Treatment resistance in psychiatry: state of the art and new directions.
Treatment resistance in psychiatry: state of the art and new directions.
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DOI：
10.1038/s41380-021-01200-3
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发表时间：
2022-01
影响因子：
11
通讯作者：
Pillinger T
中科院分区：
文献类型：
--
作者：
Howes OD;Thase ME;Pillinger T
治疗抵抗影响20-60%的精神疾病患者;并且与增加的医疗负担和相对于一般患者高达10倍的成本相关。虽然最近关注治疗抵抗的精神病学研究比例有所增加（R2 = 0.71，p < 0.0001），但就绝对值而言，这还不到总产出的1%，与其流行程度和影响严重不成比例。在这里，我们提供了一个治疗耐药性的概述，考虑其概念化，评估，流行病学，影响和常见的神经生物学模型。我们还回顾了新的治疗方法的发展和未来的方向。我们确定了23个关于其定义的共识指南，涵盖精神分裂症，重性抑郁症，双相情感障碍和强迫症（OCD）。这表明了其定义的三个核心组成部分，但也发现了许多疾病的异质性和缺乏标准，包括恐慌症、创伤后应激障碍和物质依赖。我们提供了一个报告检查表，以帮助比较研究。我们考虑了假性耐药的概念，与依从性差或其他因素有关，并提供了一种用于治疗耐药临床评估的算法。我们确定了九种药物和一些非药物方法正在开发的治疗阻力，精神分裂症，重性抑郁症，双相情感障碍和强迫症。治疗抵抗的主要突出问题包括异质性和缺乏共识标准，对神经生物学的理解不足，投资不足和缺乏治疗。我们提出了解决这些问题的建议，包括统一定义，研究机制和新的干预措施，以实现有针对性和个性化的治疗方法。
Treatment resistance affects 20–60% of patients with psychiatric disorders; and is associated with increased healthcare burden and costs up to ten-fold higher relative to patients in general. Whilst there has been a recent increase in the proportion of psychiatric research focussing on treatment resistance (R2 = 0.71, p < 0.0001), in absolute terms this is less than 1% of the total output and grossly out of proportion to its prevalence and impact. Here, we provide an overview of treatment resistance, considering its conceptualisation, assessment, epidemiology, impact, and common neurobiological models. We also review new treatments in development and future directions. We identify 23 consensus guidelines on its definition, covering schizophrenia, major depressive disorder, bipolar affective disorder, and obsessive compulsive disorder (OCD). This shows three core components to its definition, but also identifies heterogeneity and lack of criteria for a number of disorders, including panic disorder, post-traumatic stress disorder, and substance dependence. We provide a reporting check-list to aid comparisons across studies. We consider the concept of pseudo-resistance, linked to poor adherence or other factors, and provide an algorithm for the clinical assessment of treatment resistance. We identify nine drugs and a number of non-pharmacological approaches being developed for treatment resistance across schizophrenia, major depressive disorder, bipolar affective disorder, and OCD. Key outstanding issues for treatment resistance include heterogeneity and absence of consensus criteria, poor understanding of neurobiology, under-investment, and lack of treatments. We make recommendations to address these issues, including harmonisation of definitions, and research into the mechanisms and novel interventions to enable targeted and personalised therapeutic approaches.
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影响因子：
5.3
作者：
Augustin, Marc;Schoretsanitis, Georgios;Paulzen, Michael
通讯作者：
Paulzen, Michael
影响因子：
3
作者：
Coplan JD;Gopinath S;Abdallah CG;Berry BR
通讯作者：
Berry BR
DOI：
10.1192/bjp.2018.66
发表时间：
2019-01
期刊：
The British journal of psychiatry : the journal of mental science
影响因子：
--
作者：
Chamberlain SR;Cavanagh J;de Boer P;Mondelli V;Jones DNC;Drevets WC;Cowen PJ;Harrison NA;Pointon L;Pariante CM;Bullmore ET
通讯作者：
Bullmore ET
影响因子：
6.6
作者：
Angst, J;Gamma, A;Rössler, W
通讯作者：
Rössler, W
影响因子：
10.5
作者：
Baca-Garcia, Enrique;Perez-Rodriguez, Maria M.;Oquendo, Maria A.
通讯作者：
Oquendo, Maria A.