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1
Butorac, Marc, James Bonneson, Kristine Connolly, Paul Ryus, Bastian Schroeder, Kristine Williams, Zhenyu Wang, Seckin Ozkul, and Jerome Gluck. Assessing Interactions Between Access Management Treatments and Multimodal Users. Washington, D.C.: Transportation Research Board, 2018. http://dx.doi.org/10.17226/25344.
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C, Liebman Marcia, and Camp-Sorrell Dawn, eds. Multimodal therapy in oncology nursing. St. Louis: Mosby, 1996.
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3
Pfiffner, Linda J., and Lauren M. Haack. Nonpharmacologic Treatments for Childhood Attention-Deficit/Hyperactivity Disorder and Their Combination with Medication. Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780199342211.003.0003.
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Of the nonpharmacological treatments for childhood attention-deficit/hyperactivity disorder (ADHD), behavioral interventions have the largest evidence base. Current behavioral interventions include behavioral parent training, behavioral classroom management, child skills training, behavioral multicomponent interventions, and multimodal treatment, which combines behavioral interventions and medication. This updated review of studies reveals significant behavioral treatment effects from randomized controlled trials on a wide range of child outcomes including ADHD and oppositional defiant disorder symptoms as well as areas of functional impairment such as homework, organizational, and social behaviors. Combined behavioral and medication treatments appear to reduce the needed dose or intensity of each intervention.
4
Frank, Newman Cory, ed. El trastorno bipolar: Una aproximación desde la terapia cognitiva. Barcelona: Paidós, 2005.
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Cory F., Ph.D. Newman, Noreen Reilly-harrington, Laszlo M. D. Gyulai, Aaron T. Beck, and Robert L. Leahy. El Trastorno Bipolar / Bipolar Disorder: Una aproximacion desde la terapia cognitiva/A Cognitive Therapy Approach (Psicologia, Psiquiatria, Psicoterapia). Ediciones Paidos Iberica, 2005.
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6
Hansen, Tom G. Acute paediatric pain management. Edited by Jonathan G. Hardman and Neil S. Morton. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0073.
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Paediatric pain management has made great strides in the past few decades in the understanding of developmental neurobiology, developmental pharmacology, the use of analgesics in children, the use of regional techniques in children, and of the psychological needs of children in pain. The consequences of a painful experience on the young nervous system are so significant that long-term effects can occur, resulting in behavioural changes and a lowered pain threshold for months after a painful event. Accurate assessment of pain in different age groups and the effective treatment of postoperative pain are constantly being refined, with newer drugs being used alone and in combination with other drugs, and continue to be explored. Systemic opioids, paracetamol, non-steroidal anti-inflammatories, and regional anaesthesia alone or combined with additives are currently used to provide effective postoperative analgesia. These modalities are often best utilized when combined as a multimodal approach to treat acute pain in the perioperative setting. The safe and effective management of pain in children includes the prevention, recognition, and assessment of pain; early and individualized treatment; and evaluation of the efficacy of treatment. This chapter discusses selected topics in paediatric acute pain management, with more specific emphasis placed on pharmacology and regional anaesthesia in the treatment of acute postoperative pain management.
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(Foreword), L. W. Brady, H. P. Heilmann (Foreword), M. Molls (Foreword), J. M. Brown (Editor), M. P. Mehta (Editor), and C. Nieder (Editor), eds. Multimodal Concepts for Integration of Cytotoxic Drugs (Medical Radiology / Radiation Oncology). Springer, 2006.
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8
(Editor), Morgan T. Sammons, and Norman B. Schmidt (Editor), eds. Combined Treatments for Mental Disorders: A Guide to Psychological and Pharmacological Interventions. American Psychological Association (APA), 2001.
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9
LaFrance, W. Curt, and Laura H. Goldstein. Evidence-Based Treatments. Edited by Barbara A. Dworetzky and Gaston C. Baslet. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190265045.003.0014.
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Psychogenic nonepileptic seizures (PNES) have been in the medical literature for centuries. However, treatments were limited, being based on uncontrolled data, until the past decade. Treatment advances published since 2010 have included pilot controlled trials using psychotherapies, psychoeducational approaches, medications, and combined pharmacological and psychotherapeutic approaches that provide new treatment options for patients with PNES. This chapter describes these controlled trials in detail. It also covers studies of treatments for other functional neurological disorders including PNES. One conclusion from this review is that future studies still need to improve on as-yet limited sample sizes and provide insights into predictors of treatment outcome so that rational decisions can be made about which treatments offer the best outcome and who is likely to best respond to which treatment.
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Tolin, David F., and Blaise L. Worden. Combining Pharmacotherapy and Psychological Treatments for OCD. Edited by Gail Steketee. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780195376210.013.0081.
