Treatment Option For People Research Articles

The management and treatment of trigeminal neuralgia: Considering the options

This article discusses the diagnosis and treatment options for people suffering from trigeminal neuralgia and the treatment options available to prevent future acute exacerbations of pain. A case study is included to highlight the needs of a patient suffering from the condition. Trigeminal neuralgia is a condition characterized by paroxysms of facial pain, which may be initiated by touch, heat/cold, or eating. Pain occurs in the areas supplied by the trigeminal nerve such as the cheeks, jaw, teeth and gums.

Response to Mitoxantrone for Secondary Progressive Multiple Sclerosis in African Americans Compared with Whites

Mitoxantrone has been associated with the severe adverse effects of cardiotoxicity and myelocytic leukemia. Therefore, in considering mitoxantrone as a treatment option for people with multiple sclerosis (MS), it is important to determine whether the possible benefits outweigh the considerable risks. In a retrospective evaluation of patients who had received mitoxantrone in our MS center, we noted unexpectedly better outcomes in six African Americans with secondary progressive multiple sclerosis (SPMS) compared with six white patients with similar characteristics. Although this sample is small, if it is typical, the findings may provide support for the use of mitoxantrone in African American people with MS and indicate a need to evaluate MS patients' responses to treatment by ethnicity.

Cognitive Enhancement Therapy for a Model of Down Syndrome

Down syndrome is a complex condition that results from having a third copy of human chromosome 21. People with the syndrome experience problems with learning and memory that affect many aspects of their lives. In this issue of Science Translational Medicine, Salehi et al. report on successful drug treatment of learning deficits in an animal model of Down syndrome. This study highlights the function of the norepinephrine-ergic system in Down syndrome and suggests possible treatment options for people with Down syndrome.

Schizophrenia: Cognitive Theory, Research, and Therapy

Back to table of contents Previous article Next article Book ReviewFull AccessSchizophrenia: Cognitive Theory, Research, and TherapyLon C. Herman M.A.Lon C. Herman M.A.Search for more papers by this authorPublished Online:1 Oct 2009https://doi.org/10.1176/ps.2009.60.10.1407AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail For graduate students, residents, current practitioners, and others seeking a single body of work to deepen their understanding of schizophrenia and treatment approaches benefiting those affected by the syndrome, Schizophrenia: Cognitive Theory, Research, and Therapy is made to order. Cognitive therapy is increasingly used as a treatment option for people with schizophrenia who experience persistent symptoms, and this volume provides a compelling, though even-handed approach, for considering this treatment option. The authors are recognized leaders in promoting the cognitive model of schizophrenia and its treatment. Yet, this book goes well beyond the model by providing a concise, historic overview of how schizophrenia has been conceptualized and addressed and how contemporary biological knowledge can be integrated with the cognitive model to address this serious disorder.The four primary symptom categories that characterize schizophrenia—delusions, hallucinations, negative symptoms, and formal thought disorder—are introduced through case studies, followed by grounding in the theoretical and practical strategies that can be utilized to engage and treat. The scientific evidence underpinning each of the treatment approaches described throughout the book is accessible and balanced. In addition, the authors have provided a series of tables and guides for assessment and treatment in each of the major symptom areas.A separate chapter is devoted to the relationship between cognitive therapy and pharmacotherapy, with a focus on the need for integrating the two approaches among therapists and psychiatrists.As a therapeutic intervention embedded within a recovery orientation, the authors stress the need for establishing effective, patient-empowering therapeutic relationships. To achieve this goal, the book provides a thoughtful examination of assessment options and methods. A brief review of assessment rating scales, interviews, and tests is presented, along with a description of their empirical support and practical administrative considerations. The basic structure of cognitive therapy for people with schizophrenia is laid out in a bullet-pointed table providing an overall structure for therapy; a second table outlines the components of a typical 25- to 50-minute cognitive therapy session.The book concludes with the sharing of a number of useful instruments, such as the Beck Cognitive Insight Scale and the Cognitive Assessment of Psychosis Inventory.In developing this book, the authors clearly set a high bar with an ambitious set of objectives: providing a historical overview of schizophrenia; describing the syndrome's etiology; synthesizing theory, research, and practice; offering cognitive and biological perspectives; and providing practical advice to treatment providers. In each instance, the book has met the challenge. It is recommended for professionals across health disciplines as well as others interested in state-of-the-art treatment approaches to schizophrenia.The reviewer reports no competing interests.Mr. Herman is director, Best Practices in Schizophrenia Treatment (BeST) Center, Department of Psychiatry, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Rootstown, Ohio. FiguresReferencesCited byDetailsCited ByNone Volume 60Issue 10 October, 2009Pages 1407-1407PSYCHIATRIC SERVICES October 2009 Volume 60 Number 10 Metrics PDF download History Published online 1 October 2009 Published in print 1 October 2009

