World Psychiatry
September 15, 2023
Roger S. McIntyre, Mohammad Alsuwaidan, Bernhard T. Baune et al.
712 citations
At least 30% of people with depression meet the common definition of treatment-resistant depression (TRD): inadequate response to two or more antidepressants despite adequate trials and adherence. Many cases are actually pseudo-resistant due to insufficient treatment or non-adherence. No consensus definition with proven predictive utility for clinical decisions exists, leading to varied prevalence estimates and inconsistent care. Intravenous ketamine and intranasal esketamine are effective for TRD. Some second-generation antipsychotics (e.g., aripiprazole, quetiapine XR) help as adjuncts in partial responders, but only the olanzapine-fluoxetine combination has been studied in FDA-defined TRD. Repetitive transcranial magnetic stimulation and electroconvulsive therapy are established effective interventions. Evidence for extending trials, switching, or combining antidepressants is mixed, and manual-based psychotherapies are not effective alone but help when added to antidepressants.
World psychiatry : official journal of the World Psychiatric Association (WPA)
June 1, 2022
Paolo Fusar-Poli, Andrés Estradé, Giovanni Stanghellini et al.
225 citations
Psychosis unfolds through distinct stages, each with its own core existential experiences. Early phases (premorbid and prodromal) involve loss of common sense, perplexity, lack of immersion in the world, heightened salience, a feeling that something important is about to happen, perturbation of the sense of self, and a need to hide inner turmoil. The first episode brings transitory relief from delusions, intense self-referentiality, permeated self-world boundaries, internal noise, and dissolution of self with social withdrawal. Later stages (relapsing and chronic) involve grieving losses, feeling split, and struggling to accept inner chaos, a new self, diagnosis, and uncertain future. Treatment experiences include both positive and negative aspects, with recovery understood as reconstructing personhood and re-establishing bonds toward meaningful goals.
World psychiatry : official journal of the World Psychiatric Association (WPA)
June 1, 2024
Dan J Stein, Kris Nielsen, Anna Hartford et al.
70 citations
Psychiatric understanding and treatment benefit from integrating both objective facts and subjective values, moving beyond strict scientism toward a softer naturalism. A pluralist approach—embracing ontological, explanatory, and value pluralism—acknowledges the multi-level causal interactions underlying psychopathology and highlights the importance of lived experience and diverse difference-makers in research and practice. Embodied, embedded, and enactive views of the brain-mind offer a conceptual framework for the mind-body problem that clinically integrates cognitive-affective neuroscience with phenomenological psychopathology.