Aggression, treatment

Aggressive treatment to reduce and maintain blood pressure excludes patients from fibrinolytic eligibility. 

SBP greater than 185 mm Hg or DBP greater than 110 mm Hg at the time of treatment, or patient requires aggressive treatment to reduce blood pressure to within these limits... 

Disseminated or CNS cryptococcosis requires a more aggressive treatment approach, particularly in the immunocompromised host. Pretreatment predictors of poor outcome with antifungal therapy include ... 

Describe patients who may be observed without treatment and those who receive aggressive treatment for chronic lymphocytic leukemia (CLL). 

The most recent treatment paradigm calls for earher, more aggressive treatment of rheumatoid arthritis. DMARDs are frequently employed along with NSAIDs in the initial treatment of the disease. The COX-2 inhibitors are often used because they are less likely to cause serious GI toxicity than are the nonspecihc COX inhibitors. The usual DMARD of choice for patients with mild rheumatoid arthritis is hydroxychloroquine or sulfasalazine methotrexate is used for those with moderate to serious disease. Other DMARDs are used if these agents are poorly tolerated or do not produce suf-hcient response. Combination therapy of methotrexate and another agent is also used to treat disease that is not responsive to individual DMARDs. 

B. Status asthmaticus is a dangerous exacerbation of asthma symptoms. It requires immediate and aggressive treatment with oxygen, inhaled bronchodilators, and systemic corticosteroids. Hospitalization of the patient is often indicated. By definition, status asthmaticus is not a condition in which symptoms are well controlled. Neither cromolyn sodium nor a leukotriene modulator is indicated for the treatment of status asthmaticus, as their onset of action is too slow. Status asthmaticus often does not resolve without aggressive intervention. Indeed, the patient s condition can deteriorate rapidly to death. Upper respiratory tract infection or excessive exposure to an allergen often precedes status asthmaticus, as does increased use of inhaled bronchodilators. 

A second part consists of two chapters covering other somatic interventions, including complementary, alternative, and naturopathic medicine approaches (such as St. John s wort), as well as more aggressive treatments less commonly used in children and adolescents, such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS). 

There are as many approaches to treating TRD as there are antidepressants available. More than 300 potential treatment options are available. However, given the possibility of a substantial therapeutic decrement, it is imperative to apply adequate aggressive treatments early in therapy. 

In partially responsive or nonresponsive patients, the first issue is to determine whether an individual is truly treatment-resistant, because many receive nontherapeutic doses and the potential for improvement may not be adequately tested. Thus, in some situations, more aggressive treatment (dose increase, augmentation) may be appropriate, if not precluded by adverse effects. In selected cases, it may also be helpful to monitor plasma levels to ensure that they are in a reasonable range (see Pharmacokinetics/Plasma Levels earlier in this chapter). If a patient continues to demonstrate significant symptoms after a sufficient trial (2 to 3 weeks), alternatives to switching to another antipsychotic may include the addition of lithium, an anticonvulsant, or a second antipsychotic agent. An antidepressant or anxiolytic may also be helpful, especially if affective or anxiety symptoms are prominent. 

Is it the sequelae of an MDD episode that did not receive prompt and aggressive treatment ... 

For such patients, aggressive treatment of their mood disorder may be particularly important in achieving and maintaining sobriety. 

Keller et al. (46) were also surprised to find that 75% of the nonrecovered patients had been treated with sustained, high levels of drug and/or somatic therapies and concluded that mixed or cycling patients have a more pernicious course and require more effective therapies. In addition, to achieve earlier remission, clinicians should begin aggressive treatment in the initial symptomatic stages, because the purely manic and depressed groups also had severe episodes despite adequate... 

The most serious complication of hyperthyroidism is thyroid storm (thyrotoxic crisis). This is an acute exacerbation of hyperthyroidism with marked tachycardia, fever, mental status changes and haemodynamic collapse. It is usually precipitated by acute illness, trauma, parturition or surgery, especially of the thyroid gland. The mortality rate is 20-30%, even with aggressive treatment, due to cardiac failure, arrhythmias or hyperthermia. 

Steinberg D et al Evidence mandating earlier and more aggressive treatment of hypercholesterolemia. Circulation 2008 118 672. [PMID 18678783]... 

Fig. 11—40) and clinical features, not only as compared with clozapine (Fig. 11 — 37) but also as compared with risperidone (Fig. 11—39)- Olanzapine is atypical in that it generally lacks EPS, not only at moderate doses but usually even at high doses. Thus, olanzapine tends to be used for some of the most difficult cases of schizophrenia, bipolar disorder, and other types of psychosis in which good control of psychosis without EPS is still desired, yet aggressive treatment is required. On the other hand, this approach can be very expensive. 

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