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This chapter reviews the outcome literature on the efficacy of combined pharmacotherapy and cognitive-behavioral therapy (CBT) for obsessive compulsive disorder (OCD). By far, most research on combinations of CBT and pharmacotherapy for OCD has examined antidepressant medications, particularly those in the serotonin reuptake inhibitor (SRI) class. Quantitative review of randomized studies in which treatments were combined simultaneously indicated that combined therapy shows a small but significant advantage over exposure and response prevention (ERP) monotherapy, and a moderate advantage over pharmacologic (antidepressant) monotherapy. Studies of sequential treatment combination, in which CBT was added after a trial of antidepressant medication, suggest a significant incremental benefit of CBT, including for patients who show minimal response to antidepressant medication alone. The chapter concludes by discussing new pharmacologic possibilities for combined therapy, such as the use of D-cycloserine (DCS).
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Tolin, David F., and Blaise L. Worden. Combining Pharmacotherapy and Psychological Treatments for OCD. Edited by Gail Steketee. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780195376210.013.019_update_001.
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This chapter reviews the outcome literature on the efficacy of combined pharmacotherapy and cognitive-behavioral therapy (CBT) for obsessive compulsive disorder (OCD). By far, most research on combinations of CBT and pharmacotherapy for OCD has examined antidepressant medications, particularly those in the serotonin reuptake inhibitor (SRI) class. Quantitative review of randomized studies in which treatments were combined simultaneously indicated that combined therapy shows a small but significant advantage over exposure and response prevention (ERP) monotherapy, and a moderate advantage over pharmacologic (antidepressant) monotherapy. Studies of sequential treatment combination, in which CBT was added after a trial of antidepressant medication, suggest a significant incremental benefit of CBT, including for patients who show minimal response to antidepressant medication alone. The chapter concludes by discussing new pharmacologic possibilities for combined therapy, such as the use of D-cycloserine (DCS).
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Barlow, David H., and Stefan G. Hofmann. Efficacy and dissemination of psychological treatments. Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780192627254.003.0005.
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Chapter 5 discusses efficacy and dissemination of psychological treatments, including the comparative effectiveness of psychological, pharmacological, and combined treatments, the problems of accessibility and dissemination of effective psychosocial treatments, and the emerging role of clinical practice guidelines.
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Muralidharan, Anjana, David J. Miklowitz, and W. Edward Craighead. Psychosocial Treatments for Bipolar Disorder. Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780199342211.003.0010.
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Pharmacological interventions remain the primary treatment for bipolar disorder. However, adjunctive psychosocial interventions have the potential to increase adherence to medication regimens, decrease hospitalizations and relapses, decrease severity of symptoms, improve quality of life, and enhance mechanisms for coping with stress. Group psychoeducation, designed to provide information to bipolar patients about the disorder and its treatment, leads to lower rates of recurrence and greater adherence to medication among remitted bipolar patients at both short- and long-term follow-up. Cognitive-behavioral therapy as an ancillary treatment has found mixed results but generally supportive evidence indicating that it is useful in preventing relapse to depression in remitted patients. Family-based intervention, such as Family-Focused Therapy (FFT), may be combined with pharmacotherapy to reduce recurrences and hospitalization rates in adult patients.
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Combining Medication and Psychosocial Treatments for Addictions: The BRENDA Approach. The Guilford Press, 2001.
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15
Trelles, M. Pilar, Paige M. Siper, and Dorothy E. Grice. Current Treatments for Pediatric Psychiatric Disorders. Edited by Dennis S. Charney, Eric J. Nestler, Pamela Sklar, and Joseph D. Buxbaum. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190681425.003.0068.
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Many psychiatric disorders of childhood have a chronic course. As such, they impact multiple developmental epochs and negatively influence developmental trajectories. While early identification and intervention may minimize, or even prevent, symptoms being carried into adulthood, the availability of evidence-based treatments is sparse in children and adolescents compared to adult populations. Establishing effective interventions for psychiatric symptoms presenting in childhood is critical given the chronic course of most psychiatric disorders. This chapter describes psychopharmacological and psychosocial interventions used for the treatment of childhood psychiatric conditions, with an emphasis on empirically supported treatments. Both symptom- and diagnosis-specific approaches are described as well as the use of combined interventions for the following childhood psychiatric conditions: autism spectrum disorder (ASD), intellectual disability (ID), attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, obsessive compulsive disorder (OCD), chronic tic disorders, eating disorders, and conduct problems.
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McKay, James R., Henry R. Kranzler, Kyle M. Kampman, Rebecca L. Ashare, and Robert A. Schnoll. Psychopharmacological Treatments for Substance Use Disorders. Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780199342211.003.0024.
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The treatment of substance use disorders with medications is well established, although most experts agree that pharmacological interventions must be combined with psychosocial therapies. Many type 1 and type 2 controlled trials have shown that the use of nicotine replacement therapy significantly increases abstinence rates. Non-nicotine treatments, such as bupropion and varenicline, have been found in controlled trials to significantly increase abstinence rates. The treatment of alcohol use disorder can be enhanced by three approved medications with different mechanisms of action: disulfiram, naltrexone, and acamprosate. Methadone maintenance treatment has consistently shown efficacy in the treatment of opioid dependence, and buprenorphine has substantially expanded the options for treating the disorder. Although double-blind, placebo-controlled clinical trials of several medications have provided initial evidence of efficacy for cocaine use disorder, efficacy has not yet been shown in multisite trials.
