This book reviews all the important aspects of treatment-resistant psychiatric disorders, covering issues such as definitions, clinical aspects, neurobiological correlates, treatment options, and predictors of treatment response. The book is divided into three sections, the first of which examines the most recent thinking on treatment resistance in psychiatry, including definition and epidemiology, paradigm shift in the study of the subjects, individual susceptibility and resilience, abnormal structural or functional connectivity, and insights from animal models. The second section then discusses treatment resistance in each of the major psychiatric disorders, with particular focus on the responsible clinical and biological factors and the available management strategies. Finally, more detailed information is presented on diverse pharmacological and non-pharmacological therapeutic interventions. The book, written by leading experts from across the world, will be of value to all who seek a better understanding of the clinical-neurobiological underpinnings and the development of management for treatment resistance in psychiatric disorders.

Treatment-resistant Depress Successful management of patients with treatment-resistant depression requires a thorough understanding of the biological basis for both the depression and its failure to respond to standard treatments. This book clearly and succinctly summarizes the latest scientific research and its applications in clinical practice. A first step is a clear definition of what constitutes treatment-resistant depression so that clinical trials and other studies are using common criteria, enabling comparison and meta-analysis of their outcomes. The opening chapter reviews definitions and predictors of treatment-resistant depression originating from different fields and discusses their usefulness in clinical practice and clinical research. The next chapter proposes a new definition, adapting terminology from medicine. Biological classification requires identification of genetic risk factors and gene variants have been identified as accounting for 50% of the variance in the clinical outcomes of antidepressant treatments. Chapter 3 describes several genes already associated with treatment-resistant depression and, while further work is needed to translate findings into clinical recommendations, suggests that genetic prediction of treatment resistance could become a widespread clinical reality within a few years. Most patients with treatment-resistant depression will be treated pharmacologically, so three chapters review the latest evidence for pharmacological best practice in switching strategies for antidepressants, the role of antipsychotics and augmentation strategies to complement lithium. There are two major alternatives to pharmacotherapy: neuromodulation and psychotherapy. The brain intervention chapter summarizes clinical research and experience with electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation and magnetic seizure therapy. The final chapter reviews the literature pertaining to the effectiveness of various forms of psychotherapy in patients who have not responded to antidepressant pharmacotherapy, explaining that patients who have not responded to one or two trials of antidepressant medication have a 30%-50% chance of responding to a focused psychotherapy. It proposes indications for psychotherapy in treatment-resistant depression and summarizes general therapeutic principles. Essential reading for all psychiatrists managing patients with this distressing disorder.

A sizable percentage of patients with major psychiatric disorders do not respond to the first or second treatments they receive. This book summarizes the latest evidence from clinical studies concerning the treatment of patients with treatment-resistant psychiatric disorders. Both pharmacological and psychotherapeutic interventions are included, as well as somatic non-pharmacological treatments. The chapter authors represent the leaders in their respective fields.

"The troubling increase in treatment resistance in psychiatry has many culprits: the rise of biomedical psychiatry and corresponding sidelining of psychodynamic and psychosocial factors; the increased emphasis on treating the symptoms rather than the person; and a greater focus on the electronic medical record rather than the patient, all of which point to a breakdown in the person-centered prescriber-patient relationship. Psychodynamic Psychopharmacology illuminates a new path forward. It examines the psychological and interpersonal mechanisms of pharmacological treatment resistance, integrating research on evidence-based prescribing processes with psychodynamic insights and skills to enhance treatment outcomes for patients who are difficult to treat. The first part of the book explores the evidence base that guides how, rather than simply what, to prescribe. It describes precisely what psychodynamic psychopharmacology is and why its emphasis on combining the often-neglected psychosocial aspects of medication with biomedical considerations provides a more optimized approach to addressing treatment resistance. Part II delves into the psychodynamics that contribute to pharmacological treatment resistance, both when patients' ambivalence about their illness, the medication itself, or their prescriber manifests in nonadherence and when medications support a negative identity or are used as replacements for healthy capacities. Readers will gain basic skills for addressing the psychological and interpersonal dynamics that underpin both scenarios and will be better positioned to ameliorate interferences with the healthy use of medications. The final section of the book offers detailed technical recommendations for addressing pharmacological treatment resistance. It tackles issues that include countertransference-driven irrational prescribing; primitive dynamics, such as splitting and projective identification; and the overlap between psychopharmacological treatment resistance and the dynamics of treatment nonadherence and nonresponse in integrated and collaborative medical care settings. By putting the individual patient back at the center of the therapeutic equation, psychodynamic psychopharmacology, as outlined in this book, offers a model that moves beyond compliance and emphasizes instead the alliance between patient and prescriber. In doing so, it empowers patients to become more active contributors in their own recovery"--

