inhibits the P2Yj2 platelet ADP receptor, thus inhibiting ADP-dependent activation of the GP Ilb/IIIa receptor. It has a slow onset of action and takes 3-7 days to reach its maximal antiplatelet effect. It is inactive in vitro and must undergo activation by the hepatic cytochrome p450 enzyme system. Secondary prevention trials have found that ticlopidine-treated patients have an estimated RRR of 33% for the composite endpoint of stroke, myocardial infarction, or vascular death after ischemic stroke. Significant adverse effects include bone marrow depression, rash, diarrhea, and thrombotic thrombocytopenic purpura. No clinical trials have studied ticlopidine for the treatment of stroke in the acute phase. 

Discontinue ipratropium pharmacotherapy after the acute phase of treatment, as it is unlikely that it will provide any additional benefit... 

Shirley, NY) sodium ferric gluconate (Ferrlecit by Watson Pharmaceuticals, Inc., Corona, CA) and iron sucrose (Venofer by American Reagent, Inc., Shirley, NY). Initiation of IV iron should be based on evaluation of iron stores. A serum ferritin level less than 100 ng/mL in conjunction with a TSAT level less than 20% indicates absolute iron deficiency and is a clear indication for the need for iron replacement.31 When TSAT is less than 20% in conjunction with normal or elevated serum ferritin levels, treatment should be based on the clinical picture of the patient, as serum ferritin is an acute phase reactant, which may become elevated with inflammation and stress. Iron supplementation may be indicated if Hgb levels are below the goal level. 

The acute phase of panic disorder treatment lasts about 12 weeks and should result in marked reduction in panic attacks, ideally total elimination, and minimal anticipatory anxiety and social anxiety avoidance. Treatment should be continued to prevent relapse for an additional 12 to 18 months before attempting discontinuation. 

Treatment options include medication, psychotherapy (e.g., CBT preferred), or a combination of both. In some cases, pharmacotherapy will follow psychotherapy treatments when full response is not realized. Patients with panic symptoms without agoraphobia may respond to pharmacotherapy alone. Agoraphobic symptoms generally take longer to respond than panic symptoms. The acute phase of PD treatment lasts about 12 weeks and should result in marked reduction in panic attacks, ideally total elimination, and minimal anticipatory anxiety and phobic avoidance. Treatment should be continued to prevent relapse for an additional 12 to 18 months before attempting discontinuation. 6 49 Patients who relapse following discontinuation of medication should have therapy resumed.49... 

When advising potential travelers on prophylaxis for malaria, be aware of the incidence of chloroquine-resistant P. falciparum malaria and the countries where it is prevalent. In patients who have P. vivax or P. ovale malaria (note that some patients can have P. falciparum and one of these species), following the treatment of the acute phase of malaria and screening for glucose-6-phosphate dehydrogenase deficiency, patients should receive a regimen of primaquine for 14 days to ensure eradication of the hypnozoite stage of P. vivax or P. ovale. For detailed recommendations for prevention of malaria go to www.cdc.gov/travel/. 

Treatment of the acute phase of the disease (i.e., fever, malaise, edema of the face, and hepatosplenomegaly) is nifurtimox. The congestive heart failure associated with cardiomyopathy of Chagas disease is treated the same way as cardiomyopathy from other causes. 

The acute phase of treatment lasts 6 to 10 weeks, and the goal is remission (i.e., absence of symptoms). 

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