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Roy, Arunima, and Lily Hechtman. The Multimodal Treatment of Children with ADHD (MTA) Follow-up Study. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190213589.003.0008.
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The Multimodal Treatment of Children with ADHD (MTA) study was a 14-month randomized clinical trial with naturalistic follow-ups of participants (579 children with ADHD and 259 matched community controls) after treatment for a total of 16 years. Results from this study showed a superiority of multimodal treatment regimens for ADHD compared with the commonly available community care. Nevertheless, symptom and functioning improvements brought about by multimodal therapy lapsed after cessation of therapy. In short, the MTA study showed that ADHD is a chronic condition, requiring continuous, long-term, and well-monitored treatments. Furthermore, results showed that ADHD symptoms persist into adulthood in about half the sample, and that persistence is associated with poorer outcomes than remission or no childhood ADHD.
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M, Pettinati Helen, Zweben Allen 1940-, Mattson Margaret E, and Rutgers Center of Alcohol Studies., eds. The COMBINE Study: Conceptual, methodological and practical issues in a clinical trial that combined medication and behavioral treatments. Piscataway, NJ: Rutgers Center of Alcohol Studies, 2005.
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19
Karpova, Nina N. Pharmacological Adjuncts and Evidence-Supported Treatments for Trauma. Edited by Sara Maltzman. Oxford University Press, 2016. http://dx.doi.org/10.1093/oxfordhb/9780199739134.013.32.
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A large proportion of humans experienced a traumatic event in their lifetime, with more than 10% developing posttraumatic stress disorder (PTSD), panic disorder, phobias, and other fear/anxiety disorders. The neural circuitry of fear responses is highly conserved in humans as well as rodents, and this allows for translational research using animal models of fear. Fear/anxiety disorders in humans are most efficiently treated by exposure-based psychotherapy (i.e., cognitive behavioral therapy; CBT), the main aspects of which are closely modeled by extinction training in Pavlovian fear conditioning and extinction paradigms in rodents. To improve the efficacy of psychotherapy, pharmacological agents potent for enhancing learning and memory consolidation processing should be developed to combine with exposure-based therapy. The purpose of these adjunctive pharmacological agents is to promote fear memory erasure and the consolidation of extinction memories, thus providing a combined treatment of increased effectiveness. This review discusses established pharmacological adjuncts to behavioral therapeutic interventions for fear/anxiety disorders. The mechanisms of action of these adjuncts, as well as the evidence for and against the pharmacological treatment strategies and their limitations are discussed.
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Souza, Dmitri, Denis Snegovskikh, and Julia K. Hunter. Patients with Substance Abuse and Chronic Pain. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0032.
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Treating chronic pain in patients with a substance abuse history is challenging. Patients abusing opioids may have a high pain tolerance, making pain control difficult. Available treatments for acute pain include regional and multimodal analgesia. Non-opioid and nonpharmacological analgesia (including interventional modalities, physical rehabilitation, chiropractic manipulations, and pain psychology) can be used to treat chronic pain. Patients’ past and present opioid use—illicit drug or nonmedical prescription opioid use, maintenance on medication-assisted treatment, or abstinence—should be taken into consideration when choosing between chronic pain treatments. Consultation with an addictionologist can facilitate this population’s successful treatment.
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Chou, Jason, and George Chalkiadis. Acute Pain Management. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0059.
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Age-appropriate pain assessment and management is vital in the care of children with acute pain. Assessment should happen regularly and should be documented clearly; pain should be treated and routinely reassessed. There are both short- and long-term consequences if pain is poorly treated in the acute and postoperative setting. The most effective analgesia plans are multimodal. This chapter focuses on systemic treatments of pain in the acute setting.
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Hinshaw, Stephen P., and Richard M. Scheffler. ADHD in the twenty-first century. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198739258.003.0002.
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ADHD is a worldwide phenomenon of considerable importance, having generated major controversy throughout its history. In this chapter we emphasize the confluence of biological vulnerabilities and contextual influences essential for its manifestations. We also provide information on the sharp rises in both diagnosed prevalence and rates of medication treatment in recent years, providing a case example from the US pertaining to the influences of educational policies as one trigger of such increases. We conclude with commentary on the need for integrative and integrated perspectives on both the origins of ADHD and evidence-based treatments. Even though ADHD has important heritable and biological roots, its symptoms and impairments are amplified or diminished in homes and schools, and multimodal treatments are optimal for enhancing competence. Moreover, societal context and policy clearly shape diagnostic trends. We emphasize the need for integrative perspectives on ADHD, as reductionistic viewpoints polarize essential dialogue.
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Freidl, Eve K., Lauren J. Hoffman, and Anne Marie Albano. Outpatient Settings: The Collaborative Role of Psychiatry and Psychology. Edited by Thomas H. Ollendick, Susan W. White, and Bradley A. White. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780190634841.013.42.
