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Bortoletto R, Piscitelli F, Candolo A, Bhattacharyya S, Balestrieri M, Colizzi M. Questioning the role of palmitoylethanolamide in psychosis: a systematic review of clinical and preclinical evidence. Front Psychiatry 2023; 14:1231710. [PMID: 37533892 PMCID: PMC10390736 DOI: 10.3389/fpsyt.2023.1231710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/30/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction The endocannabinoid (eCB) system disruption has been suggested to underpin the development of psychosis, fueling the search for novel, better-tolerated antipsychotic agents that target the eCB system. Among these, palmitoylethanolamide (PEA), an N-acylethanolamine (AE) with neuroprotective, anti-inflammatory, and analgesic properties, has drawn attention for its antipsychotic potential. Methods This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020-compliant systematic review aimed at reappraising all clinical and preclinical studies investigating the biobehavioral role of PEA in psychosis. Results Overall, 13 studies were eligible for data extraction (11 human, 2 animal). Observational studies investigating PEA tone in psychosis patients converged on the evidence for increased PEA plasma (6 human) and central nervous system (CNS; 1 human) levels, as a potential early compensatory response to illness and its severity, that seems to be lost in the longer-term (CNS; 1 human), opening to the possibility of exogenously supplementing it to sustain control of the disorder. Consistently, PEA oral supplementation reduced negative psychotic and manic symptoms among psychosis patients, with no serious adverse events (3 human). No PEA changes emerged in either preclinical psychosis model (2 animal) studied. Discussion Evidence supports PEA signaling as a potential psychosis biomarker, also indicating a therapeutic role of its supplementation in the disorder. Systematic review registration https://doi.org/10.17605/OSF.IO/AFMTK.
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Affiliation(s)
- Riccardo Bortoletto
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Fabiana Piscitelli
- Department of Chemical Sciences and Materials Technologies, Institute of Biomolecular Chemistry, National Research Council (CNR), Pozzuoli, Italy
| | - Anna Candolo
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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2
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Messeni Petruzzelli A, Latorre V, Uva AE, Ranaudo C, Semisa D. Unveiling the actual cost of Schizophrenia: An Activity-Based Costing (ABC) approach. Int J Health Plann Manage 2021; 37:1366-1380. [PMID: 34939215 DOI: 10.1002/hpm.3405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Despite its relatively low lifetime prevalence, the health, social, and economic burden of Schizophrenia is very significant. In the last 10 years, several studies have analysed the economic burden of Schizophrenia, even if there is a lack of research that has considered the actual cost for the community as the result of each event in the patient's history. OBJECTIVE The present study aims to cover this gap by proposing a novel model to evaluate better the cost of Schizophrenia with real data from medical records. METHODS We applied (i) a 'real life' analysis of medical database to capture each event of the clinical history and healthcare that could have an economic impact; and (ii) a novel Activity-Based Costing model to quantify the overall annual economic burden of a patient with Schizophrenia treated by public mental health services. We carried out the study with 523 patients with a diagnosis of Schizophrenia in the Department of Mental Health of Bari, in the South of Italy. RESULTS Our results reveal an overall cost of €41.290 per patient with Schizophrenia per year. Almost half of the cost is due to rehabilitation. The second most important factor is instead related to disability and loss of productivity. CONCLUSIONS We believe that the present approach represents the most effective method to properly estimate actual costs when real-life data are available compared with other studies mainly based on prevalence-based approaches.
