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Known primarily for its stunning Baltic coastline, Palanga offers much more than just sandy beaches and scenic sunsets. This picturesque town is a treasure trove of prehistoric amber, enchanting countryside buildings, and a thriving arts scene. Visitors can marvel at the largest piece of amber in Lithuania, weighing an impressive 3. The museum also showcases stunning amber jewelry and artwork, reflecting the craftsmanship and creativity that have transformed these ancient relics into timeless pieces of art. The serene garden surrounding the museum is an ideal spot for a leisurely stroll, further enhancing the sense of stepping back in time. Spanning over hectares, the park is a verdant oasis of winding paths, serene ponds, and diverse plant species. The town hosts numerous cultural events and festivals throughout the year, drawing artists and performers from across the globe. The Palanga Summer Festival , held annually, features a diverse program of music, dance, theater, and visual arts, transforming the town into a bustling hub of artistic activity. With its state-of-the-art acoustics and elegant design, the hall hosts an array of performances, from classical concerts to contemporary dance shows. The International Thomas Mann Festival, dedicated to the German writer who spent his summers in nearby Nida, is another cultural highlight, celebrating literature, music, and intellectual discourse. Art enthusiasts can also explore numerous galleries and studios scattered throughout the town. Here, visitors can purchase unique pieces of art, from paintings and sculptures to handmade crafts and jewelry. Palanga is a town that captivates the senses and stirs the imagination. Its prehistoric amber offers a tangible connection to the ancient world, while its idyllic countryside buildings and vibrant arts scene celebrate the rich cultural landscape of Lithuania. Share Tweet. Comments Comments are closed. You may also like. By The Baltic Review. More in Lithuania. Lithuania Lithuanian international experience — for the progress of the state in the fields of defense, aviation, start-ups and other fields June 26, Recent Posts. What you need to know about car window tinting 3 days ago. New light-vehicle registrations in the Baltic States shrank October 10, Latvia Dirty Money: U. Society How to attract Estonian woman: 7 Steps November 13, views. Made in the Baltics. Riga Black Balsam. Instagram balticreview. The Baltic Review. Popular Posts. Dirty Money: U. Latvia: The Schoolboy who burned the cactus January 21, views. How to attract Estonian woman: 7 Steps November 13, views.

