Treatment Approaches

Specific interventions that counter anxiety arousing include relaxation training (15). The mindfulness approach, as popularized by Jon Katat-Zinn (24), assists patients to focus on the here and now. Music therapy has also been shown to have positive results in reducing anxiety for patients on LTMV (25). Professional support is valuable when addressing sensitive issues, such as end-of-life decisions and advanced directives for medical care. For terminally ill patients, family members can be assisted in expressing their loss, grief, and guilt. 

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The treatment approach to RA has undergone a major evolutionary change in recent years with a move away from predominantly symptomatic treatment approaches towards much earlier intervention with diseasemodifying anti-rheumatic drug (DMARD) therapy and... 

The development of effective pharmacotherapy has lagged behind progress in understanding the reward mechanisms and chronic impairments underlying stimulant abuse. Pharmacological and behavioral treatment approaches that have been used for cocaine abuse have not been as widely tested for the treatment of amphetamine abuse, limiting what can be offered for treatment of this disorder. No treatment agents are approved by the FDA for treatment of cocaine or amphetamine dependence. 

A number of randomized chnical trials have demonstrated the efficacy of CBT for treating substance use disorders, compared with no-treatment control conditions (see Carroll 1996 for review). However, the superiority of CBT over other psychosocial treatments is not as clear. Although some studies have found CBT to be more effective than other treatments, others have found this method to be comparable to other treatment approaches (Carroll 1996). In Project MATCH, for instance, CBT, MET, and 12-step facihtation produced similar outcomes, with each therapy leading to substantial improvement in alcohol-related symptoms during the 12-week treatment period (Project MATCH Research Group 1997). 

Many studies have examined the efficacy of a variety of psychosocial treatments for alcohol, cocaine, and opioid use disorders, alone and in conjunction with pharmacotherapy. However, only a handful of studies have explored how these two treatment approaches may interact. More research is needed to further explore the ways in which psychosocial interventions may be used in conjunction with pharmacotherapy to optimize outcomes for both treatments. Providing encouragement for abstinence, greater treatment retention, medication adherence, and coping with medication side effects are some potential applications of psychosocial therapies. 

To further improve sustained virologic response rates, different treatment approaches are currently under investigation. For example, individualized therapy durations on the basis of the HCV RNA concentration at baseline and early during therapy are the subject of clinical studies (Berg et al. 2006 Zeuzem et al. 2005a). In addition, triple therapy with other antiviral compounds, such as amantadine, has been evaluated in multiple studies, leading to contradictory results (Mangia et al. 2004). 

In addition to their inherent self-sustaining properties, brain tumor stem cells may be more resistant to chemotherapy and radiation therapy than other tumor cells. Bao et al. (2006) found glioma stem cells (CD133+) were relatively radioresistant compared to CD133- tumor cells and preferentially activated the DNA damage checkpoint response. This relative resistance to standard treatment approaches of tumor stem cells compared to the majority of other cells within a tumor may underlie our current inability to cure patients with aggressive brain tumors such as glioblastoma. 

The treatment approach to address these goals is illustrated in Fig. 4-4. 

FIGURE 7-5. Treatment approach for patients with VTE. INR, International Normalized Ratio IV, intravenous LMWH, low-molecular-weight heparin PO, oral SC, subcutaneous UFH, unfractionated heparin VTE, venous thromboembolism. (Adapted from Nutescu EA. Emerging options in the treatment of venous thromboembolism. Am J Health Syst Pharm 2004 61 (Suppl 7) S16, with permission.)... 

Hypnosis maybe effective for severe NVP.11 Psychotherapy is another non-invasive treatment approach that is safe during pregnancy or in situations in which adverse treatment effects and drug interactions are a concern. One small study suggested that patients with hyperemesis gravidarum may benefit from the combination of psychotherapy and antiemetics. 

The treatment approach of SE in children is similar to that in adults with a few exceptions (Table 28-4). The doses are also weight-based but are typically higher than those used in adults due to higher clearance by the liver. It may be difficult to rapidly obtain IV access in children, so alternate methods of... 

TABLE 33-6. A "Symptoms-Based" Treatment Approach for Opioid Withdrawal... 

Recommend treatment approaches for special populations of patients with bipolar disorder, including pediatric patients, geriatric patients, and pregnant patients. 

Psychotherapy is an appropriate treatment approach for patients with psychogenic or mixed dysfunction. It should address immediate causes of dysfunction, and if possible the partner should attend sessions as well. Effectiveness is not well documented for organic dysfunction unless combined with other therapies. Advantages include non-invasiveness and partner participation, while disadvantages include increased cost and time commitment. 

Describe nonpharmacologic treatment approaches (including surgery) for urinary incontinence or pediatric enuresis. 

Acne is categorized as mild, moderate, or severe based on lesion type and severity and successful treatment approaches are developed based on these categories. 

Recommend treatment approach for the initial treatment of immune thrombocytopenic purpura (UP). 

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

Following resection of liver metastases, infusion of chemotherapy through the portal vein provides an additional adjuvant treatment approach. Historically 5-FU and floxuri-dine have been the agents used most commonly for hepatic portal vein infusion owing to their high metabolism in the liver. Although some studies demonstrate a decrease in recurrence rates, the value of portal vein infusion of chemotherapy for colon cancer remains to be determined.25 Table 88-4 summarizes adjuvant treatment recommendations for colon cancer. 

Finally patients who fail standard treatment for metastatic colorectal cancer should be encouraged to participate in a clinical trial evaluating new treatment approaches for this incurable disease. Table 88-5 lists options for first- and second-line... 

Outline the general treatment approach to follicular indolent and diffuse aggressive non-Hodgkin s lymphoma for localized and advanced disease. 

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