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Best practices in child and adolescent mental health often point to multimodal treatments for moderate-to-severe distress and impairment in functioning. Mental health professionals, however, are not often experienced in recognizing and addressing various factors that promote or impede effective collaboration by clinicians of diverse training or orientation. This chapter presents the role of child psychiatrists in working within a collaborative care model with clinical child and adolescent psychologists. Discussed are the benefits and barriers to collaborative clinical care, strategies for addressing sometimes complex administrative issues, and models for promoting professional development and supervision within a collaborative care team. Optimizing patient benefits and reducing risk are key positive outcomes in productive collaboration between medical and psychosocial treatment providers.
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Lam, Raymond W. Psychotherapy. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199692736.003.0006.
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• Evidenced-based psychotherapies for depression include problem solving therapy, cognitive behaviour therapy, interpersonal psychotherapy, and cognitive behavioural-analysis system of psychotherapy.• For mild to moderate severity of depression, evidence-based psychotherapies are first-line treatments and are as effective as pharmacotherapy.• For more severe, chronic or comorbid depressions, combined treatment with psychotherapy and pharmacotherapy is indicated....
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Boison, Detlev. Overview of Ketogenic Diet in the Laboratory. Edited by Detlev Boison. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190497996.003.0019.
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Increased clinical interest in the ketogenic diet and similar metabolic treatments has naturally spurred research into mechanisms underlying their anticonvulsant/antiepileptogenic efficacy; significant progress and new insights are being made after many decades of relative obscurity. This section, “Ketogenic Diet in the Laboratory,” includes discussions of a number of molecular targets that are affected by ketogenic diet feeding. New insights into mechanisms, combined with clinical observations, are potentially expanding the utilitiy of this metabolic approach. In parallel, several alternative experimental methods to either elucidate or mobilize ketogenic diet mechanisms are explored. Based on this laboratory research, putative and novel uses for metabolic treatments are proposed.
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Perez, David L., and Valerie Voon. The Neurobiology of PNES and Other Functional Neurological Symptoms. Edited by Barbara A. Dworetzky and Gaston C. Baslet. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190265045.003.0006.
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Patients with psychogenic nonepileptic seizures (PNES) and related functional neurological symptoms are highly prevalent yet poorly understood on a neurobiological level. Clinical and research efforts in PNES and other functional neurological symptoms have lagged behind clinical neuroscience advancements in other neuropsychiatric conditions, despite the high frequency with which clinicians encounter PNES and other functional neurological symptoms. In this chapter, systems-level neurobiological studies in PNES are reviewed. Specific emphasis is given to structural and functional neuroimaging, electrophysiology, autonomic, and neuroendocrine investigations. Early systems-level neurobiology research suggests that PNES may develop in the context of alterations within and across brain networks mediating emotion processing, regulation and expression, cognitive control, multimodal integration, and sensory-motor functions. An improved biological understanding of PNES may reduce the stigma associated with this neuropsychiatric disorder and aid the development of biologically informed treatments and biomarkers of treatment response in this population.
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McFarr, Lynn, Julie Snyder, Lisa Benson, and Rachel Higier. Psychosocial Treatment Approaches for Substance Use. Edited by Shahla J. Modir and George E. Muñoz. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190275334.003.0013.
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Multiple psychosocial treatments for substance-use disorders have been studied for efficacy. A recent meta-analysis indicates that psychosocial interventions are effective across multiple types of substances used. In the case of opiates, psychosocial interventions combined with medication appear to be the most effective. Many studies further agree that psychosocial interventions are an integral and necessary part of treating substance-use disorders. Although theoretical orientations may differ across psychosocial treatments, they have several principles and practices in common. All involve talk therapy or talk in communities as a way to clarify triggers, build commitment, and improve accountability. Many also target addiction behaviors and work to develop alternative contingencies to reduce or eliminate use. Finally, targeting repeated performance (or building “chains of committed behavior”) decreases the likelihood of relapse. This chapter discusses the most frequently studied and employed psychosocial treatments for substance use including CBT, motivational interviewing, contingency management, mindfulness, and community-based programs.
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Prior, Helen M. Shape as understood by performing musicians. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780199351411.003.0014.
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Recent studies of musicians’ use of the concept of shape have examined its multimodal characteristics and expression; its link with musical identity; and its function as one of many heuristics for achieving a particular effect rapidly and without cumbersome amounts of conscious thought. This chapter analyses interview data, leading to the construction of a model encompassing the levels at which shaping was discussed, triggers for musical shaping, heuristics, technical modifications, and the resulting change in sound. An overview of the data is provided through an explanation of each component, and the distribution among the participants of the use of each idea discussed. The model is then used to represent selected parts of the data to give an insight into how the components of the model were combined in the interviews. Finally, the model is discussed in relation to its potential for generalization embracing other performing musicians.
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Gannon, Jessica M., and Shaun M. Eack. Psychosocial Treatment for Psychotic Disorders: Systems of Care and Empirically Supported Psychosocial Interventions. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199331505.003.0007.
