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The clinical staging approach for bipolar disorder suggests a model, in which there is a progression from "at risk" symptoms to the first presentation, to multiple episodes right through to refractory illness (Kapczinski et al. 2009).
Adjunctive anticonvulsants may be useful for some patients with refractory illness [ 799- 802].
The mean duration of illness was 15.7 years (s.d.= 9.4, range 2 37) and all met criteria for refractory illness.
Medical students and physicians often work with individuals with severe and refractory illness, thus see a skewed sample of those with mental illness [ 7, 8].
Inmates in any of the 185 correctional facilities in Japan displaying highly refractory illness or who pose a potential physical risk are often transferred to a medical prison.
Moreover, patients often present different clinical results: patients with fewer depressive episodes can achieve a rapid remission while others present with prolonged, remittent, or refractory illness [ 31– 31].
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There is considerable variation in the use of long acting injectable (LAI or 'depot') medication geographically and between individual services; it could be argued that fewer than expected individuals with medication refractory illnesses were on this treatment modality at the time of referral.
Patients who do not respond to several medication trials and/or CBT are considered to have treatment-refractory illness.
Patients who do not respond to first- or second-line agents are considered to have treatment-refractory illness.
These findings are consistent with NMDA-R hypofunction, leading to compensatory glutamate excess in treatment-refractory illness.
Patients who do not respond to multiple courses of therapy are considered to have treatment-refractory illness.
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