Treatment resistance definition

For approximately 20% to 30% of people with schizophrenia, drug treatment is ineffective. A standard definition of treatment resistance includes patients who have persistent positive symptoms despite treatment with at least two different antipsychotics given at adequate doses (at least 600 chlorpro-mazine equivalents) for an adequate duration (4 to 6 weeks). In addition, patients must have a moderately severe illness as defined by rating instruments, and have a persistence of illness for at least 5 years.40 These patients are often highly symptomatic and require extensive periods of hospital care. 

Approximately 30-40% of patients will not respond to a given antidepressant and 60-75% may fail to achieve complete remission [16]. Consequently, in its least restricted definition, treatment resistance could be detected in the majority of depressed patients under treatment. Moreover, prior treatment failure negatively influences the response to subsequent antidepressant treatment, decreasing the odds of treatment response by a factor of 15-20% for each failed treatment [17]. The delayed onset of symptom relief (which takes three to eight weeks to occur) and the presence of adverse drug reactions contribute significantly to low treatment compliance. 

It has been estimated that at least 30% of patients with major depression fail to respond to a 6-week course of a TCA antidepressant. A major problem arises however in the definition of "treatment resistance". To date, there appears to be no internationally acceptable definition of the condition. A practical definition which many clinicians find useful is that treatment resistance occurs when the patient fails to respond to ... 

Controlled studies involving lipid manipulation in children date back to the 1920s, when the ketogenic diet was pioneered to control treatment-resistant seizures in select pediatric populations (Freeman et al., 1998). However, no controlled evidence is available in children with depression, bipolar disorder, behavioral problems, or ADHD. In the absence of definite empirical data about effectiveness, treatment with EFA supplements should be considered unproven and patients ought to be advised accordingly. 

Fava M High-dose fluoxetine in the treatment of depressed patients not responsive to a standard dose of fluoxetine. J Affect Disord 25 229-234, 1992 Fava M, Davidson KG Definition and epiemiology of treatment-resistant depression. 

Nierenberg AA, Amsterdam JD Resistant depression definition and treatment approaches. J Chn Psychiatry 51 (suppl) 39-47, 1990 Nierenberg AA, Adler LA, Peselow E, et al Trazodone for antidepressant-associated insomnia. Am J Psychiatry 151 1069-1072, 1994a Nierenberg AA, Feighner JP, Rudolph R, et al Venlafaxine for treatment-resistant unipolar depression. J Chn Psychopharmacol 14 419-423, 1994b... 

Before making a definitive diagnosis of a primary depression or concluding the existence of treatment resistance, one must consider the possibility of another concurrent, confounding medical or psychiatric disorder, in addition to depression. 

Fava, M. and Davidson, K. G. (1996) Definition and epidemiology of treatment-resistant depression. Psychiatr Clin North Am 19, 179-200. 

In a 12-week, double-blind, randomized, placebo-controlled study in 40 patients with treatment-resistant schizophrenia (funded by Johnson Johnson Pharmaceutical Research Development), the addition of risperidone to clozapine improved overall symptoms and positive and negative symptoms (49). The adverse events profile of clozapine + risperidone was similar to that of clozapine + placebo. Clozapine + risperidone did not cause additional weight gain, agranulocytosis, or seizures compared with clozapine + placebo. All the patients completed 12 weeks of treatment however, the small sample size precluded definitive conclusions. 

An official definition of treatment resistance does not exist. In general, itreflects apatient who has had inadeqnate symptom response... 

Treatment-resistant depression has varying definitions but usually refers to a failttre to... 

Fava M. Diagnosis and definition of treatment resistant depression. Biol Psychiatry 2003 53 649-659. 

When treatment is initiated before definitive culture and sensitivity results are known, consider that these agents are only effective in the treatment of infections caused by pneumococci, group A beta-hemolytic streptococci, and penicillin G-resistant and penicillin G-sensitive staphylococci. 

Clear abnormalities of the dopamine system have not been identified in the periphery or the brain of OCD patients. Nevertheless, repetitive stereotypies and OCD-like behaviors can be produced in humans by the administration of exogenous D2 agonist or stimulants, which suggests that the dopaminergic system may be involved in some way in OCD. Conversely, antipsy-chotics can be used adjunctively in the treatment of selective serotonin reuptake inhibitor (SSRl)-resistant OCD patients with a definite benefit in a significant proportion of patients. 

Finally, it is universally accepted at present that Helicobacter pylori infection has a definitive ethiological role in peptic ulcer disease, and that erradication therapy is warranted in these clinical scenarios. The majority of therapeutic trials have included the application of triple therapy with proton pump inhibitors or ranitidine bismuth citrate, clarithromycin and either amoxycillin or metronidazol and is to date the treatment of choice. However, recent studies have reported antibiotic resistance which can be one reason for failure of treatment of Helicobacter pylori infection [101-103], and new treatment strategies are therefore Wellcome. Flavonoids, in addition to their gastroprotective activity previously commented, have been also shown to inhibit Helicobacter pylori growth in vitro. In this way, Beil et al. [50]... 

The mood stabilizer lithium was developed as the first treatment for bipolar disorder. It has definitely modified the long-term outcome of bipolar disorder because it not only treats acute episodes of mania, but it is the first psychotropic drug proven to have a prophylactic effect in preventing future episodes of illness. Lithium even treats depression in bipolar patients, although it is not so clear that it is a powerful antidepressant for unipolar depression. Nevertheless, it is used to augment antidepressants for treating resistant cases of unipolar depression. 

What is accomplished by adhesion promotion treatments in IC manufacturing should actually be referred to as wafer substrate preparation, and not adhesion. Adhesion in the structural sense, as experienced in airplane composite material parts attachment, is not accomplished by silane wafer processing treatments except for the PI applications discussed early in this paper. The term adhesion, as it is used here, refers to a more practical definition—that is, resist image adhesion. Nevertheless, this type of adhesion is essential to the huge international semiconductor business, and the early silane work of Plueddemann and others was essential to early wafer adhesion process development. 

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