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Creative, Person-Centered Psychopharmacology for Treatment Resistance in Psychiatry

  • Miro Jakovljevic
Chapter

Abstract

Treatment resistance in psychiatry is one of the most important issues facing psychiatrists and their patients alike. It is not only a highly important topic but a very hot and controversial one as well. There is no generally accepted agreement of what defines treatment resistance for any of the individual mental disorders; thus it is a metaphor with different meanings which implies negative, pessimistic, and frightening connotations. This metaphor complicates treatment in psychiatry as well as the lives of patients with the so-called treatment-resistant mental disorders. Treatment resistance as a construct should be reconsidered as well as delaying “wait-and-see” and “monotherapy before polytherapy” treatment strategies. Changing treatment philosophy may be a critical step toward overcoming what some sign as “therapeutic stagnation in psychiatry” associated with a high rate of treatment failures. A “paradigm shift” is needed from the mechanistic, formistic, and reductionistic ways of thinking of technical, nomothetic, and impersonal psychopharmacology to contextual, systemic, and creative thinking with a new treatment holodigm of individualized and person-centered psychopharmacology. The best treatments are those that timely utilize and integrate multiple therapeutic modalities. The concept of creative, person-centered narrative psychopharmacotherapy gives a hope for increasing treatment effectiveness and efficiency in psychiatry and thus overcome treatment failures and resistance.

Keywords

Treatment failures and resistance Difficult-to-treat mental disorders Resilience and resiliency Placebo and nocebo Therapeutic narratives Creative person-centered psychopharmacology 