Treatment-resistant major depression and bipolar disorder are highly prevalent and disabling conditions associated with substantial morbidity and mortality. The assessment and management of refractory patients with mood disorders is a major clinical challenge for mental health providers. Part of the Oxford Psychiatry Library (OPL) series, this pocketbook provides a concise view of the current definitions, assessment and evidence-based management of treatment-resistant mood disorders and reviews novel therapeutic targets for mood disorders, which may enhance the therapeutic armamentarium of clinicians in the near future. The pocketbook serves as a useful guide for mental health practitioners, including psychiatrists, clinical psychologists, trainees, and interested primary care physicians.

Growing evidence derived from cerebrospinal fluid (CSF), neuropathological, imaging, genetic, and epidemiological studies link neuroinflammation and immune dysregulation to a subset of individuals with a variety of severe mental disorders (SMDs), including affective and non-affective psychotic disorders. Further, the recent discoveries of neuronal surface antibodies (NSAs) in autoimmune encephalitis (AE) presenting with diverse neuropsychiatric disorders such as psychosis and cognitive decline, among many others, provides further support to the notion that CNS autoimmunity and neuroinflammation can contribute to the neurobiology of psychiatric disturbances. Further, these immune mechanisms may contribute to a subset of patients currently diagnosed as having treatment-resistant SMDs such as schizophrenia and major depressive disorder. Additionally, mounting data indicate that various infections can serve as an immunological trigger of aberrant immune responses, presumably by causing release of excess neural antigen, thereby giving rise to NSAs or aberrant immune cellular responses to give rise to primary or secondary psychiatric disorders such as schizophrenia and those associated with AE, respectively. Collectively, these findings support the “mild encephalitis” hypothesis of SMD. The significant overlap among AE-associated psychosis, systemic autoimmune disorder-associated psychosis, and psychotic disorders associated with pathological processes involving inflammation and immune dysregulation has also prompted some authors to adopt the term “autoimmune psychosis” (AP). This term reflects that this psychosis subtype is mechanistically linked to complex neuroimmune and inflammatory signalling abnormalities that can be responsive to early immunomodulatory treatment. It also suggests that a subset of AP might represent an incomplete or “forme fruste” subtype of AE presenting with dominant or pure psychiatric symptoms mimicking primary psychiatric illnesses. Because data indicate that delayed diagnosis and treatment may lead to permanent sequelae, early recognition of AP utilizing neurodiagnostic workup (e.g., CSF analysis, neuroimaging, and EEG) and its early treatment with appropriate immunotherapy are paramount to a meaningful recovery. This eBook will provide an overview of the current knowledge and research areas from epidemiology, risk factors and diagnosis to the management of these conditions, in this rapidly emerging field, helping to bridge the gaps in knowledge that currently exist in the disciplines of Psychiatry, Neurology, and Neuroimmunology.

