Maintenance phase

However, when there is clear evidence of persistent illness or when the patient endures several acute episodes of illness, treatment shonld be indefinite and probably lifelong. Except in the residual phases of illness, discontinuing antipsychotic medication exposes the schizophrenia patient to a serious risk of relapse. However, there is evidence that gradually decreasing the dose of antipsychotic in 4 week intervals can still provide good protection from relapse while lowering the risk of side effects. 

Some researchers have investigated the notion of intermittent treatment. Patients are intensively monitored off medication, and a medication is started once prodromal signs of an impending acnte exacerbation are detected. One thought is that this minimizes the risk of side effects snch as tardive dyskinesia. Althongh in theory this may sound attractive, nnfortnnately, it rarely is successful in practice. Patients receiving intermittent treatment are at exceptionally high risk for relapse. 

During the maintenance phase, treatment can be fine-tnned. If persistent side effects (especially EPS) are a problem, then the antipsychotic can be gradnally switched or conntermeasures snch as anticholinergic therapy can be taken. In addition, maintenance therapy is also an appropriate time to address the less dramatic bnt nonetheless tronblesome symptoms snch as a mood distnrbance. Antidepressants are often used to treat depressed mood in patients with schizophrenia. Likewise, benzodiazepines are commonly nsed with an antipsychotic to treat persistent yet subsyndromal anxiety in schizophrenia patients. 

For patients in whom treatment noncompliance is a recurring problem, the snccess of maintenance therapy can greatly be enhanced by administering a depot formnlation of the antipsychotic. Depot formulations are currently available for haloperidol (which must be administered once every 4 weeks) and risperidone or fluphenazine (each of which must be administered once every 2 weeks). 

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Failure analysis statistics have consistently shown that many machinery components failures can be directly attributed the equipment being operated outside of design parameters or unintended conditions. Most failure analysis and trouble-shooting activities are usually post-mortem and commence after installation and start-up of the equipment. The maintenance phase is now in motion, and failure analysis and trouble-shooting is now an integral part of that phase. 

During the maintenance phase dose reductions are aimed. However, in most cases a dual or triple combination therapy is still necessary. The use of drugs with different mechanisms of immunosuppressive action allows the application of lower doses additionally resulting in decreased toxicity. 

Explain the purpose of induction, consolidation, and maintenance phases for acute leukemia. 

The treatment for ALL consists of three main elements remission induction, intensification (consolidation), and continuation (maintenance) phases of treatment.3 Therapy to eradicate subclinical CNS leukemia is also an integral part of therapy for ALL (Table 92-7). 

If hyperkalemia is present after the hydrocortisone maintenance phase, additional mineralocorticoid usually is required. Fludrocortisone acetate 0.1 mg orally once daily is the agent of choice. 

The necessary components of oral rehydration therapy (ORT) solutions include glucose, sodium, potassium, chloride, and water (Table 39-2). The American Academy of Pediatrics recommends rehydration with an electrolyte-concentrated rehydration phase followed by a maintenance phase using dilute electrolyte solutions and larger volumes. 

The maintenance phase should not exceed 100 to 150 mL/kg/day and is generally adjusted to equal stool losses. 

The maintenance phase lasts at least 12 to 36 months, and the goal is to prevent recurrence of a separate episode of depression. 

Something like 70% of work on the average software design is done after its first installation. This means that an approach, such as reuse, aimed at reducing costs must be effective in that maintenance phase and not just in the initial design (see Figure 11.1). 

Aikens JE, Nease Jr DE et aL (2005) Adherence to maintenance-phase antidepressant medication as a function of patient beliefs about medication. Ann Fam Med 3 23-30 Blenkinsopp A, Bond C, Britten N (1997) From compliance to concordance. Achieving shared goals in medicine taking. Royal Pharmaceutical Society of Great Britain and Merck Sharpe Dome, London UK... 

