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Blay M, Duarte M, Dessouli MA, Durpoix A, Rüfenacht E, Weibel S, Speranza M, Perroud N. Proposition of a transdiagnostic processual approach of emotion dysregulation based on core triggers and interpersonal styles. Front Psychiatry 2024; 15:1260138. [PMID: 38384590 PMCID: PMC10879599 DOI: 10.3389/fpsyt.2024.1260138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
Emotion dysregulation (ED) has primarily been described in patients suffering from borderline personality disorder (BPD) and is an integral part of this diagnosis, but it is also a transdiagnostic construct that can be found in several other psychiatric disorders. The strong relationships between ED and BPD may lead clinicians to underestimate ED associated to other clinical contexts. This can lead to difficulties in diagnostic and treatment orientation, especially in the context of comorbidities. In this article, after reviewing the literature on the development and functioning of emotion dysregulation, and on the evidence for emotion dysregulation in eight disorders (borderline personality disorder, pathological narcissism with/without narcissistic personality disorder, obsessive-compulsive personality disorder, antisocial personality disorder, bipolar disorder, autism spectrum disorder, complex post-traumatic stress disorder, and adult attention deficit hyperactivity disorder), we present a transdiagnostic processual model of emotion dysregulation based on core triggers and interpersonal styles to try to address this issue and to provide a simple but technical tool to help clinicians in their diagnostic assessment and treatment orientation. By focusing more on typical patterns and interpersonal dynamics than only on categories, we believe that this model may contribute to the actual need for improvement of our current psychiatric classifications, alongside other well-studied and under-used dimensional models of psychopathology (e.g., HiTOP, AMPD), and may be useful to build more specific treatment frameworks for patients suffering from ED.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Addictology and Psychiatry Outpatient Center, Santé Basque Développement Group, Lyon, France
- Centre de recherche en Epidemiologie et Sante des Populations Team ‘DevPsy’, INSERM, Universite Paris-Saclay, UVSQ, Villejuif, France
| | - Miguel Duarte
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Marie-Alix Dessouli
- Department of Emergency Psychiatry, University Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Amaury Durpoix
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
| | - Eva Rüfenacht
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Sébastien Weibel
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
- U1114, INSERM, Strasbourg, France
| | - Mario Speranza
- Centre de recherche en Epidemiologie et Sante des Populations Team ‘DevPsy’, INSERM, Universite Paris-Saclay, UVSQ, Villejuif, France
- University Department of Child and Adolescent Psychiatry, Versailles Hospital Center, Le Chesnay-Rocquencourt, France
| | - Nader Perroud
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
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Bateman A, Rüfenacht E, Perroud N, Debbané M, Nolte T, Shaverin L, Fonagy P. Childhood maltreatment, dissociation and borderline personality disorder: Preliminary data on the mediational role of mentalizing in complex post-traumatic stress disorder. Psychol Psychother 2023. [PMID: 38108566 DOI: 10.1111/papt.12514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Treatments for borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) are less effective for patients with co-occurring symptoms of both disorders, who are considered to have complex PTSD (cPTSD), compared with patients with either condition alone. Evidence suggests that co-occurrence of symptoms indicates greater impairment in mentalizing. This study examines evidence for targeting mentalizing when treating individuals with co-occurring symptoms, irrespective of their exposure to developmental trauma and, for the first time, investigates the mediational role of mentalizing in the associations between BPD symptomatology and cPTSD. DESIGN We identified in a routine clinical service a group of patients with BPD, with or without co-occurring symptoms of PTSD. We hypothesized that patients with co-occurring symptoms and a history of childhood maltreatment will show more severe clinical profiles and greater mentalizing problems, which in turn lead to symptoms consistent with cPTSD. METHOD Clinical profiles of 72 patients with BPD (43 with and 29 without co-occurring symptoms of PTSD; mean age in both groups 28 years, 79% and 83% female, respectively) were identified using the Structured Clinical Interview for DSM-IV Axis II Disorders. Patients completed self-report measures of BPD and PTSD symptoms, well-being, dissociation and reflective functioning. Childhood trauma histories were evaluated. RESULTS Compared with patients with BPD-only, those with co-occurring BPD and PTSD showed greater severity in terms of BPD and dissociative symptoms, met a broader range of BPD diagnostic criteria, had a greater sense of personal worthlessness and self-evaluated their well-being as considerably diminished. This group was also more inclined to recall increased instances of childhood sexual abuse. In a mediation analysis, mentalizing acted as a partial mediator for the relationship between BPD severity and cPTSD, as well as between dissociative symptoms and cPTSD. Interestingly, mentalizing did not mediate the relationship between childhood sexual abuse and cPTSD. CONCLUSIONS Overall, the correlational findings are consistent with an intended focus on mentalizing to treat cPTSD symptoms in individuals who also meet criteria for a diagnosis of BPD.