References

  1. 1.
    Riva Posse P, Nemeroff CB. The problem of treatment resistant psychiatric disorders. In: Nemeroff CB, editor. Management of treatment-resistant major psychiatric disorders. USA: Oxford University Press; 2012. p. 1–21.Google Scholar
  2. 2.
    Jakovljevic M. How to increase treatment effectiveness and efficiency in psychiatry: creative psychopharmacotherapy – Part 1: definition, fundamental principles and higher effectiveness polypharmacy. Psychiatr Danub. 2013a;25:269–73.PubMedGoogle Scholar
  3. 3.
    Jakovljevic M. How to increase treatment effectiveness and efficiency in psychiatry: creative psychopharmacotherapy – Part 2: creating favorable treatment context and fostering patients’ creativity. Psychiatr Danub. 2013b;25:274–9.PubMedGoogle Scholar
  4. 4.
    Jakovljevic M. Creativity, mental disorders and their treatment: recovery-oriented psychopharmacotherapy. Psychiatr Danub. 2013c;25:311–5.PubMedGoogle Scholar
  5. 5.
    Jakovljević M. The creative psychopharmacotherapy and personalized medicine: the art and practice of the learning organization. Psychiatr Danub. 2010;22:309–12.PubMedGoogle Scholar
  6. 6.
    Fonagy P, Luyten P, Allison E, Campbell C. What we have changed our minds about: Part 1. Borderline personality disorder as a limitation of resilience. Borderline Personal Disord Emot Dysregulation. 2017;4:11.  https://doi.org/10.1186/s40479-017-0061-9.CrossRefGoogle Scholar
  7. 7.
    Gillespie AL, Samanaite R, Mill J, Egerton A, MacCabe JH. Is treatment-resistant schizophrenia categorically distinct from treatment responsive schizophrenia? A systemic review. BMC Psychiatry. 2017;17:12.CrossRefGoogle Scholar
  8. 8.
    Jakovljevic M. The placebo-nocebo response: controversies and challenges from clinical and research perspective. Eur Neuropsychopharmacol. 2014a;24:333–41.CrossRefGoogle Scholar
  9. 9.
    Jakovljević M. The placebo-nocebo response in patients with depression: do we need to reconsider our treatment approach and clinical trial designs? Psychiatr Danub. 2014b;26:92–5.PubMedGoogle Scholar
  10. 10.
    Demjaha A, Lappin JM, Stahl D, Patel MX, MacCabei JH, Howes OD, et al. Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors. Psychol Med. 2017;47:1981–9.CrossRefGoogle Scholar
  11. 11.
    Jakovljevic M. Person-centered psychopharmacotherapy: what is it? – Each patient is a unique, responsive and responsible subject. Psychiatr Danub. 2015;27(suppl 1):s28–33.PubMedGoogle Scholar
  12. 12.
    Jakovljevic M. Long-acting injectable (depot) antipsychotics and changing treatment philosophy: possible contribution to integrative care and personal recovery of schizophrenia. Psychiatr Danub. 2014c;26:304–7.PubMedGoogle Scholar
  13. 13.
    Bressan RA, Grohs GEM, Matos G, Shergil S. Hope or hype in the treatment of schizohrenia – what’s the role of the physician. Br J Psychiatry. 2018;212:1–3.CrossRefGoogle Scholar
  14. 14.
    Insel TR. Rethinking schizophrenia. Nature. 2010;468:187–93.CrossRefGoogle Scholar
  15. 15.
    Shrivastava A, De Sousa A, Sonavane S, Shah N. Resilience improves neurocognition and treatment outcomes in schizophrenia: a hypothesis. Open J Psychiatry. 2016;6:173–87.CrossRefGoogle Scholar
  16. 16.
    Nabi A, Khan I. Resilience as predictor of mental well-being among cardiovascular disorder. Int J Indian Psychol. 2017;4:182–90.Google Scholar
  17. 17.
    Southwick SM, Charney DS. Resilience – the science of mastering life’s greatest challenges. New York: Cambridge University Press; 2013.Google Scholar
  18. 18.
    Shin SJ, Yung DY, Hwang EA. Concept analysis of resilience in patients with cardiovascular diseases. J Korean Acad Nurs. 2009;39:788–95.  https://doi.org/10.4040/jkan.2009.39.6.788.CrossRefPubMedGoogle Scholar
  19. 19.
    Clarke J, Nicholson J. Resilience – bounce back from whatever life throws at you. Great Britain: Crimson Publishing; 2010.Google Scholar
  20. 20.
    Reutter KK, Bigatti SM. Religiosity and spirituality as resilience resources: moderation, mediation, or moderated mediation? J Sci Study Relig. 2014;53:56–72.CrossRefGoogle Scholar
  21. 21.
    Jakovljevic M. Placebo and nocebo phenomena from the perspective of evidence based and person centered medicine. Hosp Pharmacol Int Multidiscip J. 2017;4:512–20.CrossRefGoogle Scholar
  22. 22.
    Kalisch R, Mueller MB, Tuescher O. A conceptual framework for the neurobiological study of resilience. Behav Brain Sci. 2015;62:1–79.Google Scholar
  23. 23.
    Davidson JRT, Payne VM, Connor KM, Foa EB, Rothbaum BO, Hertzberg MA, et al. Trauma, resilience and saliostasis: effects of treatment in post-traumatic stress disorder. Int Clin Psychopharmacol. 2005;20:43–8.CrossRefGoogle Scholar
  24. 24.
