Alternatives to DRGs: research issues

Paranoid schizophrenia: prognosis under DSM-II and DSM-III-R

DSM-III-R subtype-specific criteria and Tsuang-Winokur demographic criteria for paranoid schizophrenia were applied to records of discharged schizophrenic inpatients diagnosed according to DSM-II. Those meeting DSM-III-R subtype-specific criteria for paranoid schizophrenia and those who did not, ie, they received more hopeful diagnoses, had equally good prognoses. Good outcome was associated with the presence of prior affective symptomatology, absence of formal thought disorder, or other negative-type symptoms as well as Tsuang-Winokur demographic criteria of onset after age 25, married or employed status, and/or absence of family history. Patients with particularly poor outcome were identified by the coexistence of unsystematized or poorly developed persecutory ideation, symptoms of thought disorder, and/or disorganized behavior. The clinical and demographic descriptors discussed in this report may be particularly useful in creating homogeneous patient groupings for both clinical and rate-setting payment classifications.

Pharmacoepidemiologic methods for identifying and quantifying behavioral effects of neuropharmacological agents

The possibilities and limitations of the pharmacoepidemiologic methods of determining neuropharmacologic drug efficacy and safety in psychiatric patients are discussed in this review. Such methods can improve both the scientific evaluation and clinical practice aspects of our knowledge of these drugs by providing: (1) incidence rates of drug usage and adverse events from computerized information on large populations; (2) quantitative methods for risk-to-benefit assessments that incorporate multiple outcome measures, provide long-term effectiveness and safety data, and use statistical methods to distinguish drug-induced from illness-based behaviors; and (3) systematic epidemiologic approaches to resolving dilemmas that involve the political and social context in which neuropharmacological drugs are used.