SYMPOSIA

Abstracts of the Invited Speakers
An indirect approach is looking for comorbidity of trauma related disorders in treatment resistant cases. One study has pointed out that
OCD cases with comorbid PTSD have worse treatment outcomes. A meta-analysis study has revealed that childhood trauma not only
effects lifetime risk of major depression, it also negatively effects severity of clinical parameters and results of treatment. This particular
study, which included 16 epidemiological studies (23544 cases), showed that childhood abuse is related to recurrent and persistent
depressive episodes. Another meta-analysis of 10 clinical studies with a total of 3098 cases, found that childhood abuse is related to
absence of remission and absence of treatment response in depression.
In bipolar disorder, those who have had childhood trauma, had earlier onset of illness, more severe current symptoms of mania or
depression and more frequent episodes of depression. Half of adult bipolar disorder patients were found to have severe childhood trauma.
In patients with early childhood trauma such as early loss of parents and physical or sexual abuse or neglect, psychotherapy alone had
favorable results compared to monotherapy of antidepressants, while interestingly combination of psychotherapy and pharmacotherapy
was slightly more effective than psychotherapy alone. Researchers have stressed that psychotherapy must be included in the treatment
of chronic depression patients with childhood trauma.
Studies which directly investigate the relationship of treatment resistance and childhood trauma are scarce. Some comorbid conditions,
such as personality disorders, that complicate treatment of depression are known to be related to childhood trauma.
As a result, we can with great confidence state that childhood trauma is related to treatment resistance in most psychiatric conditions.
Especially in cases of treatment resistance, childhood trauma should be investigated and appropriate treatment modalities should be
added to the treatment regime.
Key words: Treatment resistance, childhood trauma
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S85-6
Pyshosocial approaches for treatment resistant symptoms in patients with schizophrenia
Mustafa Yıldız
Kocaeli University School of Medicine, Department of Psychiatry, Kocaeli, Turkey
E-mail: myildiz60@yahoo.com
One of the main goals in the treatment of schizophrenia is to increase psychosocial functioning and to provide a satisfying life for patients
with schizophrenia who have persistent symptoms although all treatment efforts, including ECT, had been performed. Whatever the
clinical conditions of the patients are, they have a right to live in dignity in their community like other people. The emphasis in psychiatric
rehabilitation approaches is on enhancing psychosocial functioning and quality of life of patients. Increasing the functioning of patients
depends on controlling symptoms as much as possible and preventing exacerbations. Patients should learn and practice coping skills
(humming or singing, reading aloud, thinking “stop”, listening to the radio, watching TV, doing favorite hobbies, telling the voices to go
away, doing physical exercise, going to movies etc.) for their persistent symptoms. Sometimes it may be necessary to use behavioral
techniques; for example, a patient showing 20 aggressive behaviors due to command hallucinations a week, showed on aggressive
behavior a month after applying a behavior modification program. Patients should be placed in a program, in which their healthy
aspects can be developed and keep them in continuing daily activities, so that they become empowered. All these results can take place
by collaboration and coordination of different services. Being provided a safe environment, getting positive feedback, participating in
occupational activities and working in a less stimulating milieu are also important for patients.
It could be possible for patients to live a more satisfying and more normal life by integrating treatment and rehabilitation services. The
elements of integrated approaches are: patients’ participation in treatment and the maintenance of treatment, development of treatment
alliances, teaching illness management, using cognitive behavioral treatment methods, modifying new resources to attain personal
goals, accommodating community resources, establishing relationships with psychosocial clubs, involving families in the treatment, and
providing personal support services (case management), supported employment, supported residence, and peer supports.
Key words: Schizophrenia, persistent symptoms, functioning, rehabilitation
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S86
S86 Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org