C David Taylor, Carol Paton and Shitij Kapur. Published by John Wiley & Sons, Ltd. 2 The Maudsley Prescribing Guidelines in Psychiatry (e.g. Request PDF on ResearchGate | On Jan 1, , D. Taylor and others published Maudsley Prescribing Guidelines in Psychiatry - 11th Edition. Apr , Wiley-Blackwell The lead author of all editions of the Maudsley Prescribing Guidelines, Professor Taylor is the author of several other texts and.

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Prescribing guidelines. The souTh london and Maudsley nhs FoundaTion TrusT oxleas nhs FoundaTion TrusT. 10th edition david Taylor carol Paton shitij Kapur. Pris: kr. E-bok, Laddas ned direkt. Köp Maudsley Prescribing Guidelines in Psychiatry. E-bok (PDF - DRM), Engelska, Ladda ned. Maudsley Prescribing Guidelines Conference To mark the launch of the 11th edition of The Maudsley Prescribing Guidelines.

The leading clinical reference for handling prescribing problems as encountered in daily practice and for formulating prescribing policy. Evidence-based and written by experts This book is the essential guide for anyone responsible for prescribing, dispensing or administering drugs for patients with mental health disorders. All the evidence has been reviewed and summarized succinctly by an expert team of psychiatrists and pharmacists. New content and improved format This new edition makes greater use of tables and boxes to facilitate quick reference and includes new sections on cytochrome-mediated interactions and psychiatric side effects of non-psychotropic drugs.

Clinically relevant Chapters address plasma monitoring, schizophrenia, bipolar disorder, depression and anxiety, children and adolescents, substance abuse and special patient groups. Each section has a full reference list. The book covers prescribing drugs outside their licensed indications and their interaction with substances such as alcohol, nicotine and caffeine. Useful for all levels of experience Trainees will gain important information regarding the rational, safe and effective use of medications for patients with mental illness.

Experienced clinicians will find excellent guidance regarding more complex issues that they may not encounter regularly. Why the Maudsley Prescribing Guidelines in Psychiatry? Long recognized as an international trailblazer in mental health care, the Maudsley Hospital earned its reputation for excellence in both in-patient and community care.

This distinction is made for the simple pragmatic reason that we know more about the contribution of subthreshold symptoms in relapse and maintenance of depressive episodes.

However, relevance of these propositions has to be tested. The standard duration of remission to separate two episodes is two months. There is no clear reason as to why this duration was chosen, other than the assumption that, in the event of a new episode when the remission has been under two months, may simply be a continuation of the initial illness process rather than emergence of a relapse episode.

There is clear uncertainty regarding duration of remission that heralds the onset of a more sustained remission. Further research in this area is warranted. Three duration categories are recognised in the MSM.

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This should include the period prior to the initiation of the treatment. In our research and clinical practice at a tertiary centre, the MSM is completed by research or clinical psychiatrists and trainee psychiatrists. However, the MSM may be rated by a trained research nurse or junior research staff who can complete standard instruments, such as the HRSD. In research context where multiple users are likely to be involved, inter-rater agreement needs to be established.

Agreement on the definition of TRD has remained elusive in four decades. Nevertheless, treatment resistance is a vexed concept even in other chronic conditions. TRE was defined in less than a third of the studies. When a definition was given, it typically included the number of failed antiepileptic medications tried, and in some cases included the adequacy of dosage, the frequency of seizures and the duration of illness [ ].

In line with this consensus definition for RTE, and evidence that failure of the first antidepressant may be associated with subsequent reduced responsiveness, we have suggested that failure of one treatment should be the threshold for defining TRD.

We thus suggest that failure to respond to the first treatment should count towards defining TRD. The term refractory implies that virtually all chances of the person responding to treatment are gone. This proposition is contrary to reports of outcome studies, which suggest that, despite chronicity, most patients improve in the longer term with or without treatment [ 27 , — ]. There is no clear evidence to support the occurrence of a similar phenomenon in the treatment of depression.

Treatment-resistance is not an all or none phenomenon but is rather a continuum, and the preferable representation of treatment resistance would be to describe the level of treatment-resistance in terms of various severity grades. Such severity gradation would be useful as the term TRD itself is non-specific and generic. Although remission remains a recommended treatment target, this is not always achievable and should not be a cause for therapeutic nihilism.

Improving symptoms with antidepressants when the severity scores go down to the mild and subthreshold range may be even more challenging and the risk-benefit balance of psychotropic medications more difficult to determine.

Systematic follow-up and monitoring of patients without changing or adding medications may be of meaningful benefit to patients with treatment-resistant illness.

However, further short- and long-term development work is required. For example, the definitions of remission, the threshold for TRD and how previous history of non-response to treatment should be incorporated into a staging method is unclear.

The potential role of suicidality as severity indicator may need further exploration. Most importantly, the treatment implication of the MSM should be explored. Matching the staging with recovery goals of patients is another key challenge that requires further work. AF and AJC drafted the paper. All authors contributed to the finalisation of the paper and approved the final submission.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Electronic supplementary material.

