Overall, nonresponse

to treatment can be considered if the patient’s objective condition and subjective experience do not evolve favorably after a therapeutic trial that was coherent with Axis I and Axis II diagnoses, provided adequate pharmacological doses were used, initial physical disorders were controlled, and detrimental extraneous influences were eliminated. History Jean Esquirol (1772-1840), a student of Philippe Pinel, was the first to underline the importance of the statistical assessment of treatment response. He stated his faith in evaluation and statistics in his treatise on clinical psychiatry, Des maladies mentales, considérées sous les rapports médical, hygiénique, et médicolégal Inhibitors,research,lifescience,medical (1838): “The physician … must give a sincere report of his cases of success and failure. … I love statistics in medicine because I believe that it is useful; therefore, I have been using statistics to help me in my research into mental Inhibitors,research,lifescience,medical illness for the last 30 years. Statistics is the best instrument to measure the influence

of locality, regimen, and treatment methods.“3 In his statistics on patients admitted to the Charenton hospital near Paris over an 8-year period, he reported that a proportion of 1:3 were cured and discharged; he added that the rate was as high as 1:2.33 if incurable Inhibitors,research,lifescience,medical patients were excluded from the analysis.3 In his textbook, Allgemeine Psychopathologie, Karl Jaspers (1883-1969) had a critical approach to using treatment Inhibitors,research,lifescience,medical response as an instrument of knowledge (therapeutischer Erfolg als Erkenntnismittel). He warned against the reticence to report treatment failure, particularly in psychotherapy, and against the physician’s complacent belief that the patient’s condition improved thanks to medical intervention.4 Therapeutic expectations change with the times. Today, treatment response is considered mostly in the context of pharmacotherapy, whose appearance in the 1950s considerably broadened our therapeutic armamentarium. Expectations were more

modest up to the second Inhibitors,research,lifescience,medical half of the 20th century, because therapeutic means were considerably less efficient. The foremost psychotropic agent was chloral, which was synthesized in 1832 and recognized as a useful hypnotic for anxious or depressed patients in 1869 by Matthias E. O. Liebreich (1839-1908), a pharmacologist in Berlin. The less severely ill TCL could be managed with hypnotism, introduced by Franz Anton Mesmer (1734-1815) and developed by Jean-Martin Charcot (BLU9931 1825-1893), or by the “rest cure” introduced in 1875 by the American physician Silas Weir Mitchell (1829-1914) for the treatment of neurasthenia. Asylum was the only option for the severely ill. In the 19th century, it was accepted that some patients were incurable. A pessimistic course was part of the theory of degeneration (Bénédict-Augustin Morel [1809-1873]), which posited that the disease could only worsen from one generation to the next.