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Affiliation(s)
- Anthony Bateman
- Department of Clinical, Educational and Health Psychology, Psychoanalysis Unit, University College London, London, UK
| | - Eva Rüfenacht
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Tobias Nolte
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud Centre, London, UK
| | - Lisa Shaverin
- Anna Freud Centre, London, UK
- Tavistock Trauma Service, Tavistock & Portman NHS Foundation Trust, London, UK
| | - Peter Fonagy
- Anna Freud Centre, London, UK
- Division of Psychology and Language Sciences, University College London, London, UK
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Rüfenacht E, Euler S, Prada P, Nicastro R, Dieben K, Hasler R, Pham E, Perroud N, Weibel S. Emotion dysregulation in adults suffering from attention deficit hyperactivity disorder (ADHD), a comparison with borderline personality disorder (BPD). Borderline Personal Disord Emot Dysregul 2019; 6:11. [PMID: 31360522 PMCID: PMC6637623 DOI: 10.1186/s40479-019-0108-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/25/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Emotional dysregulation (ED) is now considered as an important symptom of attention deficit hyperactivity disorder (ADHD). It is believed to have a considerable impact on the severity of the disorder, one's global functioning, and the prognosis. Our research aimed to evaluate and compare ED and cognitive emotional regulation strategies between ADHD and borderline personality disorder (BPD) patients. METHODS Four hundred six French-speaking outpatients (N = 279 ADHD, N = 70 BPD, N = 60 BPD + ADHD) were assessed with the Emotion Reactivity Scale (ERS), the Cognitive Emotional Regulation Questionnaire (CERQ), The Basic Empathy Scale (BES-A), the Adult ADHD Self-Report Scale (ARSV-v1.1) and the Beck Depression Inventory II (BDI-II). ADHD, BPD and comorbid patients were compared with each other and with samples of controls extracted from already published data. RESULTS ADHD patients, although having higher ED than samples derived from the general population, had less ED, better control over their emotions with higher use of adaptive cognitive strategies and lesser use of non-adaptive strategies than BPD patients. However, ADHD subjects had similar scores as BPD subjects when looking at difficulties in perceiving self and others. ED generated considerable distress in all groups and was also positively associated with ADHD symptomatology. ADHD patients with comorbid BPD had the highest scores of ED. CONCLUSIONS Our results suggest that there may be similarly inefficient cognitive emotional regulation skills leading to ED in both disorders (ADHD and BPD). However, ADHD patients showed a higher use of adaptive cognitive emotional strategies and a lower level of ED than BPD patients.