Palanga: Pre-Historic Eocene Amber, Idyllic Countryside Buildings, and Arts

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Official websites use. Share sensitive information only on official, secure websites. Anxiety disorders are very prevalent and often persistent mental disorders, with a considerable rate of treatment resistance which requires regulatory clinical trials of innovative therapeutic interventions. They confer a substantial socioeconomic burden 5 , 6 , 7 and often take a debilitating course, with a high proportion of cases having only intermittent recovery Searching clinicaltrials. The only systematic review available to date 55 could not discern a consistent definition in 62 studies investigating treatment resistance in anxiety disorders. In A large proportion of studies Most studies While some studies The ADRN presently includes 28 members across 14 countries and has the principal goal of addressing currently unmet needs in anxiety and related disorders. A further 18 experts academics, clinicians, basic scientists and three key stakeholders two representatives of regulatory bodies, and a representative from a mutual aid advocacy organization were selected to form the final panel see supplementary information. The questionnaire, along with a narrative review of the current state of the evidence, was sent to the panel in November Anonymized responses to the questionnaire and a revised version of the narrative review were sent back to the panel and discussed in an online meeting in March , using a nominal group technique to agree on the selection and wording of consensus statements. After each iterative round, participants received feedback in the form of a cumulative statistical representation of the overall panel's response, and had access to anonymized comments by their fellow panelists see Figure 1 and supplementary information. Where participants gave a score of 1 to 3 to a statement on the Likert scale, low agreement was assumed. A score of 4 to 6 indicated moderate agreement with a statement. When a statement was scored 7 to 9, it was considered to be agreed upon substantially Clinician ratings have been suggested to possibly increase the effect sizes 69 , 70 , but might at the same time be more sensitive to change and can be applied in an adequately blinded way. For an international consensus, the recommended scales should be translated, validated and available in as many languages and countries as possible. It was also noted that operationalization of treatment resistance based on symptom reduction may not sufficiently portray the full picture of how well a patient does in the long term, which might be better reflected by Sheehan Disability Scale scores. Several additional, but optional, recommendations on how to define treatment failure in regulatory trials concerning specific anxiety disorders were agreed upon by the panel. For regulatory trials, it might be useful to differentiate between resistance to pharmacotherapy and psychotherapy. These trials should involve two different classes of medications e. This flexibility is particularly relevant for anxiety disorders, as pharmacotherapy and psychotherapy have been considered similarly effective in these disorders, and as resistance to pharmacotherapy does not preclude response to psychotherapy and vice versa , or to a combination of the two modalities. Also, the bio mechanisms of treatment resistance to pharmacotherapy and psychotherapy might be partly distinct. The model proposed by the panel in order to capture the spectrum of levels of treatment resistance in anxiety disorders comprises a first stage of failure of either two adequate courses of pharmacotherapy or at least one adequate trial of psychotherapy; a second stage of failure of both two adequate courses of pharmacotherapy and at least one adequate trial of psychotherapy; and a third stage of failure of multiple adequate courses of poly pharmacotherapy and multiple adequate trials of psychotherapy. Biographical factors such as socioeconomic status, social support, specific life events e. Additionally, it might be difficult to delineate distinct episodes. Research into this topic has been deemed to be of importance. Consequently, it is essential to be sensitive and not judgmental towards persons experiencing treatment resistance, and to ensure respectful language awareness and use e. It is imperative that persons with anxiety disorders are fully informed about the comparative efficacy of the various treatment modalities based on current official guidelines, and that their preferences are respected. It is to be taken into consideration that certain classes of medication or psychotherapy might be unacceptable or untimely from a patient's point of view, or that certain treatment options might simply not be available or delivered optimally. Research into clinical, epi genetic, proteomic, metabolomic, microbiome, physiological and neuroimaging biomarkers as predictors of treatment resistance in anxiety disorders, allowing for a more personalized and precise care in this field, was welcomed by the panel see Table 1 , statement However, the very limited currently available evidence was acknowledged 92 , 93 , 94 , Machine learning approaches could aid in integrating biological, biographical and ecological momentary assessment markers At least one failed trial of adequately delivered e. The international experts and stakeholders selected for this study represent a broad range of expertise in the field. This represents in itself an important development. It is desirable to identify factors predicting and mechanistically underlying treatment resistance in anxiety disorders. Some studies of limited quality and highly heterogeneous in design suggest a number of potential risk factors — such as high expressed emotions within the family, higher severity and longer duration of the disorder, earlier age of onset, or presence of comorbid conditions — which however have not been consistently replicated 13 , 19 , 81 , In a similar vein, the identification of reliable and valid biomarkers indicating an increased risk of treatment resistance would be helpful to inform algorithms for individually tailoring an intensified treatment for those patients 22 , 23 , 25 , 93 , 94 , If they are empirically validated, a dissemination plan could include their endorsement by professional associations and health care authorities to facilitate their implementation in practice. Baldwin, B. Bandelow, I. Branchi, J. Burkauskas, S. Davis, B. Dell'Osso, K. Domschke, N. Fineberg, M. Latas, V. Masdrakis, S. Pallanti, S. Pini, M. Schiele, N. As a library, NLM provides access to scientific literature. World Psychiatry. Find articles by Katharina Domschke. Find articles by Patrik D Seuling. Find articles by Miriam A Schiele. Find articles by Borwin Bandelow. Find articles by Neeltje M Batelaan. Find articles by Wicher A Bokma. Find articles by Igor Branchi. Find articles by Karl Broich. Find articles by Julius Burkauskas. Find articles by Simon JC Davies. Find articles by Bernardo Dell'Osso. Find articles by Harry Fagan. Find articles by Naomi A Fineberg. Find articles by Toshi A Furukawa. Find articles by Stefan G Hofmann. Find articles by Sean Hood. Find articles by Nathan TM Huneke. Find articles by Milan Latas. Find articles by Nicky Lidbetter. Find articles by Vasilios Masdrakis. Find articles by Antonio E Nardi. Find articles by Stefano Pallanti. Find articles by Giampaolo Perna. Find articles by Steve Pilling. Find articles by Stefano Pini. Find articles by Andreas Reif. Find articles by Soraya Seedat. Find articles by Gemma Simons. Find articles by Shrikant Srivastava. Find articles by Dan J Stein. Find articles by Murray B Stein. Find articles by Michael van Ameringen. Find articles by Nic van der Wee. Find articles by Peter Zwanzger. Find articles by David S Baldwin. Issue date Feb. Open in a new tab. GAD — generalized anxiety disorder. At least two separate failed full trials of pharmacological monotherapy. At least at the minimal approved dose. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. The definition of psychotherapeutic treatment resistance in anxiety disorders should rest on at least one failed trial of adequately delivered e. Subgroups of AD e. Specific biographical factors e.

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