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Abstract Pharmacological resistance poses a significant challenge for individuals with severe recurrent mood or anxiety disorders in the evolving landscape of biological psychiatry. This case report explores the decision-making process physicians undergo when treating patients resistant to traditional therapies, particularly those with underlying personality disorders. The patient in focus underwent extensive treatment with antidepressants, antipsychotics, mood stabilizers, anxiolytics, and hypnotics. This journey sheds light on the multifaceted nature of treatment resistance, emphasizing the active role of patients in influencing and occasionally sabotaging their treatment. The report highlights the delicate balance between minor medication adjustments and a departure from established clinical practices. The pivotal role of the patient-physician relationship is emphasized, with a specific focus on identifying and addressing the patient's past feelings of anger towards physicians as a contributing factor. Failure to recognize this dynamic can result in physician frustration and a sense of helplessness. The exploration also stresses the importance of understanding physician emotions in managing medications for challenging patients. By uncovering the underlying causes of treatment resistance in this case, the physician's confidence improved, enabling a more beneficial course for the patient. However, a lack of continuity and a weak therapeutic relationship led to treatment failure in this instance. In conclusion, this case underscores the critical importance of identifying factors contributing to treatment resistance to disrupt the cyclical pattern of medication changes. Both patient and physician emotions significantly influence deviations from clinical practice. The narrative emphasizes the value of psychodynamic understanding in addressing these challenges, facilitating a more comprehensive and effective approach to patient care.
Baur et al. (Tue,) studied this question.