scholarly journals The Case of "Hiro": Treating Tourette Syndrome by Comprehensive Behavioral Intervention for Tics (CBIT)

2017 ◽  
Vol 13 (1) ◽  
pp. 1
Author(s):  
Jeremy D. Lichtman
Keyword(s):  
Tourette Syndrome ◽  
Behavioral Intervention ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Treatment Options ◽  
Case Formulation ◽  
Efficacious Treatment ◽  
Treatment Considerations ◽  
New Treatment

Cognitive-behavioral therapy (CBT) with Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious treatment for Tourette Syndrome (TS), with a manualized version available for guiding practitioners through treatment. However, CBIT is still a fairly new treatment for TS and rigorous training in its application is sparse. Additionally, potential treatment considerations are not thoroughly described in the manual. This dissertation presents a systematic case study that specifically analyzes the use of the manual with 10-year-old "Hiro," a South Asian Indian boy with TS who also had attention deficit hyperactivity disorder (ADHD), which is a confounding factor in the treatment of TS. To do this meant applying flexibility and an "hypothesizing-then-testing" mentality. The creation of an individualized case formulation and an associated treatment plan for Hiro were very valuable components in his treatment. The case study chronicles Hiro's successful treatment and explores how and when adherence to the manual was effective as well as how and when greater flexibility was required. Furthermore, the case study explores factors in the clinician/client relationship and how that relationship can prove a powerful tool in treatment. Options for how to maintain treatment goals after termination are also examined.

Updates in insomnia diagnosis and treatment

2019 ◽  
Vol 54 (4-5) ◽  
pp. 275-289 ◽  
Author(s):  
Scott Bragg ◽  
JJ Benich ◽  
Natalie Christian ◽  
Josh Visserman ◽  
John Freedy
Keyword(s):  
Drug Therapy ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Treatment Options ◽  
First Line ◽  
Safety Concerns ◽  
Diagnostic And Statistical Manual ◽  
First Line Therapy ◽  
Appropriate Treatment ◽  
Central Nervous System Depression

Introduction Insomnia is the most commonly reported sleep disorder and remains undertreated in many patients. New changes to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, have changed the way insomnia is diagnosed. In patients who suffer from insomnia, a number of available treatment options exist including both behavioral therapy and medications. Literature Review: First line therapy for insomnia should always include behavioral modifications such as sleep hygiene and insomnia-oriented cognitive behavioral therapy. In patients deemed to need pharmacotherapy, first line medications include nonbenzodiazepine hypnotics (i.e., z-drugs) and antidepressants depending on the patients’ needs and comorbidities. The risk of next day impairment, parasomnias, and central nervous system depression are some of the most feared side effects with z-drugs. Second line drug therapy includes melatonin and suvorexant. Several concerns exist for suvorexant similar to other insomnia medications, but melatonin remains one of the safest medication alternatives. Other medication options such as benzodiazepines, antihistamines, and antipsychotics should rarely be used because of weak effectiveness data or serious safety concerns. Discussion The most appropriate treatment plan needs to be tailored to meet the needs of individual patients. Many patient factors (e.g., age, other comorbidities, specific problems with sleep) need to be considered before prescribing drug therapy for patients suffering from insomnia. Medications with the best evidence and fewest safety concerns should be prioritized when clinicians work with patients to determine the most appropriate treatment plan. Conclusions Nondrug treatment should be the emphasis for managing insomnia, but several options exist for patients needing multimodal therapy to improve their symptoms and maximize their quality of life. Z-drugs and antidepressants are first line medications options, but other options may be considered when tailored to individual patients. Medications should only be used intermittently and short term until nondrug treatments help to change a patient’s sleep routine.

Recent Updates in Both the Diagnosis and Treatment Options that Impact the Clinical Treatment of Pulmonary Arterial Hypertension

2010 ◽  
Vol 2 ◽  
pp. CMT.S4192
Author(s):  
Charles D. Burger
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Treatment Plan ◽  
Treatment Options ◽  
Pharmaceutical Formulations ◽  
World Health ◽  
New Agents ◽  
Pulmonary Arterial ◽  
New Treatment ◽  
Health Organization

The evaluation and management of pulmonary arterial hypertension (PAH) is a rapidly evolving area of subspecialty medicine requiring regular clinical updates. Most notably are changes in the World Health Organization diagnostic scheme whereby the clinician categorizes the correct type of pulmonary hypertension in order direct the most specific evaluation and treatment plan. In addition, there have been several changes in both the FDA-approved pharmaceutical formulations and new agents for the treatment of PAH. This review will provide an update in these areas and more importantly, guidance to the clinician on the most appropriate utilization of these new treatment options.