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Abebaw Fekadu, Email: Jacek G. Donocik, Email: Anthony J. Cleare, Email: National Center for Biotechnology Information , U.

BMC Psychiatry. Published online Apr Abebaw Fekadu , 1, 2, 3 Jacek G. Donocik , 3 and Anthony J. Cleare 3. Author information Article notes Copyright and License information Disclaimer.

Corresponding author. Received Nov 30; Accepted Mar This article has been cited by other articles in PMC. Associated Data Supplementary Materials Additional file 1: DOC kb. Abstract Background Treatment-resistant depression TRD is a serious and relatively common clinical condition. Method Based on the initial development of the MSM and a narrative review of the literature, the developers of the MSM provide explicit guidance on how the three dimensions of the MSM--treatment failure, severity of depressive episode and duration of depressive episode-- may be rated.

Conclusion The approaches provided should have clinical and research utility in staging TRD. Electronic supplementary material The online version of this article Depressive disorder, Treatment-resistant depression, Remission, Staging; Maudsley staging method. Background Treatment-resistance is a common clinical phenomenon in medicine.

Methods The methods were guided by three questions relevant to the objectives of the study: Ethical considerations Not applicable. Definitions Definitions from treatment studies A review of 47 treatment trials explored the definitions and staging criteria in TRD [ 37 ]. Table 1 The main definitions of treatment-resistance in depression. Primarily staging method NICE Failure of 2 antidepressant medication from different classes BAP Failure of 2 antidepressant medication from different classes Refers to commonly used definitions instead of attempting to provide a definition of its own MSM Failure of 1 adequately given antidepressant medication Failure to achieve remission suggested as main outcome criteria; Primarily for staging DM-TRD Failure of 1 adequately given antidepressant medication Based on the MSM Conway et al Failure of 2 adequate dose-duration antidepressants or psychotherapy from different classes Antidepressants given in current episode.

Combinations count individually. Open in a separate window. Current staging methods of TRD Six staging methods were identified. The Maudsley staging method: Considerations in developing the method Definition of treatment-resistance The MSM defines treatment-resistance as: Dimension 1-treatment failure Failure of the first treatment appears important in that once the first treatment trial fails, the response rate to each successive treatment declines [ 15 ].

Severity of depression Inclusion of severity of depression as a staging criterion not only makes clinical sense, but severity of illness has also been consistently associated with non-response in numerous treatment [ 69 — 72 ] and follow-up studies [ 73 — 77 ].

Table 4 Severity ratings compatible with the MSM for commonly used rating scales. Chronicity Studies have consistently demonstrated that the longer the duration of illness, the poorer the response to treatment in the acute phase of [ 81 , 82 , 92 , 93 ] or augmentation [ 94 ] and predicted shorter relapse free survival [ 79 , 95 ]. How to complete rate the MSM: The MSM completion tool The recommendations here target research settings where a standardised and replicable assessment is essential.

Rating for treatment failure dimension 1 We propose the use of one of three options to rate for treatment failure: The antidepressant treatment history form ATHF Is a semi-structured tool that is used to define treatment resistance and treatment history for current and past episodes , including somatic therapies [ 98 — ].

The Maudsley treatment inventory MTI The MTI is a semi-structured instrument that we have developed to document psychotropic medications and physical therapies used in the treatment of depression and assist the completion of the MSM. Dimension 2: Dimension 3: Duration of depressive episode The two key questions regarding duration of the depressive episode are: Table 5 Rating for duration of depressive episode.

Who should complete the MSM? Discussion Agreement on the definition of TRD has remained elusive in four decades. Additional file Additional file 1: Funding None for this work. Availability of data and materials Not applicable. Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors developed the MSM.

Standardisation framework for the Maudsley staging method for treatment resistance in depression

Footnotes 1 Italicised words in bracket are added by authors for clarity of reading Electronic supplementary material The online version of this article Contributor Information Abebaw Fekadu, Email: References 1.

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Unheard voices: outcomes of tertiary care for treatment-refractory psychosis

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The longitudinal interval follow-up evaluation a comprehensive method for assessing outcome in prospective longitudinal studies. The hidden third: Severity and duration of depression, not personality factors, predict short term outcome in the treatment of major depression.Long recognized as an international trailblazer in mental health care, the Maudsley Hospital earned its reputation for excellence in both in-patient and community care.

Refers to commonly used definitions instead of attempting to provide a definition of its own. External link. Sartorius N. Nevertheless, we borrow some approaches from systematic review methodology to make sure all key works in the field of research are captured and minimise risk of bias.

In line with this consensus definition for RTE, and evidence that failure of the first antidepressant may be associated with subsequent reduced responsiveness, we have suggested that failure of one treatment should be the threshold for defining TRD. Treatment of depression. Most studies defined treatment failure only in relation to the presenting episode while few also included treatment failures, or recurrences whilst on treatment, in previous episodes.