Meeting the ongoing needs of survivors of rarer cancer

With more treatment options for people with cancer long-term survivorship is increasing. Physical and psycho-social needs have been identified in survivors of common cancers but very little has been written about the needs of patients with rarer cancers. Patients treated for rarer cancer are discharged to the primary health care team (PHCT), yet little is known about the assessment, management and support of these patients. Thirty-nine semi-structured interviews were conducted with (1) survivors of and (2) people living with rarer cancer (i.e. <5% of cancer burden). Participants were asked about physical and psycho-social needs and service provision. Data were analysed thematically using Atlas ti. Contrary to expectation, disease-free survivors of rarer cancer were indistinguishable from those living with disease in their ability to cope, and range of symptoms and needs. Participants with a clinical nurse specialist (CNS) reported that they were well supported on their return home and their needs were met. Participants without a CNS were referred to the PHCT who were unsure how to assess or support them. These participants felt abandoned. There is a need for the rehabilitation of patients with rarer cancer to strengthen individual coping mechanisms, and family and social support. Although there are resource and training implications, this is a potential role for the PHCT, district nursing in particular, and may lead to more focused and targeted provision of services.

Telecounseling in Rural Areas for Alcohol Problems

ABSTRACT The prevalence of alcohol problems is roughly equal in urban and rural communities. In rural areas, however, treatment options for people with problem drinking tend to be limited at best. One way to reach rural populations is to deliver alcohol counseling services via telephone or interactive televideo links, called telecounseling in this paper. Tele-counseling can overcome not only the geographic barriers to treatment, but also concerns with confidentiality and stigma, which may be particularly salient in small rural communities. This approach to service delivery may be particularly important in areas with large rural and frontier regions. This paper reports on current use of common long-distance methodologies, their strengths and limitations.

Best Practices: Implementation of a Consumer-Directed Approach in Behavioral Health Care: Problems and Prospects

Consumer-directed care, a payment system designed to make patients aware of the costs of care, requires treatment seekers to be active participants in their health care. Core components of consumer-directed care, such as higher deductibles and increased decision-making responsibilities, might preclude its easy translation from medical to behavioral health care. Aspects of behavioral disorders will force providers, insurers, and patients to compensate for unique barriers to increasing self-care, such as stigma, neuropsychological complications, and poor self-efficacy. This column describes important components of consumer-directed care and the unique barriers that behavioral health care creates for those components. Possible best practices are suggested for surmounting those barriers.

The importance of serotonin and noradrenaline in anxiety

The therapeutics of obsessive-compulsive disorder (OCD) involves the serotonergic system in the brain; the selective serotonin reuptake inhibitors (SSRIs) are the only class of drugs to be consistently effective for this disorder. Preclinical studies in the orbito-frontal cortex – a brain area known to be involved in mediation of OCD symptoms – show that sustained administration of SSRI for 2 months leads to enhanced 5-HT release. Initially, raised 5-HT levels, resulting from serotonin (5-HT) reuptake inhibition, over-activates the cell body 5-HT1A autoreceptor, which has an inhibitory effect on the neuronal firing rate. However, after long-term administration of SSRIs, these 5-HT1A autoreceptors become desensitized to the raised extracellular 5-HT levels, and increase 5-HT transmission. The recovery of neuronal firing rate is faster with escitalopram (the active S-enantiomer of citalopram) than with citalopram, which may be due to different mechanisms of action. The 5-HT system has reciprocal interactions with the noradrenaline (NA) system. Although not a major mediator in the treatment of OCD symptomatology, patients with anxiety disorders such as panic disorder have increased NA reactivity and/or tone. Long-term SSRI administration reduces the firing rate of NA neurones, unlike 5-HT neurones. Evidence indicates that accrued 5-HT levels have an inhibitory modulatory effect on NA transmission, thus indicating the clinical relevance of SSRI treatment for anxiety disorders. The different effectiveness of the SSRIs escitalopram and citalopram in enhancing synaptic 5-HT levels may be due to the inhibitory action of the R-enantiomer in racemic citalopram on S-enantiomer binding to the 5-HT transporter. This allows escitalopram to produce higher extracellular 5-HT levels than can be achieved by the equivalent S-enantiomer dose of citalopram. Escitalopram is therefore a viable front-line treatment option for people with anxiety disorders, and possibly for those who have failed to respond to conventional SSRI therapies.

Insulin glargine and its place in the treatment of Types 1 and 2 diabetes mellitus

Insulin treatment in Type 1 and Type 2 diabetes has come a long way since its discovery by Banting and Best in 1922. Early insulin therapy was life-saving, but was associated with practical problems and had side effects such as lipoatrophy. Initial modifications of insulin structure produced several classes of insulins with varying pharmacokinetics, but did not sufficiently mimic physiological insulin release. Novel long- and short-acting insulin analogues, the so-called ‘designer insulins’, developed through genetic engineering in the 1990s, paved the way for more physiological insulin therapy, which was theoretically less problematic in terms of hypoglycaemia and patient satisfaction. Insulin glargine (glargine) was the first DNA-recombinant long-acting insulin analogue. The replacement of asparagine with glycine and the addition of two arginine molecules in the molecular structure results in modified pharmacokinetics. Consequently, glargine has a longer, often 24-h profile, which is described as ‘peakless’ compared with other insulins such as neutral protamine Hagedorn insulin (NPH) and insulin ultralente. Since its launch, the use of glargine in Type 1 and Type 2 diabetes has been extensively reviewed to determine its place in the current insulin market. A potential advantage of glargine seems to be a lower risk of hypoglycaemia, particularly at night. The UK National Institute of Clinical Excellence has recommended that glargine is a treatment option for people with Type 1 diabetes. In Type 2 diabetes, it has been advised that glargine only be considered for: those who require assistance to administer insulin injections; those whose lifestyle is restricted significantly by recurrent symptomatic hypoglycaemic episodes; or those who would otherwise need twice-daily basal insulin injections in combination with oral glucose-lowering drugs.