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In this chapter, we discuss psychosocial interventions, including psychotherapies and other services useful for helping individuals with psychotic disorders. We explain the basics components of the systems of care through which these services are frequently offered, focusing on outpatient treatments. Psychosocial rehabilitation is highlighted, as it helps patients move towards recovery, which is an important model for psychosocial care. A number of evidence-based psychotherapies are explored, notably cognitive-behavioral therapy (CBT), family therapy, and cognitive remediation. Many of these treatments can be given individually or in groups, and although underutilized, can improve outcome when combined with somatic therapies. Other services have been shown to be useful in recovery, such as case management, assertive community treatment, and housing, and these are explored in this chapter as well. Finally, we review the role of hospitalization and involuntary treatment in the care of patients with psychotic disorders.
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Aaronson, Cindy J., Gary Katzman, and Rachel L. Moster. Combination Pharmacotherapy and Psychotherapy for the Treatment of Major Depressive and Anxiety Disorders. Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780199342211.003.0016.
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Clinical wisdom and intuition suggest that when treating major depression and/or anxiety disorders, combining two documented efficacious treatments such as antidepressants and psychotherapy would improve outcome. However, the data do not completely support this conclusion. This chapter reviews randomized clinical trials comparing combined pharmacotherapy and psychotherapy with monotherapy for the treatment of major depressive disorder, panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, generalized anxiety disorder, and social anxiety disorder in adults. Although DSM-V no longer categorizes posttraumatic stress disorder and obsessive-compulsive disorder as anxiety disorders, the authors continue to include them in this chapter.
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Jabbour, Pascal, and Eric Peterson, eds. Radial Access for Neurointervention. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780197524176.001.0001.
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Although femoral artery catheterization has been the mainstay of arterial access for cerebral angiography, there has been a recent increase in the use of transradial access among neurointerventionalists. Despite its widespread use among interventional cardiologists, there is a paucity of evidence for its use in the neurosurgical literature. With the constant evolution of device technology and the need of multimodal treatments for complex neurovascular pathologies, most neurointerventionalists resort to femoral artery access because of the vessel’s larger diameter and having been trained with that approach. However, transradial access confers a number of benefits, most notably lower risk of vascular complications, shorter recovery, and increased patient satisfaction and cost reduction. Femoral artery catheterization requires patients to tolerate a painful and uncomfortable procedure, with associated potential complications such as pseudo-aneurysm formation, retroperitoneal hematoma, and artery occlusion. Compared with groin access, radial artery catheterization has been shown to confer a lower risk of local neurovascular complications and improved quality-of-life metrics. This book is the first of its kind, detailing step by step all the technical nuances of the transradial approach in the neurointerventional world, from diagnostic cerebral angiograms to neurointerventional procedures. This is the perfect book for physicians who decided to make the transition of their practice to transradial.
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Kulkarni, Kunal, James Harrison, Mohamed Baguneid, and Bernard Prendergast, eds. Emergency medicine. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198729426.003.0006.
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Emergency medicine is a dynamic discipline encompassing critical and acute care for the complete spectrum of health problems. The specialty continues to adapt, in response to external pressures arising from increasing demand, demographic changes, service reconfigurations, and political contrivances. These developments, combined with the prodigious volume of patients attending emergency departments, offer a rich potential for research. Although the field of emergency medicine initially developed slowly outside of America, studies are now regularly conducted and result in a powerful impact on patient care. Emergencies occur at all ages, in diverse body systems, and with undifferentiated presentations. The challenge of reaching accurate early diagnoses and instigating rapid effective treatments in these divergent conditions mandates a broad research approach comprising diagnostic, prognostic, and therapeutic studies. This chapter collates research papers reflecting these diverse methods and representing groundbreaking studies which have shaped modern emergency medicine practice.
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Kissane, David W., and Matthew Doolittle. Depression, demoralization, and suicidality. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0173.
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The development of clinical depression is common during palliative care, adversely affects quality of life and adherence to medical treatments, yet regrettably can pass unrecognized. Screening for distress as the sixth vital sign is therefore highly recommended. Demoralization is another form of distress where the apparent pointlessness of continued life may lead to suicidal thinking. As the mental condition deteriorates, co-morbid states of anxiety, depression, and demoralization become more likely. Rates of suicide are increased with advanced cancer and poor symptom control. Fortunately, combined treatment with medication and counselling is effective in ameliorating depression, demoralization, and suicidality. Meta-analyses of psychotherapy trials confirm clear benefits, with behavioural activation, supportive, interpersonal, and cognitive behavioural therapies all making contributions. Group, couple, and family therapies optimize support for all involved. All members of the multidisciplinary team contribute to the active treatment of depression, demoralization, and the prevention of suicide.
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Olshan, Andrew F., and Mia Hashibe. Cancer of the Larynx. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190238667.003.0027.
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Cancer of the larynx can affect the glottis, supraglottis, subglottis, and laryngeal cartilage. Traditional treatments for laryngeal cancer caused significant disfigurement, difficulty with swallowing and speech, and poor quality of life. Newer treatment methods seek to preserve laryngeal function. Worldwide, an estimated 157,000 new cases and 83,000 deaths from laryngeal cancer occurred in 2012, accounting for 1.1% of all new cancer cases and 1.0% of all cancer deaths. The risk of cancer of the larynx is nearly five times higher in men than women in the United States. Incidence and mortality rates of these cancers in males are decreasing in most high-income countries; this decrease is seen in all racial and ethnic groups in the United States. Active cigarette smoking is the strongest risk factor and explains the greatest proportion of cases. All tobacco products are strongly associated with increased risk, especially when combined with alcohol consumption.