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Affiliation(s)
- Eva Rüfenacht
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Paco Prada
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Rosetta Nicastro
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Karen Dieben
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Roland Hasler
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Eléonore Pham
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
| | - Nader Perroud
- TRE Unit, Department of Psychiatry, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20bis rue de Lausanne, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sébastien Weibel
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, Strasbourg, France
- INSERM 1114, Strasbourg, France
- FMTS, University of Strasbourg, Strasbourg, France
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Badoud D, Rüfenacht E, Debbané M, Perroud N. Mentalization-based treatment for adults with attention-deficit/hyperactivity disorder: a pilot study. ACTA ACUST UNITED AC 2018; 21:317. [PMID: 32913767 PMCID: PMC7451325 DOI: 10.4081/ripppo.2018.317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/04/2018] [Indexed: 11/23/2022]
Abstract
Recent literature suggests that, in addition to its core cognitive and behavioural symptoms, socioemotional difficulties represent key characteristics of adult attention-deficit/hyperactivity disorder (ADHD). Importantly, these deficits not only contribute negatively to the low social functioning and poorer professional achievements of ADHD patients relative to healthy individuals, they also respond poorly to medication and are not specifically addressed by current evidence-based psychological treatments. Mentalization-based treatment (MBT) is a psychological intervention focused on promoting the imaginative capacity to understand human behaviour as being driven by mental states. MBT has been shown to be effective in patients with chronic emotional dysregulation; it may therefore represent a valuable approach to address sociocognitive deficits and shape adaptive functioning in ADHD. In this study, we tailored the timelimited MBT program developed for borderline personality disorder to the specific clinical needs of individuals with ADHD. We report on the first eight patients with ADHD included in our programme at the Geneva University Hospitals. Preliminary results support the feasibility and relevance of the MBT model for ADHD. We discuss conceptual and clinical implications of the current data.
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Affiliation(s)
- Deborah Badoud
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland.,Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, Geneva, Switzerland
| | - Eva Rüfenacht
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, Geneva, Switzerland.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland
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Prada P, Perroud N, Rüfenacht E, Nicastro R. Strategies to Deal With Suicide and Non-suicidal Self-Injury in Borderline Personality Disorder, the Case of DBT. Front Psychol 2018; 9:2595. [PMID: 30619004 PMCID: PMC6304419 DOI: 10.3389/fpsyg.2018.02595] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/03/2018] [Indexed: 11/28/2022] Open
Abstract
One of the most problematic aspects of borderline personality disorder resides in repeated non-suicidal self-injury (NSSI) and suicide attempts. These behaviors constitute the prime therapeutic target and a factor that complicates patient care, namely in terms of therapeutic continuity. It has been demonstrated that Dialectical Behavior Therapy (DBT) is efficient in reducing the symptomatology of this disorder, as well as NSSI and suicide. DBT is a multi-component psychotherapeutic treatment, and the effectiveness of its individual constituents is therefore a relevant question. Studies comparing its various components (individual therapy, group therapy, and standard DBT) have not revealed any marked difference between them, other than a tendency toward improved patient retention rates in the standard version of the treatment. The aim of this study is to review the various components of DBT and their constituent parts, in order to highlight the importance of focusing on self-harm behaviors within the therapy as a whole. Although therapeutic strategies may differ and target directly suicide or NSSI, managing the quality of life, and the persistence of the therapeutic alliance (and of the interpersonal alliance) is equally important in terms of treatment efficacy.
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Affiliation(s)
- Paco Prada
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Nader Perroud
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Eva Rüfenacht
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Rosetta Nicastro
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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Weibel S, Nicastro R, Prada P, Cole P, Rüfenacht E, Pham E, Dayer A, Perroud N. Screening for attention-deficit/hyperactivity disorder in borderline personality disorder. J Affect Disord 2018; 226:85-91. [PMID: 28964997 DOI: 10.1016/j.jad.2017.09.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/21/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A valid screening instrument is needed to detect attention-deficit/hyperactivity disorder (ADHD) in treatment-seeking borderline personality disorder (BPD) patients. We aimed to test the performance of the widely-used Adult ADHD Self-Report Scale v1.1 screener (ASRS-v1.1). METHODS 317 BPD subjects were systematically assessed for comorbid ADHD and completed the ASRS-v1.1. 79 BPD patients also completed the Wender Utah Rating Scale (WURS-25). RESULTS The prevalence of adult ADHD was of 32.4%. The overall positive predictive value of the ASRS-v1.1 was of 38.5%, the negative predictive value 77.0%, the sensitivity 72.8%, and the specificity 43.9%. Combining WURS-25 and ASRS-v1.1 improved sensitivity to 81.8% and specificity to 59.6%. LIMITATIONS Cross-sectional study on treatment-seeking patients. CONCLUSIONS We found a high prevalence of ADHD using structured interviews. The ASRS-v1.1 was not a sensitive screener for identifying possible ADHD cases in a BPD population, with a high number of false positives. When combined with the WURS-25, it offered improved screening.