Treatment of Meniere’s disease with the low-pressure pulse generator (Meniett device)

Until recently, surgery was the only treatment option for people with disabling Meniere’s disease that did not respond to adequate medical therapy. A new intermediate level treatment modality, the Meniett device, which applies low-pressure micropulses to the inner ear, has now been shown to be safe and effective. The device is portable and self-administered, requiring a 5-min three-times daily application for an indefinite period. Placement of a tympanostomy tube in the ear drum of the affected ear is necessary. Patient acceptance has been high. Long-term success in control of vertigo is over 80%. Although hearing loss is not improved, Meniett device usage does not adversely affect balance, as do most forms of surgical therapy. Use of the device does not preclude later surgical therapy.

Right‐sided Vagus Nerve Stimulation as a Treatment for Refractory Epilepsy in Humans

We present three children who underwent right-sided vagus nerve stimulation (R-VNS). This treatment option for people with refractory epilepsy has not been described in children. We reviewed our database of >350 patients implanted with vagus nerve stimulators and now describe our experience in three patients with R-VNS for the treatment of intractable seizures. All three patients improved dramatically with left-sided vagus nerve stimulation (L-VNS), but the devices had to be removed because of infection. The patients were thought to be at high risk for nerve injury if they were reapproached for L-VNSs; therefore R-VNSs were implanted. All three patients with an R-VNS had a reduction in seizures. Our first patient has had an R-VNS for 5 years; he has been seizure free for >2 years on R-VNS monotherapy. The second patient had an R-VNS for 8 months. His seizure control improved slightly, but not as dramatically as with L-VNS. The third child has had an R-VNS for >7 months and has cessation of his most disabling seizure type (generalized tonic-clonic seizures). None of the patients had cardiac side effects from therapeutic R-VNS. However, two of the three patients had respiratory events with R-VNS. VNS is known to be an effective treatment in pharmacoresistant epilepsy. R-VNS should be considered if a patient has significant benefit from L-VNS but is unable to continue with L-VNS. R-VNS appears also to have antiepilepsy effects. Additionally, our case report suggests that in some patients, a differential response is found regarding seizure control with R-VNS or L-VNS, raising the question whether L-VNS failures should pursue a trial of R-VNS. Patients should be cautioned and monitored for reactive airway disease if they undergo R-VNS. More research is needed to compare the effects of right- and left-sided VNS on cardiac and pulmonary function in humans and to determine which has the best antiseizure effect.

Occupational Therapists' Beliefs regarding Treatment Options for People with Chronic Pain

An expanding body of chronic pain research is now evident within occupational therapy and strong support has developed during the last 10 years for the multidisciplinary approach to the management of chronic pain. Although this stand is now subject to growing scrutiny, a multidisciplinary structure continues to be the environment for most outcome studies. Occupational therapists, as accepted and involved members of pain management programmes, need to examine the values and beliefs that they bring to the treatment team. As part of a wider research study of the congruence between what service providers and service users believe to be necessary treatments for chronic pain, the members of the National Occupational Therapy Pain Association were surveyed in January 2001. The survey asked therapists' opinion about whether specific treatment components were needed or not needed for people with chronic pain. The survey also included Skevington's (1990) Beliefs about Pain Control Questionnaire (BPCQ), which measures beliefs in the internal or personal control of pain, beliefs that powerful others (doctors) control pain and beliefs that pain is controlled by chance events. The findings showed that there were few treatment components that 100% of the respondents agreed were needed. Endorsements clustered around treatments that focused on self-management and a statistically significant relationship emerged between certain treatment components and BPCQ scores. The paper concludes by discussing some possible influences on occupational therapists' decision making in relation to treatments for chronic pain.

Group therapy for people with borderline personality disorder: interventions associated with positive outcomes.

Group psychotherapy is becoming a more prevalent treatment option for people with borderline personality disorder. Various types of group approaches have been discussed; however, data about specific interventions and their relationship to outcomes for subgroups of people with borderline personality disorder are lacking. The purpose of this study was to explicate the interventions used in a successful group therapy program developed for community mental health center clients with borderline personality disorder. Two independent raters used the Hill Counselor Verbal Response Category System-Revised to describe and categorize the therapists' verbal responses. Coding of eight videotaped sessions indicated that the therapists' level and type of verbal activity did not change over time. The most frequently utilized interventions across sessions were providing information and seeking information. These responses are indicative of a moderate and high degree of structure. The results suggest that clinicians must consider the unique needs of serious and persistently ill people with borderline personality disorder and plan group interventions accordingly.