GENERAL CLINICAL PRACTICE

The mood stabilizers were so called because they prevent recurrences of mood swings in people with bipolar disorder. The evidence for this is best with lithium, but is based on smdies carried out more than 20 years ago. However, recent naturalistic surveys tend to find that lithium is far less useful in general clinical practice than in research settings. Many patients discontinue lithium... 

As mentioned in chapter 2, individuals particular personality style and unique psychodynamics will often dramatically influence how they respond to pharmacotherapy. Robert Michaels (1992) has commented that in general clinical practice two-thirds of patients with Axis I disorders appear to respond quite well either to medication treatment or to brief, targeted psychological interventions, such as cognitive-behavioral or interpersonal therapy. However, a significant minority of patients with clear-cut Axis I disorders don t respond well to such treatments, primarily due to serious co-morbid character pathology. In treating these people, at the very least the clinician must be alert to how personality factors influence treatment outcome often medication treatment must be accompanied by more intensive psychotherapy that addresses the personality disorder. 

The high improvement rates are seen in those individuals for whom the diagnosis is correct and for whom treatment is appropriately managed. Diagnostic and treatment errors abound, and in general clinical practice success rates usually fall below 80 percent. 

The following list of pharmacist practice activities describes a general clinical practice model ... 

Nestler EJ, Hyman SE, Malenka RC Molecular Neuropharmacology A Foundation for Clinical Neuroscience. New York, McGraw Hill, 2001 Novick DM, Pascarelli EE, Joseph H, et al Methadone maintenance patients in general medical practice a preliminary report. JAMA 259 3299—3302, 1988 Nunes EV, Quitkin EM, Donovan SJ, et al. Imipramine treatment of opiate-dependent patients with depressive disorders a placebo-controlled trial. Arch Gen Psychiatry 55 153-160, 1998... 

The most common criticism of our meta-analysis is the claim that the clinical trials we analysed were flawed, and that better results would have been found if the studies had been designed better. The trials were too short to show the real effect of antidepressants, the critics said. The people recruited to participate in them were not depressed enough, or they were too depressed. In any case, they were not representative of the patients who are generally seen in clinical practice. 

NICE, Depression Management of Depression in Primary and Secondary Care. Clinical Practice Guideline No. 23 , National Institute for Clinical Excellence www.nice.org.uk/page.aspxio = 235213 Nitzan, Uriel and Pesach Lichtenberg, Questionnaire Survey on Use of Placebo , British Medical Journal 329 (2004) 944-46 Park, Lee C. and Lino Covi, Nonblind Placebo Trial , Archives of General Psychiatry 12, no. 4 (1965) 336-45... 

Turning to the section on drugs for clinical disorders, we will examine some general principles about best clinical practice. In many chapters it was concluded that the best therapy comprises an effective... 

Before a genetic test can be generally accepted in clinical practice, data must be collected to demonstrate the benefits and risks that accrue from both positive and negative results" (Holtzman and Watson, 1998, p. 29). 

In general, it is preferable to choose excipients and processes for IR dosage forms that do not result in a formulation that requires a particular pH to function well. In the general population, the pH in the stomach is quite variable (see the subsection Choice of Dissolution Test Conditions for Quality Control ) and there is no guarantee that the dosage form will be exposed to acid, so dosage forms that require acid to facilitate release are unlikely to perform robustly in the clinical practice setting. 

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