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Nestler, Eric J. New Approaches for Treating Depression. Edited by Dennis S. Charney, Eric J. Nestler, Pamela Sklar, and Joseph D. Buxbaum. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190681425.003.0030.
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Several obstacles have impeded the introduction of new antidepressant medications over the past six decades. These obstacles include our still rudimentary knowledge of the biological basis of depression, as well as difficulties in evaluating the therapeutic efficacy of new putative antidepressant mechanisms in pathophysiologically distinct subtypes of the syndrome. Despite these obstacles, several tangible steps can be taken to advance depression treatment moving forward. The field needs to continue to take advantage of serendipitous discoveries in humans, such as the demonstration of rapid antidepressant effects of ketamine. Re-establishing experimental pharmacology in humans, to make it possible to establish the actions of new mechanisms in people, is essential, combined with the judicious use of a growing range of chronic stress models in animals. We anticipate that, with these approaches, the field can at long last breakthrough the logjam of discovery and introduce new treatments for depression over the next decade.
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Raper, Daniel M. S., and John A. Jane. Craniopharyngiomas. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190696696.003.0025.
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Craniopharyngiomas (CPs) are rare tumors arising from the developmental Rathke’s pouch and present in a bimodal distribution peaking at 5 to 14 and 50 to 74 years. Symptoms at onset include visual loss, headache, and hypopituitarism. Most tumors contain solid and cystic components, and fluid within the cyst usually contains cholesterol crystals. Histopathology is classified into adamantinomatous (most common in children) and papillary (almost exclusively in adults) subtypes. Magnetic resonance imaging is the definitive diagnostic modality for sellar and suprasellar lesions. In addition to imaging, formal visual evaluation and detailed endocrinologic workup are a critical aspect of preoperative assessment. The role of radical surgical resection, versus decompression combined with radiotherapy, remains controversial. The most common complications of surgical and radiotherapeutic treatments include pituitary stalk and hormonal deficiencies, along with cerebrospinal fluid leak. As 5-year overall survival for patients with CP is in the range of 55% to 85%, CP remains a challenging condition to treat and requires a multidisciplinary approach.
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Fye, W. Bruce. Creating Coronary Care Units and Empowering Nurses. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199982356.003.0013.
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The coronary care unit (CCU) concept was proposed in 1961 as a strategy to save the lives of patients hospitalized after an acute myocardial infarction (heart attack). The notion was to place vulnerable patients in an area where their heartbeats were monitored continuously and where specially trained nurses could initiate cardiopulmonary resuscitation (CPR) if a patient had a cardiac arrest. Cardiac defibrillators and temporary pacemakers, technologies developed in the 1950s to treat life-threatening heart rhythms, were combined with CPR in 1960 in an attempt save patients’ lives. Nurses played a vital role in CCUs, and the new care model transformed the traditional nurse-doctor relationship. Nurses were trained to initiate life-saving treatments without a physician being present. The resulting empowerment of nurses had significant implications for their status as health care providers. The CCU movement also contributed to the development of cardiac arrest teams and paramedic-staffed, defibrillator-equipped ambulances.
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Steketee, Gail, and Brian H. McCorkle. Future Research on Obsessive Compulsive and Spectrum Conditions. Edited by Gail Steketee. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780195376210.013.0108.
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This chapter reviews comments raised by authors of 25 chapters of the Handbook of Obsessive Compulsive and Spectrum Disorders. Among the challenges raised are those within the areas of diagnosis and features of the several OC spectrum conditions, including revisions to the diagnostic nomenclature for DSM-V under consideration, especially with regard to the possible addition of hoarding disorder to distinguish this more clearly from OCD. Research on clinical versus nonclinical samples, and controversies regarding possible subtypes of OCD and of some of its spectrum conditions like BDD and hoarding, are examined. Relationships among OCD and the spectrum conditions are examined with attention to the general lack of information about this issue. Several authors in the handbook comment on personality features and their association with outcomes following treatment, with a general consensus that assessing features rather than disorders will be most useful. The impact of culture on expression of OC spectrum conditions is clearly under-studied. Causes and mechanisms underlying OCD and spectrum conditions are examined, including neurological and genetic underpinnings, information processing, beliefs and cognitive models, as well as social and familial factors. Concerns about assessment are raised with regard to OCD and its expression in older adults, in hoarding and in BDD, and the impact of culture on assessment. With regard to treatment, chapters focus on research needs concerning mechanisms of action and predictors of change, and the need to improve treatments to enhance their effects. Improvement of outcomes in a variety of areas (e.g., hoarding, children, culturally sensitive treatments) is noted, including outcomes for medications and combined CBT plus medication regimens. Special issues are raised with regard to BDD, tic disorders, and trichotillomania.