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Affiliation(s)
| | - Valeria Latorre
- Department of Mental Health, Azienda Sanitaria Locale Bari, Bari, Italy
| | - Antonio Emmanuele Uva
- Department of Mechanics, Mathematics and Management, Polytechnic Institute of Bari, Bari, Italy
| | - Carlo Ranaudo
- Department of Pharmacy, University of Salerno, Fisciano, Italy
| | - Domenico Semisa
- Department of Mental Health, Azienda Sanitaria Locale Bari, Bari, Italy
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3
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Serretti A, Mandelli L, Bajo E, Cevenini N, Papili P, Mori E, Bigelli M, Berardi D. The socio-economical burden of schizophrenia: A simulation of cost-offset of early intervention program in Italy. Eur Psychiatry 2020; 24:11-6. [DOI: 10.1016/j.eurpsy.2008.07.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 07/25/2008] [Accepted: 07/26/2008] [Indexed: 11/28/2022] Open
Abstract
AbstractSchizophrenia is associated with a high familiar, social and economic burden. During the recent years early and specific intervention for first psychotic episodes has been suggested to improve the long term outcome of the disease. Despite the promising results obtained so far, early intervention is still scarcely applied. One major problem arises from the translation of research findings into stakeholder policies. In fact very few analyses of cost reductions obtained with early intervention have been reported. In the present paper we present a simulation of direct cost reduction that can be obtained with early intervention programmes. We based our analysis on available data about schizophrenia care costs in Italy and the expected cost reduction with the use of early intervention. We observed that the increase in costs due to the more intensive early intervention is largely compensated by the reduction of inpatient admissions with a reduction of direct costs of 6.01%. Despite the apparently small economic gain, early intervention offers more clinical and social benefits as it seems to be effective also in decreasing relapse rates, in improving the patients' quality of life and disability associated with psychosis and in increasing employment rates. Those indirect costs however are difficult to estimate and were not included in our model.In conclusion, our study supports the use of early intervention in schizophrenia, which could allow an outcome improvement with lower direct and indirect costs.
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Fasseeh A, Németh B, Molnár A, Fricke FU, Horváth M, Kóczián K, Götze Á, Kaló Z. A systematic review of the indirect costs of schizophrenia in Europe. Eur J Public Health 2019; 28:1043-1049. [PMID: 30395217 PMCID: PMC6241204 DOI: 10.1093/eurpub/cky231] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Schizophrenia is a chronic disease associated with significant and long-lasting effects on health, and it is also a social and financial burden, not only for patients but also for families, other caregivers, and the wider society. It is essential to conduct the assessment of indirect costs, to understand all the effects of the disease on society. Our aim is to gain a better understanding of the indirect costs of schizophrenia in Europe. Methods We conducted a comprehensive systematic literature review covering EMBASE, Medline, and PsycINFO as well as reviewing Health Technology Assessment databases from different countries. We used a qualitative research synthesis for presenting information, as most of the studies were methodologically diverse, a quantitative analysis would have been impractical. Results Indirect cost adjusted to inflation ranged vastly between studies included in the review from 119 Euros to 62, 034 Euros annually. The average proportion of indirect costs of total costs was 44%. Studies highlighted important cost drivers as age, gender, and disease severity, explaining the variation in costs between treatment and patient groups. Conclusions Regardless of the methodological heterogeneity of the reviewed studies, there was an agreement about the significance of indirect costs of schizophrenia on the society. Considering the relatively high prevalence of schizophrenia in Europe, a need for more cost of illness studies especially from Central Eastern and Southern Europe is suggested.
