Treatment-resistant

Roffman RA, Barnhart R Assessing need for marijuana dependence treatment through an anonymous telephone interview. Int J Addict 22 639-631, 1987 Russo EB Clinical endocannabinoid deficiency (CECD) can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions Neuro Endocrinol Lett 25(1-2) 31—39, 2004... 

Davies LM, Drummond MF (1993). Assessment of costs and benefits of drug therapy for treatment-resistant schizophrenia in the United Kingdom. Br JPsychiatry 162, 38-42. 

Revicki DA, Luce BR, Weschler JM et al (1990). Cost-effectiveness of clozapine for treatment-resistant schizophrenic patients. Hosp Community Psychiatry 850-69. 

The drug was subsequently reintroduced for treatment-resistant or treatment-intolerant patients in the UK and USA in 1990. The drug is completely free of extrapyramidal side effects but has to be monitored for the development of neutropenia and agranulocytosis. Other problems include sialorrhoea, sedation, reduction in seizure... 

Conley RR, Tamminga CA, Bartko JJ, et al (1998). Olanzapine compared with chlorpromazine in treatment resistant schizophrenia. Am J... 

Kane), Honigfeld G, Singer), et al (1988). Clozapine for the treatment resistant schizophrenic. A double blind comparison with chlorpromazine. Arch Gen Psychiatry h hy 766-71. 

Staphylococcus aureus is less sensitive to erythron rdn than are pneumococci or haemolytic streptococci, and there may be a rapid development of resistance, especially of staphylococci, in vitro. However, in vivo with successM short courses of treatment, resistance is not usually a serious clinical problem. On the other hand, resistance is likely to develop when the antibiotic is used for long periods. 

Most people experience pain at some time in their lives, and pain is a symptom of a variety of diseases. For some, pain may be mild to moderate, intermittent, easily managed, and has minimal effect on daily activities. For others, pain may be chronic, severe or disabling, all consuming, and be treatment resistant. Thus, identifying the exact prevalence of pain is a difficult task. According to the American Pain Foundation, more than 50 million people in the United States suffer from... 

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. 

To date, clozapine remains the only drug with proven and superior efficacy in treatment-resistant patients, and it is currently the only drug approved for the treatment-resistant schizophrenic. Studies have shown a response of approximately 30% to 50% in these well-defined treatment-resistant patients. Clinical trials have consistently found clozapine to be superior to traditional antipsychotics for treatment-refractory patients, and it is efficacious even after nonresponse to other SGAs and in partially responsive patients. It is often rapidly effective even in those who have had a poor response to other medication for years. Recent studies have demonstrated that it has a beneficial effect for aggression and suicidality, which led to the Food and Drug Administration (FDA) approval for the treatment of suicidal behavior in people with psychosis.41... 

Conley RR, Kelly DL. Management of treatment resistance in schizophrenia. Biol Psychiatry 2001 50 898-911. 

Vagus nerve stimulation (VNS) may be used for adult patients with treatment-resistant depression. A pulse generator is surgically implanted under the skin of the left chest, and an electrical lead connects the generator to the left vagus nerve. Stimulation of this nerve sends signals to the brain. This therapy is intended to be used along with traditional therapies, such as pharmacotherapy and ECT.20... 

Fava M. Augmentation and combination strategies in treatment-resistant depression. J Clin Psychiatry 2001 62(suppl 18) 4—11. 

Optimize the dose of mood-stabilizing medication(s) before adding on benzodiazepines if psychotic features are present, add on antipsychotic ECT used for severe or treatment-resistant manic/mixed episodes or psychotic features... 

Treatment-resistant depression Depression characterized by multiple failed trials of antidepressants and/or electroconvulsive therapy. 

Chen, J., Lu, Z., Jiang, S. D. et al. (2005). Association between polymorphism in the cytochrome P450 enzymes 1A2 2C19 gene and treatment-resistant depression. Shanghai Archive of Psychiatry, 17(2), 95-8. 

Patients respond variably to the more than 20 FDA-approved antidepressants Only 60-70% of patients show significant response to any specific antidepressant, and there is no predictor of response to those drugs. Thus, the development of novel therapies should be geared to solve two important issues in treatment treatment resistance or refractoriness to current antidepressants, and medication compliance. 

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. 

Amsterdam JD, Maislin G, Potter L. Fluoxetine efficacy in treatment resistant depression. Prog Neuropsychopharmacol Biol Psychiatry 1994 18 243-261. 

Nevertheless, a rapid disappearance of resistant bacteria was observed after stopping the antibiotic treatment (fig. 5). Different kinetics of disappearance were, however, observed. The aerobic species showed a more rapid return to the baseline sensitive status whereas the anaerobic bacteria, especially the Gram-negative rods, regained sensitivity to rifaximin more slowly. In any case, 3 months after the end of treatment resistant strains were no longer detectable in the feces [82], These results support the cyclic use of rifaximin that has been adopted by the investigators in the treatment of hepatic encephalopathy [77] and colonic diverticular disease [79]. 

Gionchetti P, Rizzello F, Venturi A, Ugolini F, Rossi M, Brigidi P, Johansson R, Ferrieri A, Poggioli G, Campieri M Antibiotic combination therapy in patients with chronic, treatment-resistant pouchitis. Aliment Pharmacol Ther 1999 13 713-718. 

In a recent study, we found no acquisition of rifaximin resistance in 27 rifaximin-treated subjects colonized by Enterococcus [37]. The MIC50 and MIC90 for the treatment group (rifaximin at a dose of either 400 or 200 mg twice daily for 3 days) were similar (16-64 pg/ml). In two published studies, rifaximin resistance was shown to occur in the bacterial flora of individuals who received treatment with rifaximin at a dose of 800 mg/day for 5 days [9, 27]. Within 1-2 weeks after the end of rifaximin treatment, resistance rates appeared to have decreased to less than 20% of the intestinal flora. The resistant strains detected during treatment appeared to be unstable and unable to persistently colonize the intestinal tract. 

Phenelzine, an MAOI, is effective, but is reserved for treatment-resistant patients because of dietary restrictions, potential drug interactions, and adverse effects. 

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