The Maudsley® Prescribing Guidelines in Psychiatry The new edition of the world-renowned reference guide on the use of medications for patients presenting with mental health problems The Maudsley Prescribing Guidelines in Psychiatry is the essential evidence-based handbook on the safe and effective prescribing of psychotropic agents. Covering both common and complex prescribing situations encountered in day-to-day clinical practice, this comprehensive resource provides expert guidance on drug choice, minimum and maximum doses, adverse effects, switching medications, prescribing for special patient groups, and more. Each clear and concise chapter includes an up-to-date reference list providing easy access to the evidence on which the guidance is based. The fourteenth edition has been fully updated to incorporate the latest available research, the most recent psychotropic drug introductions, and all psychotropic drugs currently used in the UK, USA, Canada, Australia, New Zealand, and Japan. Several new sections cover topics such as deprescribing of major psychiatric drugs, prescribing psychotropics at the end of life, the treatment of agitated delirium, the genetics of clozapine prescribing, the use of weekly penfluridol, and the treatment of psychotropic withdrawal. Featuring contributions by an experienced team of psychiatrists and specialist pharmacists, the new edition of The Maudsley Prescribing Guidelines in Psychiatry: Provides succinct coverage of drug treatment of psychiatric conditions and formulating prescribing policy in mental health Covers a wide range of psychiatric conditions including schizophrenia, bipolar disorder, depression and anxiety, borderline personality, eating disorders, and many others Provides advice on prescribing for children and adolescents, older people, pregnant women, and other special patient groups Offers new sections on genetic prescribing, long-acting injectable formulations, ketamine administration and uses, and dopamine super-sensitivity Includes referenced information on off-label prescribing, potential interactions with other substances such as alcohol, tobacco, and caffeine, and treating patients with comorbid physical conditions Whether in the doctor’s office, in the clinic, or on the ward, The Maudsley Prescribing Guidelines in Psychiatry, Fourteenth Edition is a must-have for psychiatrists, pharmacists, neuropharmacologists, clinical psychologists, nurses, and other healthcare professionals working in mental health, as well as trainees and students in medicine, pharmacy, and nursing.

This book provides the readers with a series of complex cases that are organized by psychiatric disorder. Written by experts in the field, the cases offer insight on how to navigate care in delicate situations while considering preexisting medical conditions. Topics cover pharmacological concerns in women who are pregnant or nursing, working with dementia patients suffering from HIV, assessing and treating ADHD in special populations, monitoring medication use in patience recovering from Substance Use Disorder, and working with patients suffering from personality disorders. Each chapter offers guidance through the maze of classifications, clinical features, diagnosis and various complex interventions. The book also covers new information on the advances in research and management aspects. Complex Clinical Conundrums in Psychiatry is a valuable resource for psychiatrists, psychologists, family physicians, geriatricians, counselors, social workers, nurses, and all medical professionals working with complex psychiatric patients.

Fully revised and updated for the new edition, the Oxford Handbook of Psychiatry provides the most up-to-date information clinically relevant to the doctor on the ground. Using a presentation-based format it provides detailed advice on clinical decision making after diagnosis. This handbook is an indispensable companion for any professional working in psychiatric medicine. Covering all major psychiatric conditions and sub-specialties, this handbook provides practical and comprehensive guidelines and in-depth coverage of psychiatric assessment, psychopathology, evidence-based practice, therapeutic issues, and transcultural psychiatry. It is indexed alphabetically by ICD-10 / DSM-IV classification codes and acute presentations for quick access. It reflects the recent major changes to psychiatric training and examination as well as the latest drug information. Reviewed by experienced clinicians, and revised by Specialist Trainees, this handbook not only gives expert advice for psychiatry professionals, but is also directly relevant to trainees in psychiatry. For the third edition, new information includes guidance on Adult ADHD, information on new drugs of abuse (e,g, GBL, GHB, mephodrone), and clinical decision-making in the prison setting. With such broad coverage and depth of guidance, this is the must-have pocket guide for all professionals and trainees working in psychiatry.

Now in a new Fourth Edition, Psychiatry remains the leading reference on all aspects of the current practice and latest developments in psychiatry. From an international team of recognised expert editors and contributors, Psychiatry provides a truly comprehensive overview of the entire field of psychiatry in 132 chapters across two volumes. It includes two new sections, on psychosomatic medicine and collaborative care, and on emergency psychiatry, and compares Diagnostic and Statistical Manual (DSM-5) and International Classification of Diseases (ICD10) classifications for every psychiatric disorder. Psychiatry, Fourth Edition is an essential reference for psychiatrists in clinical practice and clinical research, residents in training, and for all those involved in the treatment psychiatric disorders. Includes a a companion website at www.tasmanpsychiatry.com featuring PDFs of each chapter and downloadable images