Comorbidity of Bulimia Nervosa and Substance Abuse: Etiologies, Treatment Issues, and Treatment Approaches

2010 ◽  
Vol 32 (2) ◽  
pp. 125-138 ◽  
Author(s):  
Rebecca Carbaugh ◽  
Shari Sias
Keyword(s):  
Substance Abuse ◽  
Bulimia Nervosa ◽  
Coping Skills ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Skills Training ◽  
Dialectical Behavioral Therapy ◽  
Coping Skills Training ◽  
Prevent Weight Gain

Recently the comorbidity of substance abuse and eating disorders has become a concern. Treating these disorders is particularly important for bulimia nervosa, which is characterized by "binge eating and inappropriate compensatory methods to prevent weight gain" (American Psychiatric Association, 2000, p. 589). In this article we explore common pathways to the development of bulimia nervosa and substance abuse, how treatment is begun, and treatment options (cognitive behavioral therapy/coping skills training and dialectical behavioral therapy). A case study shows the application of coping skills training and dialectical behavioral therapy in clinical practice.

Integrative Nursing Management of Anxiety

2018 ◽  
pp. 221-239
Author(s):  
Pamela Lusk ◽  
Michelle Kahn-John
Keyword(s):  
Symptom Management ◽  
Clinical Decision Making ◽  
Treatment Plan ◽  
Treatment Options ◽  
Management Strategies ◽  
Clinical Decision ◽  
Nursing Management ◽  
Emotional Wellbeing ◽  
Patient Centered

Anxiety is a sense of perceived threat to one’s physical safety or emotional wellbeing, and symptoms are experienced in body, mind, and spirit. This chapter focuses on anxiety as a normal reaction to stressors—external, internal, or existential. Everyone experiences anxiety, both trait anxiety and state anxiety at multiple points in their lives; however, prolonged and severe symptoms of anxiety can evolve into a clinical form of anxiety, such as generalized anxiety disorder, panic disorder, or posttraumatic stress disorder. This chapter reviews assessment of anxiety, including evidence-based screening measures and the patient-centered interview. Symptom identification and management incorporating integrative nursing principles are presented, including patient self-management strategies as well as provider-directed treatment options. In clinical decision-making for anxiety symptom management, concordance with the patient in establishing a treatment plan is emphasized. A case study highlights a patient-centered and culturally sensitive approach to the management of anxiety.

scholarly journals Behavioral Intervention versus Pharmacotherapy or Their Combinations in the Management of Overactive Bladder Dysfunction

2009 ◽  
Vol 2009 ◽  
pp. 1-10 ◽  
Author(s):  
Khanh Tran ◽  
Robert M. Levin ◽  
Shaker A. Mousa
Keyword(s):  
Overactive Bladder ◽  
Behavioral Intervention ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Cost Effective ◽  
Pharmacological Therapy ◽  
Anticholinergic Drugs ◽  
Life Threatening ◽  
Bladder Symptoms

Overactive bladder syndrome (OAB) refers to individuals with the following symptoms: urinary urgency, increased urinary frequency, and urge incontinence. These symptoms are not life threatening but can cause embarrassment and significantly impact quality of life. There are numerous treatment options for OAB, including behavioral therapy, traditional pharmacological therapy or a combination of the two. These options are considered the mainstay of treatment for OAB. We carried out a comprehensive systematic review of the available literature on the effectiveness of behavioral intervention, anticholinergic drugs, and their combination in the management of adults with overactive bladder, with emphasis on results from clinical trials and primary literature. Each treatment intervention is efficacious, and the choice should be based on the patient's severity of symptoms, tolerability, compliance and satisfaction with the treatment. Based on available literature, management of OAB using a combination of behavioral therapy and drug intervention is the most efficacious in terms of patient satisfaction, perceived improvement, and reduction of bladder symptoms. It is also the most practical and cost effective for optimal management of patients with OAB. Pharmacological treatment, in addition to behavioral therapy, remains important in the management of adults with OAB syndrome.

