Treatments relapse problems

Every patient who uses tobacco should be offered at least brief treatment. All patients attempting tobacco cessation should be offered practical counseling (problem-solving/skills training), social support, stress management, and relapse prevention. 

Relapse prevention for clients with psychiatric conditions must include treatment of the comorbid conditions in order to be effective. This generally means developing a collaborative relationship with a psychiatrist if the treatment includes pharmacotherapy. The relapse plan must provide checks on adherence to the treatment of the comorbid condition, and if adherence is a problem, then motivation... 

This team must be skilled in handling the complex origin of disability. Risk factors for the disease to become chronic are often of a psychosocial and not a physical nature. Primary targets of treatment should be physical fitness and the self-management of problems by the patient. Awareness of the psychosocial factors, which can disturb occupational reintegration, should be developed. Rehabilitation is based on measures to modify patient s beliefs and fitness. The prescribed treatment should aim to relieve pain, correct disability, prevent relapses, inform and educate the patient. 

However, over time, the chronic cycles of relapse and recovery that characterize most drug careers chipped away at the hope for a relationship unfettered by the baggage of the drug problem. The hope that, this time, their son or daughter, sister of brother would become free of drugs was harder to maintain after numerous episodes in treatment and subsequent relapse. Over time it appeared to become harder to hold onto this memory of what their child or sibling had been and sadly, too, there appeared to be a leaking away of faith that this return journey could be made ... 

In order to illustrate the kinds of arguments and considerations which are needed in relation to intention-to-treat, the discussion in this section will consider a set of applications where problems frequently arise. In Chapter 13 we will cover methods for the analysis of time-to-event or so-called survival data, but for the moment I would like to focus on endpoints within these areas that do not use the time-point at which randomisation occurs as the start point for the time-to-event measure. Examples include the time from rash healing to complete cessation of pain in Herpes Zoster, the time from six weeks after start of treatment to first seizure in epilepsy and time from eight weeks to relapse amongst responders at week 8 in severe depression. 

Although adolescents who discontinue maintenance treatment have a high (92%) rate of relapse compared to those who maintain lithium treatment (37%) (Strober et al., 1990), reliable continuation of medication is a serious problem in bipolar adolescents, particularly those with comorbid behavior disorders (Carlson et al., 2000a). 

Follow-up studies between 5 and 10 years after onset of illness show that about one-half of BN patients fully recover while one-fifth continue to meet full criteria for that disorder. Relapse is a serious problem for bulimics, as about one-third of recovered bulimics relapse within 4 years after treatment. About 20% of bulimics seem to sustain an unremitting bulimic disorder (Keel and Mitchell, 1997). 

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