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Cutter, David, and Martin Scott-Brown. Treatment of cancer. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0325.
Full textAbstract:
The variety of conditions that are considered to be ‘cancer’ is extremely wide, with marked variation in the management approach from disease to disease. A common feature in the management of malignant conditions, however, is the involvement of a wide range of medical professionals at different stages of the patient pathway. This commonly includes physicians, surgeons, radiologists, pathologists, medical oncologists, radiation oncologists, and specialist nurses, as well as a plethora of other allied disciplines. As such, a practice that has been widely adopted is to work as a multidisciplinary team (MDT), with regular meetings to decide the appropriate treatment for each patient with a cancer diagnosis, on an individual and case-by-case basis. The main treatment modalities for the treatment of cancer are surgery, radiotherapy, and chemotherapy. While these are often combined to form a multimodality therapy, they are all, in isolation, potentially radical (curative) therapies for certain conditions. For example, surgery (in the case of a Stage I colon adenocarcinoma), radiotherapy (in the case of early laryngeal squamous cell carcinoma), and chemotherapy (in the case of acute lymphoblastic leukaemia) are all curative as single-modality treatments. It is commonly the case, however, for a patient to require more than one mode of therapy to achieve the best outcome, for example a combination of surgery, chemotherapy, and radiotherapy for early breast cancer. It can also be the case that two or more different management strategies are thought to give equivalent oncological results, for example surgery or radiotherapy for early prostate cancer. In this situation, the MDT and the patient need to decide on the ‘best’ management plan for the individual, based on their personal and professional opinions and on the differing toxicity profiles of the alternate treatments.
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Watson, Louise, and Michael W. Beresford. Paediatric-onset systemic lupus erythematosus. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0119.
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Paediatric or juvenile-onset systemic lupus erythematosus (JSLE) is a rare autoimmune condition, differing from the adult form in terms of severity, organ manifestations, and a less striking female predominance. The diagnosis relies on the adult-derived American College of Rheumatology SLE classification criteria. Genetic, autoantibody, and host immune responses, characteristic of this disease, result in a clinically heterogeneous phenotype. A proportion of paediatric SLE patients will have evidence of a genetic deficiency known to be associated with SLE, such as C1q deficiency, and screening for these is required. A challenging diagnosis to make in the younger age group, the management of JSLE compared to adult-onset SLE requires special consideration towards the significant long-term consequences of the disease and treatment toxicity, combined with an onset during a fundamental time with regards to growth and development. A comprehensive, multidisciplinary team approach to the management of JSLE is essential. With a more severe phenotype and limited comorbidities, patients with JSLE represent an invaluable opportunity for investigating the pathogenesis. To date, clinical trials informing interventions in JSLE are very limited and treatment choices rely on the outcome of adult trials. Patient and family involvement in research to improve outcomes and understanding is essential. New treatments, including biological therapies, are becoming available for clinical use and new treatment combinations have been used to induce and maintain clinical remission.
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Steketee, Gail, and Christiana Bratiotis. Hoarding. Oxford University Press, 2020. http://dx.doi.org/10.1093/wentk/9780190946395.001.0001.
Full textAbstract:
Hoarding disorder is the excessive saving of objects and difficulty parting with them to a point that interferes with one's ability to properly use rooms and furnishings in the home. Hoarding can become dangerous, sometimes resulting in structural problems and fires, or in hazardous sanitary conditions. Studies indicate that around one in every 25 people suffers from hoarding. This means that almost all of us know someone who hoards. Hoarding: What Everyone Needs to Know demystifies this complex problem, what it looks like and why it may develop, and how it can be treated. With their combined expertise in psychological treatments for hoarding and community interventions, Drs. Steketee and Bratiotis explain how to understand hoarding as a mental illness, describing the disorder in layman's terms and explaining the various facets and manifestations of the behavior. Chapters focus on one or more common questions regarding diagnosis, features, how to assess severity, and treatment. The book will dispel myths and help readers identify hoarding that touches their own lives. As such it will be of great value not only to those who suspect a loved one may be hoarding, but also to first responders, such as firefighters, public health officials, and housing and social service personnel, who will find here an essential resource for use in the field.
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Fearn, David. Pindar's Eyes. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198746379.001.0001.
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This book assesses the ways in which Pindar, as well as other epinician poets, investigates the theme of aesthetic, and specifically visual, experience in early classical Greece. Major case studies offer complete readings of Pindar’s Nemean 5, Nemean 8, and Pythian 1. These poems reveal Pindar’s deep interest in the relation between lyric poetry and the material and visual world of commemorative and religious sculpture and other significant visual phenomena. The book offers an account of the reception of Pindaric themes in the Aeginetan logoi of Herodotus’ Histories and also offers new insights into Simonides’ own material-cultural interests, a fresh treatment of narrative style and material culture in Bacchylides, and a visual and material-cultural reading of Pindar’s Nemean 10. Pindar uses the concept of vision within his poetry to assess the extent to which either encomiastic poetry or sculpture can achieve its commemorative or religious purposes; this book uses current theoretical methodologies to evaluate how this is done. New claims are made about the nature of classical Greek visuality and ritual subjectivity. Literary studies of Pindar’s evocation of cultural attitudes through elaborate use of the lyric first person are combined with art-historical treatments of ecphrasis, of image and text, and of art’s framing of ritual experience in ancient Greece. Pindar uses a particularly complex and alluring poetic language to create empowering and highly valued paradigms for social, cultural, and religious subjectivity.