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Affiliation(s)
- Sébastien Weibel
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France; Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Paco Prada
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Cole
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eva Rüfenacht
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eléonore Pham
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Alexandre Dayer
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
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Adams M, Soukop M, Barley V, Yosef H, Anderson H, Boesen E, Trask CW, Rüfenacht E, de Bruijn KM. Tropisetron alone or in combination with dexamethasone for the prevention and treatment of emesis induced by non-cisplatin chemotherapy: a randomized trial. Anticancer Drugs 1995; 6:514-21. [PMID: 7579555 DOI: 10.1097/00001813-199508000-00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study compared the efficacy and tolerability of tropisetron (Navoban, Novaban) alone or in combination with dexamethasone for the treatment of emesis induced by moderately emetogenic non-cisplatin chemotherapy. In total, 126 patients with cancer, who had never received chemotherapy and who required at least two courses of moderately emetogenic non-cisplatin chemotherapy each lasting for a minimum of 5 days, were recruited into the study. Patients were randomized to receive tropisetron, 5 mg o.d., plus either dexamethasone, 12 mg i.v. on day 1 followed by 4 mg orally b.i.d. on days 2-5, or placebo. Greater control of acute and delayed vomiting and nausea was achieved in patients given the tropisetron-dexamethasone combination than in those who received the tropisetron-placebo treatment. The majority of adverse events were mild and could be attributed to the chemotherapeutic regimen used or to the underlying disease. Patients and investigators both rated tropisetron alone or in combination with dexamethasone as a highly effective and well-tolerated antiemetic treatment. The results of this study show that tropisetron, 5 mg o.d., is an effective, well-tolerated and simple to use antiemetic treatment for patients receiving moderately emetogenic non-cisplatin chemotherapy. The addition of dexamethasone increases the efficacy of tropisetron without significantly decreasing its tolerability.
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Affiliation(s)
- M Adams
- Velindre Hospital, Whitchurch, Cardiff, UK
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Bruntsch U, Rüfenacht E, Parker I, Drechsler S, de Bruijn K. Tropisetron in the prevention of chemotherapy-induced nausea and vomiting in patients responding poorly to previous conventional antiemetic therapy. Ann Oncol 1993; 4 Suppl 3:25-9. [PMID: 8363995 DOI: 10.1093/annonc/4.suppl_3.s25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
An open, two-armed, multicentre trial was conducted in 231 patients with malignant disease who had previously failed to respond to conventional antiemetic treatment for the prevention of chemotherapy-induced nausea and vomiting. Patients were randomized to receive either tropisetron (5 mg/day; n = 115) or a standard antiemetic therapy, which was considered optimal for each individual but did not include a 5-HT3 receptor antagonist (n = 116). Acute vomiting on Day 1 was controlled in 60 (52%) tropisetron patients, compared with only 29 (25%) patients receiving optimal standard therapy (p < 0.001). Acute nausea was completely inhibited in 37 (32%) tropisetron patients, compared with 22 (19%) patients on optimal standard therapy (p < 0.05). On Day 1, delayed vomiting was also significantly better prevented by tropisetron (p < 0.001). Side effects from tropisetron (headache and constipation) were mild, and no extrapyramidal symptoms were observed in any tropisetron patients, in contrast, to 14 (13%) patients in the 'optimal standard' group. In conclusion, in cases of acute nausea and vomiting it is more effective to switch refractory patients to tropisetron rather than attempt to optimize the dose of standard antiemetic therapy. For delayed nausea and vomiting, combination antiemetic therapy, with differing types of receptor antagonism and corticosteroids may provide the best way forward. Such studies are in progress.
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Affiliation(s)
- U Bruntsch
- Med. Klinik, Institut für Med. Onkologie und Hämatologie, Nuremberg, Germany
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