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Related Concept Videos

Drug Therapy01:28

Drug Therapy

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The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
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Behavior Therapy01:22

Behavior Therapy

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Behavior therapy incorporates diverse techniques rooted in classical conditioning principles to address maladaptive behaviors and anxiety disorders. These methods aim to reduce avoidance behaviors, foster adaptive coping mechanisms, and alter associations between stimuli and responses, making them effective in a wide range of therapeutic contexts.
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Desensitization and Tachyphylaxis01:20

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Tachyphylaxis is described as a rapid decrease in response to a drug after repeated or continuous administration of the same drug dose. It is a phenomenon where the body becomes less responsive to a particular substance or intervention over time, requiring higher doses or stronger interventions to achieve the same effect. It results from adaptive changes in the body's receptors, signaling pathways, or physiological processes that occur in response to prolonged exposure to a stimulus.
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Electroconvulsive Therapy01:30

Electroconvulsive Therapy

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Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
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MS treatment de-escalation: review and commentary.

Krzysztof Selmaj1,2, Hans-Peter Hartung3,4,5,6, Marcin P Mycko7

  • 1Department of Neurology, University of Warmia & Mazury, Olsztyn, Poland. kselmaj@gmail.com.

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De-escalating disease-modifying therapies (DMTs) for multiple sclerosis (MS) in older adults may be safe and effective, potentially reducing risks associated with long-term immunosuppression. Further research is needed to confirm optimal strategies for this growing population.

Keywords:
De-escalationDisease-modifying therapiesImmunosenescenceMultiple sclerosis

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Area of Science:

  • Neurology
  • Immunology
  • Geriatrics

Background:

  • Current multiple sclerosis (MS) treatments often require lifelong administration, posing risks like infections and cancers, especially with age-related immune system changes (immunosenescence).
  • Inflammatory activity in MS typically declines with age, suggesting potential for modifying treatment intensity in older individuals.
  • Existing studies on de-escalating disease-modifying therapies (DMTs) for MS have focused on specific circumstances, with limited data on older populations.

Purpose of the Study:

  • To review the evidence supporting DMT de-escalation as a viable strategy for older individuals with MS.
  • To explore various de-escalation approaches, including dose adjustments, switching to less potent therapies, or treatment discontinuation.
  • To assess the safety and efficacy of DMT de-escalation in the context of age-related immunosenescence and declining MS activity.

Main Methods:

  • Review of existing literature on DMT de-escalation strategies in MS, including extended dosing, switching therapies, and discontinuation.
  • Analysis of retrospective and observational studies examining the impact of age on DMT efficacy and outcomes.
  • Consideration of a recent randomized-controlled discontinuation study in stable MS patients over 55 years old.

Main Results:

  • Extended interval dosing of natalizumab maintained efficacy while reducing PML risk; ocrelizumab dosing mitigated Ig decline.
  • Age is a significant factor in DMT efficacy; older patients discontinuing treatment showed stable disease, unlike younger counterparts.
  • A recent study found stable MS in older patients (>55 years) after DMT discontinuation, with only a minor increase in MRI activity.

Conclusions:

  • DMT de-escalation or discontinuation in MS patients over 55 may be non-inferior to continued high-risk immunosuppression, with potentially lower health risks.
  • While current evidence is promising, larger, longer-term prospective studies are essential to definitively establish the benefits and risks of de-escalation.
  • Future research should include randomized controlled trials comparing de-escalation, continuation, and discontinuation, with subgroup analyses by age and sex, and incorporate immunosenescence markers.