scholarly journals Treatment of anxiety disorders

2017 ◽  
Vol 19 (2) ◽  
pp. 93-107 ◽  
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Burden Of Illness ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Treatment Options ◽  
Level Of Evidence ◽  
Randomized Controlled Studies ◽  
Meta Analyses

Anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, social anxiety disorder, and others) are the most prevalent psychiatric disorders, and are associated with a high burden of illness. Anxiety disorders are often underrecognized and undertreated in primary care. Treatment is indicated when a patient shows marked distress or suffers from complications resulting from the disorder. The treatment recommendations given in this article are based on guidelines, meta-analyses, and systematic reviews of randomized controlled studies. Anxiety disorders should be treated with psychological therapy, pharmacotherapy, or a combination of both. Cognitive behavioral therapy can be regarded as the psychotherapy with the highest level of evidence. First-line drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for routine use. Other treatment options include pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. After remission, medications should be continued for 6 to 12 months. When developing a treatment plan, efficacy, adverse effects, interactions, costs, and the preference of the patient should be considered.

The Use of Family and Individual Cognitive Behavioral Therapy with a Patient with Anorexia Nervosa

2013 ◽  
pp. 361-392
Author(s):  
Barbara Cubic
Keyword(s):  
Anorexia Nervosa ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Cognitive Behavioral ◽  
Behavior Patterns ◽  
Evidence Based ◽  
Case Formulation ◽  
Core Knowledge ◽  
Assessment And Treatment

Chapter 14 covers treatment of a patient with anorexia nervosa, and the use of individual and family cognitive behavioral therapy (CBT) in the treatment plan. It focuses on a case example of a patient with anorexia nervosa to illustrate both evidence-based assessment and treatment. It includes demographic and referral information, assessment strategy, clinical interview information, assessment data, evidence-based case formulation, treatment and the need for family therapy, treatment outcomes, key principles and core knowledge used to approach the case, typical behavior patterns, epidemiological considerations, evidence for the intervention model, alternative options, case non-specifics, strategies to deal with therapy complications, ethical considerations, common mistakes to avoid in treatment, relapse prevention, and case conclusions.

scholarly journals Features of the modern antihistamines use in the treatment of allergic rhinitis

2021 ◽  
pp. 101-108
Author(s):  
A. A. Krivopalov ◽  
S. A. Rebrova ◽  
P. A. Shamkina
Keyword(s):  
Allergic Rhinitis ◽  
Treatment Plan ◽  
Severe Disease ◽  
Treatment Options ◽  
Individual Treatment ◽  
Allergen Specific Immunotherapy ◽  
Ocular Symptoms ◽  
New Treatment

Allergic rhinitis remains one of the most relevant problems of modern otorhinolaryngology. The widespread prevalence, late diagnosis, underestimation of the possible risks of disease progression, the development of complications (including asthma) prompts the development and improvement of new treatment options for allergic rhinitis. Allergic rhinitis is a heterogeneous disease that presents with various clinical phenotypes, and therefore the severity of nasal symptoms can vary from mild malaise to severe disease.. Today, pharmacotherapy remains the most frequently used treatment tactic for patients with allergic rhinitis. While prescribing therapy the doctor develops an individual treatment plan based on the principles of personalized medicine, considering: the dominant symptoms, anamnesis data on previous therapy and the effect of treatment, the type of inflammation (Th2-type, mixed inflammation), concomitant diseases (conjunctivitis, asthma, etc.) etc.) and patient preferences. The tissue effects of the histamine mediator lead to the development of symptoms during the course of the disease, which determines the wide-spread use of antihistamines in the treatment of rhinitis. Antihistamines of the second generation are devoid of sedative effects, have a long-lasting effect and a good safety profile. One of the modern II generation antihistamines is bilastine. The research results proved the high antihistaminic activity of bilastine 20 mg in vitro and in vivo, the absence of cardiac and sedative side effects on the central nervous system, the ability to eliminate the nasal and ocular symptoms of disease and improve the quality of life of patients with allergic rhinitis. Thus, bilastine fully complies with current EAACI / WAO ARIA requirements for drugs used to treat AR. The paper presents a clinical case of a patient with chronic persistent allergic rhinitis, household sensitization with a slight uncontrolled course. The oral antihistamine bilastine was added to intranasal glucocorticosteroids, which help to relieve symptoms of the disease, stabilize the condition and prepare the patient for subsequent allergen-specific immunotherapy. 

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