    Jakovljevic M. Contemporary psychopharmacotherapy in the context of brave new psychiatry, well-being therapy and life coaching. Psychiatr Danub. 2007;19:195–201.PubMedGoogle Scholar
  25. 25.
    Bolos A. Considerations on assisted resilience and individualized therapy in bipolar affective disorder, with a clinical case exemplification. Clujul Med. 2015;88:462–7.CrossRefGoogle Scholar
  26. 26.
    Jakovljević M, Borovecki F. Epigenetics, resilience, comorbidity and treatment outcome. Psychiatr Danub. 2018;30. (In press).CrossRefGoogle Scholar
  27. 27.
    Feder A, Nestler EJ, Charney DS. Psychobiology and molecular genetics of resilience. Nat Rev Neurosci. 2009;10:446–57.CrossRefGoogle Scholar
  28. 28.
    Dudley KJ, Li X, Kobor MS, Kippin TE, Bredy TW. Epigenetic mechanisms mediating vulnerability and resilience to psychiatric disorders. Neurosci Biobehav Rev. 2011;35:1544–51.CrossRefGoogle Scholar
  29. 29.
    Wu G, Feder A, Cohen H, Kim JJ, Calderon S, Charney DS, et al. Understanding resilience. Front Behav Neurosci. 2013;7:10.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Moore RC, Eyler LT, Mills PJ, O’Hara RM, Wachmann K, Lavretsky H. Biology of positive psychiatry. In: Jeste DV, Palmer BW, editors. Positive psychiatry – a clinical handbook. Washington, DC: American Psychiatric Publishing; 2015. p. 261–83.Google Scholar
  31. 31.
    James LM, Engdahl BE, Georgopoulous AP. Apolipoprotein E: the resilience gene. Exp Brain Res. 2017;235:1853–9.CrossRefGoogle Scholar
  32. 32.
    Yehuda R, Brand SR, Golier JA, Yang RK. Clinical correlates of DHEA associated with post-traumatic stress disorder. Acta Psychiatr Scand. 2006;114:187–93.CrossRefGoogle Scholar
  33. 33.
    Bartone PT, Spinosa T, Robb J, Pastel RH. Hardy-resilient style is associated with high density lipoprotein levels. Presented at the Association of Military surgeons of the United States annual meeting, San Antonio, Texas, 11 November, 2008.Google Scholar
  34. 34.
    van Zuiden M, Haverkort SO, Tan Z, Daams J, Lok A, Olf M. DHEA and DHEA-S levels in posttraumatic stress disorder: a meta-analytic review. Psychoneuroendocrinology. 2017;84:76–82.CrossRefGoogle Scholar
  35. 35.
    Binder E, Karim M, Paya Cano JL, Fernandes C, Aitchison KJ, Mathe AA, et al. Antidepressants and the resilience to early-life stress in inbred mouse strains. Pharmacogenet Genomics. 2011;21:779–89.CrossRefGoogle Scholar
  36. 36.
    Breitfeld J, Scholl C, Steffens M, Laje G, Stingl JC. Gene expression and proliferation for antidepressant treatment resistance. Transl Psychiatry. 2017;7(3):e1061.CrossRefGoogle Scholar
  37. 37.
    Davidson J, Baldwin DS, Stein D, Pederson R, Ahmed S, Musgnung J, et al. Effects of venlafaxine extended release on resilience in posttraumatic stress disorder: an item analysis of the Conor-Davidson Resilience Scale. Int Clin Psychopharmacol. 2008;23:299–303.CrossRefGoogle Scholar
  38. 38.
    Min JA, Lee NB, Lee CU, Lee C, Chae JH. Low trait anxiety, high resilience, and their interaction as possible predictors for treatment response in patients with depression. J Affect Disord. 2012;137:61–9.CrossRefGoogle Scholar
  39. 39.
    Camera P, Molino C, Girardi L, Gattoni E, Feggi A, Gramaglia C, et al. The role of resilience and coping strategies in different psychiatric diseases: a comparison among schizophrenic spectrum, depression and personality disorders. Evid Based Psychiatr Care. 2016;2:123–6.Google Scholar
  40. 40.
    Bernstein JG. Creative psychopharmacology: medication-intolerant and refractory patients. In: Bernstein JG, editor. Drug treatment in psychiatry. 3rd ed. St. Louis: Mosby; 1995. p. 522–45.Google Scholar
  41. 41.
    Jasovic Gasic M. Is treatment resistance in psychiatric disorders a trap for polypharmacy. Psychiatr Danub. 2015;27:308–13.PubMedGoogle Scholar
  42. 42.
    Jakovljevic M, Abou-Salex MT. Person centered psychopharmacotherapy. In: Mezzich JE, Botbol M, Christodoulou GN, Cloninger CR, Salloum IM, editors. Person centered psychiatry. Switzerland: Springer, International Publishing AG; 2016. p. 235–45.CrossRefGoogle Scholar
  43. 43.
    Senge PM. The fifth discipline – the art and practice of the learning organisation. London: Random House; 2006.Google Scholar
  44. 44.
    Doran CM. Prescribing mental health medication – the practitioner’s guide. New York: Routledge; 2003.Google Scholar
  45. 45.
    Stahl SM. Stahl’s essential psychopharmacology – neuroscientific basis and practical applications. 4th ed. New York: Cambridge University Press; 2013.Google Scholar
  46. 46.
    Stahl SM. Stahl’s essential psychopharmacology – neuroscientific basis and practical applications. 3rd ed. New York: Cambridge University Press; 2008.Google Scholar
