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doi: N/Apmid: N/A
Meltzer, HY; Cola, P; Way, L; Thompson, PA; Bastani, B; Davies, MA; Snitz, B
doi: N/Apmid: 8105705
OBJECTIVE: The goal of this study was to determine whether clozapine is a cost-effective treatment for treatment-resistant schizophrenia. METHOD: Data were collected on 96 treatment-resistant patients with schizophrenia for 2 years before they entered a clozapine treatment study and for at least 2 years after they entered the study. Information about the cost of inpatient and outpatient treatment, housing costs, other costs, and family burden through direct interview or questionnaire of these patients and their families were available for 47 of the 96 patients. Data on lost income and Social Security disability insurance were also obtained. Outcome measures included psychopathology, quality of life, global functioning, work function, and rehospitalization. RESULTS: The cost of treatment was significantly decreased in the patients who continued clozapine treatment for at least 2 years. This was primarily due to a dramatic decrease in the frequency and cost of rehospitalization. Costs were nonsignificantly lower in patients who dropped out of treatment. The estimated total 2- year cost for the 59 patients who continued clozapine treatment, the 34 patients who dropped out, and the three who interrupted treatment decreased from $7,390,206 to $5,719,463, a savings of $8,702/year per patient. There was a decrease in total costs of $22,936/year for the 37 patients who continued clozapine treatment for whom cost data were available. There were no significant changes in lost income or Social Security disability insurance payments in either group. Clozapine produced a marked improvement in Brief Psychiatric Rating Scale total scores as well as positive negative symptom scores, Global Assessment Scale scores, Quality of Life Scale scores, work functioning, capacity for independent living, and rehospitalization rates. CONCLUSIONS: Clozapine is a cost-effective treatment for treatment-resistant schizophrenic patients. Cost savings result almost
Ribeiro, SC; Tandon, R; Grunhaus, L; Greden, JF
doi: N/Apmid: 8214170
OBJECTIVE: The authors undertook a review of the literature on the dexamethasone suppression test (DST) as a predictor of course and outcome in major depression, to illustrate clinical and pathophysiological implications of studying the relation between biological measures and course of illness in psychiatry. METHOD: In computerized searches and cross-references, 144 articles were found that related DST results to prediction of treatment response or outcome. Meta-analysis was performed on pooled data from all of the studies and separately on data from selected studies that had used stricter methodology. RESULTS: 1) Baseline DST status did not predict response to antidepressant treatment or outcome after hospital discharge. 2) Non-suppression of cortisol on the baseline DST predicted poorer response to placebo. 3) Persistent nonsuppression of cortisol on the DST after treatment was associated with high risk of early relapse and poor outcome after discharge. CONCLUSIONS: Baseline DST results may be devoid of prognostic value, but posttreatment nonsuppression of cortisol on the DST is strongly associated with poor outcome. Persistent nonsuppression may reflect a partially treated index episode or identify sicker patients who are unresponsive to treatment. The findings reiterate the importance of studying biological measures in relation to multiple
doi: N/Apmid: 8214182
OBJECTIVE: This study explored the reliability and clinical correlates of the depressive personality in nonclinical subjects. In particular, the authors were interested in determining the relationship between depressive personality and mood disorders. METHOD: The subjects were 185 college students who were selected by using a battery of screening inventories assessing a variety of psychopathological symptoms and traits. The subjects were given structured diagnostic interviews that included a section on depressive temperament. RESULTS: There were significant relationships between depressive personality and lifetime. DSM-III diagnoses of major depression and dysthymia. However, the magnitude of the associations was modest, indicating that these are distinct, although overlapping constructs. In addition, the subjects with depressive personality (N = 36) had significantly greater impairment and a higher rate of mood disorders in their first-degree relatives than did the subjects without depressive personality (N = 149). Moreover, these results were evident even after the subjects with a lifetime history of mood disorder were excluded. CONCLUSIONS: These data suggest that depressive personality is a clinically important condition that is not subsumed by existing mood disorders
doi: N/Apmid: N/A
McEvoy, JP; Schooler, NR; Friedman, E; Steingard, S; Allen, M
doi: N/Apmid: 8214172
OBJECTIVE: The goal of this study was to clarify more precisely where patients with psychotic disorders and the mental health professionals who care for them disagree regarding whether the patient is ill or needs treatment. METHOD: The authors prepared brief vignettes in everyday descriptive language that provided examples of the classical positive and negative psychopathological features of schizophrenia. Fifteen men and 11 women diagnosed as having schizophrenia or schizoaffective disorder and one physician used these vignettes as a common frame of reference to rate 1) the degree to which the patients demonstrated the features described in each vignette and 2) the degree to which the features signified the presence of mental illness. RESULTS: Disagreements between the physician's and patients' ratings, indicating deficits in insight, were associated with the recognition of the presence of conceptual disorganization, avolition-apathy, and affective blunting in the patients by the physician but not the patients and with the conceptualization of hallucinatory behavior and suspiciousness as signs of mental illness by the physician but not the patients. CONCLUSIONS: The authors conclude that the failure to acknowledge conceptual disorganization, avolition-apathy, and affective blunting and the failure to view hallucinatory behavior and suspiciousness as signs of mental illness, which proved to be additive in this study,
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