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Affiliation(s)
- A Fasseeh
- Syreon Research Institute, Budapest, Hungary.,Eötvös Loránd University (ELTE), Budapest, Hungary
| | - B Németh
- Syreon Research Institute, Budapest, Hungary
| | - A Molnár
- Syreon Research Institute, Budapest, Hungary
| | - F-U Fricke
- Technische Hochschule Nürnberg, Nürnberg, Germany
| | - M Horváth
- Gedeon Richter Plc., Budapest, Hungary
| | - K Kóczián
- Gedeon Richter Plc., Budapest, Hungary
| | - Á Götze
- Gedeon Richter Plc., Budapest, Hungary
| | - Z Kaló
- Syreon Research Institute, Budapest, Hungary.,Eötvös Loránd University (ELTE), Budapest, Hungary
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Tatsukawa T, Raveau M, Ogiwara I, Hattori S, Miyamoto H, Mazaki E, Itohara S, Miyakawa T, Montal M, Yamakawa K. Scn2a haploinsufficient mice display a spectrum of phenotypes affecting anxiety, sociability, memory flexibility and ampakine CX516 rescues their hyperactivity. Mol Autism 2019; 10:15. [PMID: 30962870 PMCID: PMC6437867 DOI: 10.1186/s13229-019-0265-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/06/2019] [Indexed: 01/13/2023] Open
Abstract
Background Mutations of the SCN2A gene encoding a voltage-gated sodium channel alpha-II subunit Nav1.2 are associated with neurological disorders such as epilepsy, autism spectrum disorders, intellectual disability, and schizophrenia. However, causal relationships and pathogenic mechanisms underlying these neurological defects, especially social and psychiatric features, remain to be elucidated. Methods We investigated the behavior of mice with a conventional or conditional deletion of Scn2a in a comprehensive test battery including open field, elevated plus maze, light-dark box, three chambers, social dominance tube, resident-intruder, ultrasonic vocalization, and fear conditioning tests. We further monitored the effects of the positive allosteric modulator of AMPA receptors CX516 on these model mice. Results Conventional heterozygous Scn2a knockout mice (Scn2aKO/+) displayed novelty-induced exploratory hyperactivity and increased rearing. The increased vertical activity was reproduced by heterozygous inactivation of Scn2a in dorsal-telencephalic excitatory neurons but not in inhibitory neurons. Moreover, these phenotypes were rescued by treating Scn2aKO/+ mice with CX516. Additionally, Scn2aKO/+ mice displayed mild social behavior impairment, enhanced fear conditioning, and deficient fear extinction. Neuronal activity was intensified in the medial prefrontal cortex of Scn2aKO/+ mice, with an increase in the gamma band. Conclusions Scn2aKO/+ mice exhibit a spectrum of phenotypes commonly observed in models of schizophrenia and autism spectrum disorder. Treatment with the CX516 ampakine, which ameliorates hyperactivity in these mice, could be a potential therapeutic strategy to rescue some of the disease phenotypes. Electronic supplementary material The online version of this article (10.1186/s13229-019-0265-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tetsuya Tatsukawa
- 1Laboratory for Neurogenetics, RIKEN Center for Brain Science, Wako, Saitama 351-0198 Japan
| | - Matthieu Raveau
- 1Laboratory for Neurogenetics, RIKEN Center for Brain Science, Wako, Saitama 351-0198 Japan
| | - Ikuo Ogiwara
- 1Laboratory for Neurogenetics, RIKEN Center for Brain Science, Wako, Saitama 351-0198 Japan.,2Department of Physiology, Nippon Medical School, Bunkyo-ku, Tokyo, 113-8602 Japan
| | - Satoko Hattori
- 3Division of Systems Medical Science, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake-shi, Aichi 470-1192 Japan
| | - Hiroyuki Miyamoto
- 1Laboratory for Neurogenetics, RIKEN Center for Brain Science, Wako, Saitama 351-0198 Japan
| | - Emi Mazaki
- 1Laboratory for Neurogenetics, RIKEN Center for Brain Science, Wako, Saitama 351-0198 Japan
| | - Shigeyoshi Itohara
- 4Laboratory for Behavioral Genetics, RIKEN Center for Brain Science, Wako, Saitama 351-0198 Japan.,5FIRST, Japan Science and Technology Agency, Kawaguchi, Saitama 332-0012 Japan
| | - Tsuyoshi Miyakawa
- 3Division of Systems Medical Science, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake-shi, Aichi 470-1192 Japan
| | - Mauricio Montal
- 6Section of Neurobiology, Division of Biological Sciences, University of California San Diego, La Jolla, CA 92093 USA
| | - Kazuhiro Yamakawa
- 1Laboratory for Neurogenetics, RIKEN Center for Brain Science, Wako, Saitama 351-0198 Japan
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6
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Ignatova D, Kamusheva M, Petrova G, Onchev G. Cost-effectiveness analysis of current treatment of individuals with acute exacerbation of schizophrenia in Bulgaria. BIOTECHNOL BIOTEC EQ 2019. [DOI: 10.1080/13102818.2018.1561209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Desislava Ignatova
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Maria Kamusheva
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Guenka Petrova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Georgi Onchev
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
