Multisystemic therapy

If the client is an adolescent or child and engaging in antisocial behavior, then comorbid Conduct Disorder should be considered, although such behavior also may indicate an Oppositional-Defiant Disorder if there is little deviant behavior but lots of arguing and defying the wishes of authorities such as parents and teachers. Adult antisocial behavior is difficult to treat but usually involves use of behavior modification (see Chapter 5) through the use of incentives. Conduct Disorder and Oppositional-Defiant Disorder can be successfully treated with behavior modification and by modifying the youth s environment (e.g., using multisystemic therapy or the community reinforcement model — see Chapter 5). 

Multisystemic Therapy (MST) Indicated An intensive intervention aiming to prevent reoccurrences of misbehavior in adolescents who once had contact with juvenile court systems. Participants are treated with cognitive-behavioral therapy, which is provided by trained professionals. 

Bums, B., Schoenwald, S., Burchard, J., Faw, L., Santos, A. (2000). Comprehensive community-based interventions for youth with severe emotional disorders Multisystemic therapy and the wraparound process. Journal of Child and Family Studies, 9, 283-314. 

Schoenwald, S. K., Borduin, C. M., Hen eler, S. W. (1998). Multisystemic therapy Changing the natural and service ecolc ies of adolescents and families. In M. H. Epstein K. Kutash (Eds.), Outcomes for children and youth with emotional and behavioral disorders and their families Programs and evaluation best practices (pp. 485-511). Austin, TX PRO-ED, Inc. 

There are over 40 lysosomal storage disorders (LSDs) characterized by the specific enzyme deficiency and accumulated substrate. Pathologies associated with LSDs are multisystemic and variable including CNS, skeletal, cardiovascular, renal, and ocular system involvement. The aggregate incidence is estimated to approach 1 in 7000 live births (Ellinwood et al., 2004). Inheritance for LSDs is primarily autosomal recessive with the exception of two X-linked diseases (Fabry and mucopolysaccharidosis (MPS) II). Treatment for LSDs relies on providing functional enzyme to the lysosomes of affected cells and has traditionally been confined to bone marrow transplantation, and enzyme replacement therapy (ERT). 

Diabetic Sequelae - While the development of insulin replacement therapy has greatly prolonged the diabetic s lifespan, it has not had a major impact in the prevention of the myriad of sequelae associated with longstanding diabetes. Kidney, retina, peripheral nerve, lens and the cardiovascular system all suffer dysfunctions secondary to diabetes. The multisystem nature of this disease has made difficult the development of a unifying hypothesis to explain these sequelae. 

Awad SS. State-of-the-art therapy for severe sepsis and multisystem organ failure. Am J Surg 2003 186 23-308. 

Desnick R J, et al (2003). Fabry disease, an under-recognized multisystemic disorder Expert recommendations for diagnosis, management, and enzyme replacement therapy. Ann. Intern. Med. 138(4) 338-346. 

Brehm G, Korting GW (1970) Bullose Hautreaktion auf Nalidixinsaure. Med Weld 11 423 Brockner J, Boisen E (1978) Fatal multisystem toxicity after Co-trimoxazole. Lancet 1 831 Brown A (1976) Risks of isoniazid therapy. Ann Intern Med 85 828 Browne SG, Harman DJ, Waudby H, McDougall AC (1981) Clofazimine (Lamprene, B 663) in the treatment of lepromatous leprosy in the United Kingdom. Int J Lepr 49 167... 

Respiratory TNFa antagonists may be of benefit in the treatment of advanced or refractory sarcoidosis, a multisystem granulomatous inflammatory disease of unknown aetiology but, paradoxically, a sarcoidosis-like reaction may sometimes occur with TNFa blockade. A sarcoid-like reaction with pulmonary symptoms occurred in a patient with psoriatic arthritis soon after the initiation of adalimumab. lATthdrawal of the mAb and antiinflammatory therapy with corticosteroids resulted in resolution of the pulmonary symptoms [75 ]. 

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