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Encountering Treatment Resistance

Solutions Through Reconceptualization

Recent studies suggest that anywhere from 20% to as much as 60% of psychiatric diagnoses are eventually labeled as treatment resistant. No consensus exists on a definition for treatment resistance, nor are there clear criteria for what is still an unrecognized diagnosis, which suggests that incomplete assessments, inadequate treatment planning, poor compliance, and faulty therapeutic alliances may be at play. Given that second opinions identify additional treatment options in two-thirds of these cases, Encountering Treatment Resistance argues that it is time to move away from treatment resistance and toward pending remission. The author addresses opportunities for practitioners to avoid treatment resistance and failure.

“Dr. Paul Putman tackles the important and dispiriting clinical problem of ‘treatment-resistant’ depression. He argues, partly from a theoretical, neurocognitive perspective, the importance of shifting the blame for lack of treatment response from the ‘treatment-resistant’ patient to the treatment, restyling the latter as treatment failure or pending remission. Crucially, he encourages seeking alternative treatments and maintaining hope and alliance with patients rather than falling victim to clinical pessimism.”
                                                                 John C. Markowitz, M.D., Professor of Clinical Psychiatry, Columbia University
                                                                 Vagelos College of Physicians & Surgeons, and Research Psychiatrist, New York State Psychiatric Institute

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