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van der Stouwe ECD, van Busschbach JT, de Vries B, Cahn W, Aleman A, Pijnenborg GHM. Neural correlates of exercise training in individuals with schizophrenia and in healthy individuals: A systematic review. Neuroimage Clin 2018; 19:287-301. [PMID: 30023171 PMCID: PMC6050351 DOI: 10.1016/j.nicl.2018.04.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/27/2018] [Accepted: 04/16/2018] [Indexed: 12/17/2022]
Abstract
A body of evidence has revealed positive effects of physical exercise on behavioral, cognitive and physical outcomes in patients with schizophrenia. Notably, the effect of exercise at the neural level may be particularly relevant as well as it is hypothesized that exercise may stimulate the brain in a way that might normalize neural alterations related to the disorder. The aim of the current systematic review was to provide an up to date overview of studies investigating the neural effects of exercise in individuals with a schizophrenia spectrum disorder and healthy individuals. The majority of included studies focused on hippocampal effects, reporting beneficial effects of exercise. In addition, in schizophrenia increased extrastriate body area (EBA) activation and increased white matter fiber integrity in tracts relevant to the disorder were found and in healthy individuals decreased connectivity of the dorsolateral prefrontal cortex (DLPFC) indicating greater cognitive efficiency was reported. Comparing individuals with a schizophrenia spectrum disorder and healthy individuals within a similar age range, most studies found similar effects on hippocampal volume and white matter tracts for both groups, although the effect in schizophrenia spectrum disorders may be attenuated which is in line with previous literature on brain plasticity. The current review indicates a lack of studies investigating neural correlates other than the hippocampus. Although those studies that did focus on other neural correlates revealed promising results, these have not been replicated in other studies and call for replication. Furthermore, future studies should expand their focus, by investigating neural mechanisms underlying positive effects of physical exercise on positive symptoms, negative symptoms and symptoms such as depression, social withdrawal and social cognition.
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Affiliation(s)
- E C D van der Stouwe
- Department of Neuroscience, BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713, AW, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Rob Giel Onderzoekcentrum, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.
| | - J T van Busschbach
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Rob Giel Onderzoekcentrum, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands; Department of Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017, CA, Zwolle, The Netherlands.
| | - B de Vries
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, The Netherlands.
| | - W Cahn
- Department of Psychiatry, Rudolf Magnus Institute for Neuroscience, University Medical Center Utrecht, Heigelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - A Aleman
- Department of Neuroscience, BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713, AW, Groningen, The Netherlands.
| | - G H M Pijnenborg
- Department of Neuroscience, BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713, AW, Groningen, The Netherlands; Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, The Netherlands; Department of Psychotic Disorders, GGZ-Drenthe, Dennenweg 9, 9404, LA, Assen, The Netherlands.
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8
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Kumar D. Psychosocial interventions in schizophrenia: a survey of clinical training and clinicians’ opinions in India. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2018. [DOI: 10.1080/17522439.2018.1430845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Devvarta Kumar
- Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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9
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Abstract
SummaryEarly intervention in psychiatry has taken a long time to emerge as a key strategy to reduce morbidity and mortality. In other fields of medicine it has received consistent support and great efforts are expended to educate the public about the value of early diagnosis and the benefits of timely intervention. There is finally substantial momentum behind similar endeavours in psychotic disorders, which, now they have reached ‘proof of concept’ stage, could begin to be extended across the spectrum of serious mental disorders. There is also ambivalence and resistance to this evidence-based reform which warrants careful analysis. The Third International Early Psychosis Conference proved to be a watershed and was the largest and most vibrant meeting to that point. This preface aims to set the scene for a selection of contributions, derived from the array of new evidence reported in Copenhagen, and recently fully updated.
