Expert consensus guidelines

  • 文章类型: Journal Article
    背景:此更新的目的是添加新批准的命名法和治疗方法以及尚未批准的重度抑郁症治疗方法,从而扩大了将耐药因素纳入临床方法的讨论。
    方法:与基于RAND/UCLA适当性方法的第一个共识指南不同,法国生物精神病学和神经精神药理学协会(AFPBN)更新了部分反应性抑郁症(PRD)和难治性抑郁症(TRD)的治疗指南.专家指南结合了科学证据和专家临床医生的意见,为珠三角和TRD提供建议。
    结果:这些建议涉及三个领域,这些领域对于更新先前的2019AFPBNTRD患者管理指南至关重要:(1)识别与TRD相关的风险因素,(2)PRD和TRD患者的治疗管理,和(3)的迹象,最近的谷氨酸受体调节剂(艾氯胺酮和氯胺酮)的使用方式和监测。
    结论:这些基于共识的指南可以在现有的经验文献和临床实践之间建立桥梁,以临床实践的“真实世界”为亮点,以TRD专业处方者的经验为中心的务实方法支持。
    BACKGROUND: The purpose of this update is to add newly approved nomenclatures and treatments as well as treatments yet to be approved in major depressive disorder, thus expanding the discussions on the integration of resistance factors into the clinical approach.
    METHODS: Unlike the first consensus guidelines based on the RAND/UCLA Appropriateness Method, the French Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) developed an update of these guidelines for the management of partially responsive depression (PRD) and treatment-resistant depression (TRD). The expert guidelines combine scientific evidence and expert clinicians\' opinions to produce recommendations for PRD and TRD.
    RESULTS: The recommendations addressed three areas judged as essential for updating the previous 2019 AFPBN guidelines for the management of patients with TRD: (1) the identification of risk factors associated with TRD, (2) the therapeutic management of patients with PRD and TRD, and (3) the indications, the modalities of use and the monitoring of recent glutamate receptor modulating agents (esketamine and ketamine).
    CONCLUSIONS: These consensus-based guidelines make it possible to build bridges between the available empirical literature and clinical practice, with a highlight on the \'real world\' of the clinical practice, supported by a pragmatic approach centred on the experience of specialised prescribers in TRD.
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  • 文章类型: Journal Article
    对于重度抑郁症无反应者的连续抗抑郁药物治疗的明确指导尚未建立。
    基于RAND/UCLA适当性方法,法国生物精神病学和神经精神药理学协会和FondaMental基金会制定了治疗难治性抑郁症的专家共识指南.专家指南结合了科学证据和专家临床医生的意见,为治疗难治性抑郁症提供建议。由36位抑郁症及其治疗领域的精神病学专家以0至9的风险收益量表完成了一项书面调查,其中包括与高度详细的临床表现相关的118个问题。科学委员会在数据分析和调查结果解释后提供关键建议。
    这些指南的范围包括评估药物耐药性和有耐药性风险的情况。以及严重抑郁症的药理和心理策略。
    专家共识指南将有助于促进临床医生在许多常见和复杂的临床情况下参与难治性抑郁症的日常评估和管理的治疗决策。
    Clear guidance for successive antidepressant pharmacological treatments for non-responders in major depression is not well established.
    Based on the RAND/UCLA Appropriateness Method, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental developed expert consensus guidelines for the management of treatment-resistant depression. The expert guidelines combine scientific evidence and expert clinicians\' opinions to produce recommendations for treatment-resistant depression. A written survey comprising 118 questions related to highly-detailed clinical presentations was completed on a risk-benefit scale ranging from 0 to 9 by 36 psychiatrist experts in the field of major depression and its treatments. Key-recommendations are provided by the scientific committee after data analysis and interpretation of the results of the survey.
    The scope of these guidelines encompasses the assessment of pharmacological resistance and situations at risk of resistance, as well as the pharmacological and psychological strategies in major depression.
    The expert consensus guidelines will contribute to facilitate treatment decisions for clinicians involved in the daily assessment and management of treatment-resistant depression across a number of common and complex clinical situations.
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    文章类型: Journal Article
    Crohn\'s disease (CD) is a chronic idiopathic inflammatory bowel disease (IBD) which affects any site of the gastrointestinal tract and occasionally extraintestinal organs. The natural history of CD varies remarkably but a considerable proportion of patients develop complications leading to hospitalizations and surgeries, impaired quality of life, and disability. In these patients, effective medical therapy should aim beyond control of clinical symptoms to include induction and maintenance of steroid-free clinical and serological remission and mucosal healing, as this has shown to reduce complications, hospitalizations and surgeries, and to decrease the risk of colorectal cancer, at least in the short term. This therapeutic goal can be achieved in a considerable proportion of patients with anti-tumor necrosis factor (TNF)-α agents if applied early in the disease course. Clinical recommendations from a panel of Greek IBD experts are herein provided, regarding the clinical profiles and the use of anti-TNF-α therapy in patients with moderate and severe CD, based on literature review and personal experience. The objectives of this advisory workshop were to define the profiles of patients with moderate and severe CD using routine clinical and laboratory parameters, as well as the clinical profiles of patients with moderate CD, severe CD, perianal CD, and/or extra-intestinal manifestations, who are candidates for biologic therapies. Emphasis was given on patients with newly diagnosed CD. The proposed recommendations may provide a useful and practical approach for improving therapeutic strategies with anti-TNF-α in patients with active moderate and severe CD.
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