  47. 47.
    Joseph S. Symptom-focused psychiatric drug therapy for managed care. New York: The Haworth Medical Press; 1997.Google Scholar
  48. 48.
    Pakman M. A systemic frame for mental health practices. In: Prosky PS, Keith DV, editors. Family therapy as an alternative to medication – an appraisal of Pharmaland. New York: Brunner – Routhledge; 2003. p. 93–110.Google Scholar
  49. 49.
    Slade M. Personal recovery and mental illness – a guide for mental health professionals. New York: Cambridge University Press; 2011.Google Scholar
  50. 50.
    Lewis B. Narrative and psychiatry. Curr Opin Psychiatry. 2011b;24:489–94.CrossRefGoogle Scholar
  51. 51.
    Hamkins SE. The art of narrative psychiatry. USA: Oxford University Press; 2014.Google Scholar
  52. 52.
    Frank A. The wounded story teller: body, illness and ethics. Chicago: University of Chicago Press; 1995.CrossRefGoogle Scholar
  53. 53.
    Rufener C, Depp CA, Gawronska MK, Saks ER. Recovery in mental illness. In: Jeste DV, Palmer BW, editors. Positive psychiatry – a clinical handbook. Washington, DC: American Psychiatric Publishing; 2015. p. 91–110.Google Scholar
  54. 54.
    Kamperman L, Nestoriuc Y, Shedden-Mora MC. Physicians’ beliefs about placebo and nocebo effects in antidepressants – an online survey among German practitioners. PLoS One. 12(5):e0178719.  https://doi.org/10.1371/journal,pone.0178719.
  55. 55.
    Chavarria V, Vian J, Pereira C, Data-Franco, Fernandes BS, Merck M, et al. The placebo and nocebo phenomena: their clinical management and impact on treatment outcomes. Clin Ther. 2017;39:477–86.CrossRefGoogle Scholar
  56. 56.
    Stassen HH, Angst J, Hell D, Sharfetter C, Szegedi A. Is there a common resilience mechanism underlying antidepressant drug response? Evidence from 2848 patients. J Clin Psychiatry. 2007;68:1195–205.CrossRefGoogle Scholar
  57. 57.
    Jopling DA. Talking cures and placebo effects. Oxford: Oxford University Press; 2008.CrossRefGoogle Scholar
  58. 58.
    Jaksic N, Aukst-Margetic B, Jakovljevic M. Does personality play a relevant role in the placebo effect? Psychiatr Danub. 2013;25:17–23.PubMedGoogle Scholar
  59. 59.
    Benedetti F. Placebo effects. 2nd ed. Oxford: Oxford University Press; 2014.CrossRefGoogle Scholar
  60. 60.
    Planes S, Villier C, Mallaret M. The nocebo effect of drugs. Pharmacol Res Perspect. 2016;4(2):e00208.CrossRefGoogle Scholar
  61. 61.
    Corsi N, Colloca L. Placebo and nocebo effects: the advantage of measuring expectations and psychological factors. Front Psychol Published online. 2017;8:308.CrossRefGoogle Scholar
  62. 62.
    Benedetti F, Armanzio M. The placebo response: how words and rituals change the patient’s brain. Patient Educ Couns. 2011;84:413–9.CrossRefGoogle Scholar
  63. 63.
    Seligman MEP. Flourish – a visionary new understanding of happiness and well-being. New York: Free Press; 2012.Google Scholar
  64. 64.
    Cloninger CR, Cloninger KM, Mezzich JE. Holistic framework for ill health and positive health. In: Mezzich JE, Botbol M, Christodoulou GN, Cloninger CR, Salloum IM, editors. Person centered psychiatry. Springer: International Publishing AG Switzerland; 2016. p. 47–59.CrossRefGoogle Scholar
  65. 65.
    Hatch S, Huppert FA, Abbott R, Croudace T, Ploubidis G, Wadsworth M, Richards M, Kuh D. A life course approach to well-being. In: Haworth J, Hart G, editors. Well-being – individual, community and social perspective. London: Palgrave Macmillan; 2012.Google Scholar
  66. 66.
    Trivedi RB, Bosworth HB, Jackson GL. Resilience in chronic illness. In: Resnick B, Gwyther LP, Roberto KA, editors. Resilience in aging – concepts, research, and outcomes. Switzerland: Springer, International Publishing AG; 2011. p. 181–97.Google Scholar
  67. 67.
    Lima de Moura Cal SF, Glustak ME, Mittermayer Bareto S. Psychological resilience and immunity. Innovative Immunology. 2015. www.austinpublishinggroup.com/ebooks.
  68. 68.
    Flaherty AW. Brain illness and creativity: mechanisms and treatment risks. Can J Psychiatr. 2011;56:132–43.CrossRefGoogle Scholar
  69. 69.
    Meyer PS, Gottlieb JD, Penn D, Mueser K, Gingerich S. Individual resiliency training: an early intervention approach to enhance well-being in people with first-episode psychosis. Psychiatr Ann. 2015;45:554–60.CrossRefGoogle Scholar
  70. 70.
    Cloninger CR. Feeling good: the science of well-being. New York: Oxford University Press; 2004.Google Scholar
  71. 71.
    Wikipedia. Self-directedness. 2018. https://en.m.wikipedia.org.

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Miro Jakovljevic
    • 1
  1. 1.Department of PsychiatryUniversity Hospital Centre ZagrebZagrebCroatia

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