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Carter, Bryan D., William G. Kronenberger, Eric L. Scott, and Christine E. Brady. Children's Health and Illness Recovery Program (CHIRP). Oxford University Press, 2020. http://dx.doi.org/10.1093/med-psych/9780190070267.001.0001.
Full textAbstract:
Adolescents with chronic illness, particularly when accompanied by debilitating, painful, and/or fatiguing symptoms, face challenges that are disruptive to their normal physical, psychological, and social development. The Children’s Health and Illness Recovery Program (CHIRP) is an evidence-based program specifically designed to address the skills needed by adolescents with chronic illnesses to become more confident and independent in coping and managing their illness and lifestyle. The flexible 12-session format of CHIRP can be administered with individual teens and their families or conducted in teen groups with a parallel parent group component. CHIRP integrates and adapts effective treatment components from behavioral family systems therapy, cognitive behavioral therapy, coping strategies intervention, interpersonal psychotherapy, assertiveness training, among others, into therapeutic activities in the companion CHIRP Teen and Family Workbook. This CHIRP Clinician Guide provides detailed instructions for implementing the manualized treatment protocol in the workbook. CHIRP was developed from both a careful review of the evidence-based literature on treatments for adolescents with chronic physical illness and the authors’ more than six decades of combined experience in helping children and families improve their quality of life and independence while coping with a chronic illness. Clinical outcome data on teens who have completed CHIRP demonstrate significant improvement in independent functioning and reduction in symptoms of fatigue and chronic pain; longitudinal data suggest these improvements not only persist but that teens continue to make gains on these factors beyond the completion of treatment, allowing them to pursue meaningful life goals as they transition to young adulthood.
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Castonguay, Louis G., Michael J. Constantino, and Larry E. Beutler, eds. Principles of Change. Oxford University Press, 2019. http://dx.doi.org/10.1093/med-psych/9780199324729.001.0001.
Full textAbstract:
This book aims to create a new venue for evidence-based practice in psychotherapy—a venue that goes beyond the traditional and unidirectional dissemination of research, whereby clinicians are typically viewed as passive recipients of scientific findings. In contrast, this book is the result of an active, intense, and bidirectional collaboration of psychotherapy researchers and practitioners. Based on an extensive review of literature, it first offers a list of 38 empirically based principles of change that are clustered within five categories: client prognostic, treatment/provider moderating, client process, therapeutic relationship, and therapist interventions. It then illustrates the expertise of six therapists from diverse theoretical orientations who describe how they implement each of these principles with specific cases of depression and anxiety disorders (with or without substance abuse or personality disorder). The book also includes exchanges between researchers and clinicians on several issues regarding the current list of principles of change, such as how similarly and differently they are addressed or used across a variety of treatments, how helpful they can be in clinical routine (and/or under which situations they may not be clinically valid), how they may be combined for particular purposes (such as teaching and training), and how the list can be expanded to guide future research based on clinicians’ observations and reflections. This book is an attempt to advance psychotherapy by having researchers and clinicians share their unique and yet complementary knowledge. It also lays the foundations for further collaborations and partnerships between different stakeholders in mental health services.
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Kreitzer, Mary Jo, Mary Koithan, and Andrew Weil, eds. Integrative Nursing. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190851040.001.0001.
Full textAbstract:
Fully updated and revised, the second edition of Integrative Nursing is a complete roadmap to holistic patient care, providing a step-by-step guide to assess and clinically treat conditions through a variety of combined methodologies including traditional and alternative therapies with all aspects of lifestyle. This text identifies both the skills and theoretical frameworks for interprofessional systems leaders to consider and implement integrative healthcare strategies within institutions, including several case studies involving practical nursing-led initiatives. This volume covers the foundations of the field; the most effective ways to optimize wellbeing; principles of symptom management for many common disorders like sleep, anxiety, pain, and cognitive impairment; the application of integrative nursing techniques in a variety of clinical settings and among a diverse patient population; and integrative practices around the world and how they impact planetary health. The academic rigor of the text is balanced by practical and relevant content that can be readily implemented into practice for both established professionals as well as students enrolled in undergraduate or graduate nursing programs. Integrative health and medicine is defined as healing-oriented care that takes account of the whole person (body, mind, and spirit) as well as all aspects of lifestyle; it emphasizes the therapeutic relationship and makes use of appropriate therapies, both conventional and alternative. Series editor Andrew Weil, MD, is Professor and Director of the Arizona Center for Integrative Medicine at the University of Arizona. Dr. Weil’s program was the first such academic program in the U.S., and its stated goal is “to combine the best ideas and practices of conventional and alternative medicine into cost effective treatments without embracing alternative practices uncritically.”