Maintenance Phase Treatment. The purpose of this phase of treatment is to provide protection against a recurrence of the illness. In contrast to a relapse, a recurrence is the development of a new episode of depression after the complete resolution of a prior episode. Though theoretically defensible, the distinction between a relapse and recurrence is often vague. 

As in the continuation phase, the antidepressant that successfully achieved remission should be continued at the same dose during the maintenance phase of treatment. A collaborative decision between patient and physician is crucial to the success of the maintenance phase of treatment. These collaborative assessments should be repeated every 1-2 years and will require exploration of the patient s attitudes toward prolonged treatment. 

Maintenance Phase Treatment. BPAD is a lifelong illness, but the severity and frequency of episodes are highly variable from patient to patient. In addition, episodes of BPAD tend to occur more frequently as the illness progresses. When we consider the kindling models suggesting that each episode of BPAD increases the patient s vulnerability to future episodes, then early and vigorous prophylactic treatment should theoretically improve the long-term course of the disorder. Consequently, appropriate maintenance therapy is critical to the successful treatment of BPAD. 

When approaching the treatment of schizophrenia, it is best to view the illness in one of four distinct phases prodromal phase, acute phase, maintenance phase, and residual phase. Let us take a look at the treatment options at each of these phases of the illness. 

The goals of treatment during the acute phase of illness are to reduce the positive symptoms of schizophrenia and to plan for extended treatment during the maintenance phase. Reducing the positive symptoms quickly is important for at least two reasons. First, the erratic behavior of an acutely psychotic patient can take a tremendous toll, risking arrest, loss of job, suicide, and the alienation of friends and family. Second, there is some evidence that psychosis itself is harmful to the brain. In other words, it may be that the longer the patient is actively psychotic, the worse the prognosis becomes. 

Maintenance Phase Treatment. Because panic disorder tends to be a chronic condition, the appropriate duration of therapy is a critically important question. Conventional practice is to continue treatment for 6-9 months after remission has been achieved and then to taper medicines gradually over several weeks to months. The relapse rate is extremely high with over one-half of those treated with medications alone experiencing a relapse within a few months of discontinuing treatment. There is some evidence that CBT may reduce this relapse rate. When relapse occurs, it is usually advisable to restart the medication that was previously used. 

Maintenance Phase Treatment. OCD is typically a lifelong disorder that rapidly recurs when treatment is discontinued. Consequently, maintenance therapy lasting at least 1-2 years is recommended for all patients with OCD. During medication discontinuation, periodic CBT sessions are commonly used to increase the likelihood of sustained remission. Long-term pharmacotherapy is recommended after only two moderately severe episodes of OCD. 

Generalized Social Anxiety Disorder, Maintenance Phase Treatment. 

Specific Serotonin Reuptake inhibitors (SSRis). To date, the only SSRI studied in AN is fluoxetine (Prozac). During the acute refeeding phase of treatment, fluoxetine shows modest improvement in weight gain while a larger controlled study during the maintenance phase of treatment demonstrated effectiveness in the prevention of relapse. From the standpoint of side effects and toxicity, the SSRIs are clearly... 

There likely remains a role for pharmacotherapy for some AN patients during the maintenance phase of treatment. Appetite stimulants, prokinetics, and anxiolytics should be tapered and discontinued at the conclusion of the acute phase of treatment. However, early evidence suggests that continued antidepressant administration may help to sustain remission. The appropriate duration for maintenance pharmacotherapy in AN has not been well studied and remains open to debate. 

The pharmacological management of bipolar disorder involves treatment of both the acute and the longer-term maintenance phase of the illness. Longterm maintenance is necessary to reduce or prevent the recurrence of the symptoms, and to minimize the risk of suicide. 

Tissues, including the brain, that have a high blood flow per unit mass (Fig. 25.1) equilibrate with the alveolar tension of anesthetic gases first. Tissues with lower blood flow require a longer time and continue to accumulate anesthetic gas during the maintenance phase of... 

Tactics for Duration and Intensity of Treatment During Acute and Maintenance Phases... 

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