The Finer Points of Treatment Resistance
When patients endure repeated trials of medications to no avail in the areas of PTSD, panic disorder, bulimia nervosa, and other illnesses, psychiatrists are there.
When patients endure repeated trials of medications to no avail and with no apparent explanation, psychiatrists face the dilemma of treatment resistance. This Special Report discusses the finer points of treatment resistance as it relates to PTSD, panic disorder, borderline personality disorder, eating disorders, and bipolar disorder. Special Report Chair: Norman Sussman, MD. See: Treatment Resistance in Psychiatry
A serious, disabling condition, treatment-resistant PTSD is less frequently addressed than other psychiatric disorders but no less serious. In fact, many patients remain symptomatic and functionally impaired despite standard treatments and require alternative interventions. Here you will find expert guidance on trauma-focused cognitive-behavioral therapy, pharmacotherapy, and other combinations for better outcomes. See: Treatment-Resistant PTSD
A common and impairing anxiety syndrome, panic disorder is generally readily diagnosable and treatable. Approximately one-third of patients have a clinical remission with standard interventions and treatable. In another third, the course of the illness is characterized by recurrent episodes, which remain treatment-sensitive. However, a third go on to have chronic, persistent symptoms-and the majority of these patients have treatment-resistant panic. See: Treatment-Resistant Panic Disorder
Originally formulated in psychoanalytic terms, resistance in treatment referred to the inevitable ways patients unconsciously express their psychology in terms of defense mechanisms and transference enactment. This form of resistance provides a window into the patient’s problems; therefore, it is a major focus of the inquiry and intervention. In terms of treatment resistance in borderline personality, sources and guidelines are discussed. Treatment-Resistant Borderline Personality Disorder
Bulimia is associated with psychiatric comorbidity, significant psychosocial impairment, medical complications, and increased mortality. Predictors of worse outcome or treatment dropout include longer duration and more severe eating disorder symptom profiles, comorbid psychopathology, and characteristics of personality pathology. Treatment approaches focus on skills and strategies designed to help patients regulate emotions and cope with altered inhibitory control and reward sensitivity. In particular, dialectical behavior therapy may be particularly effective in mitigating biologically-driven vulnerabilities, and zonisamide and lamotrigine may play a role. Treatment-Resistant Bulimia Nervosa
Most of the literature on treatment-resistant bipolar disorder is related to treatment of acute episodes of mania or depression and there is no formal universal definition of treatment resistance. This article focuses on treatment resistance to medications in adult male and non-pregnant adult female outpatients with any type of DSM-5 diagnosed bipolar disorder. Treatment-Resistant Bipolar Disorder