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10
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Addington D, Anderson E, Kelly M, Lesage A, Summerville C. Canadian Practice Guidelines for Comprehensive Community Treatment for Schizophrenia and Schizophrenia Spectrum Disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:662-672. [PMID: 28886669 PMCID: PMC5593248 DOI: 10.1177/0706743717719900] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this review is to identify the features and components of a comprehensive system of services for people living with schizophrenia. A comprehensive system was conceived as one that served the full range of people with schizophrenia and was designed with consideration of the incidence and prevalence of schizophrenia. The system should provide access to the full range of evidence-based services, should be recovery oriented, and should provide patient-centred care. METHOD A systematic search was conducted for published guidelines for schizophrenia and schizophrenia spectrum disorders. The guidelines were rated by at least 2 raters, and recommendations adopted were primarily drawn from the National Institute for Clinical Excellence (2014) Guideline on Psychosis and Schizophrenia in adults and the Scottish Intercollegiate Guidelines Network guidelines on management of schizophrenia. RESULTS The recommendations adapted for Canada cover the range of services required to provide comprehensive services. CONCLUSIONS Comprehensive services for people with schizophrenia can be organized and delivered to improve the quality of life of people with schizophrenia and their carers. The services need to be organized in a system that provides access to those who need them.
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Affiliation(s)
- Donald Addington
- 1 Department of Psychiatry, Hotchkiss Brain Institute, Foothills Hospital, University of Calgary, Calgary, Alberta
| | | | - Martina Kelly
- 3 Department of Family Medicine, University of Calgary, Calgary, Alberta
| | - Alain Lesage
- 4 Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montreal, Québec
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11
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Affiliation(s)
- Dan Siskind
- 1 Rehabilitation Academic Clinical Unit, Addiction and Mental Health Services, Metro South Health, MacGregor, QLD, Australia.,2 School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Frances Dark
- 1 Rehabilitation Academic Clinical Unit, Addiction and Mental Health Services, Metro South Health, MacGregor, QLD, Australia.,2 School of Medicine, University of Queensland, Brisbane, QLD, Australia
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12
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Martin LAL, Koch SC, Hirjak D, Fuchs T. Overcoming Disembodiment: The Effect of Movement Therapy on Negative Symptoms in Schizophrenia-A Multicenter Randomized Controlled Trial. Front Psychol 2016; 7:483. [PMID: 27064347 PMCID: PMC4815039 DOI: 10.3389/fpsyg.2016.00483] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/18/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Negative symptoms of patients with Schizophrenia are resistant to medical treatment or conventional group therapy. Understanding schizophrenia as a form of disembodiment of the self, a number of scientists have argued that the approach of embodiment and associated embodied therapies, such as Dance and Movement Therapy (DMT) or Body Psychotherapy (BPT), may be more suitable to explain the psychopathology underlying the mental illness and to address its symptoms. Hence the present randomized controlled trial (DRKS00009828, http://apps.who.int/trialsearch/) aimed to examine the effectiveness of manualized movement therapy (BPT/DMT) on the negative symptoms of patients with schizophrenia. METHOD A total of 68 out-patients with a diagnosis of a schizophrenia spectrum disorder were randomly allocated to either the treatment (n = 44, 20 sessions of BPT/DMT) or the control condition [n = 24, treatment as usual (TAU)]. Changes in negative symptom scores on the Scale for the Assessment of Negative Symptoms (SANS) were analyzed using Analysis of Covariance (ANCOVA) with Simpson-Angus Scale (SAS) scores as covariates in order to control for side effects of antipsychotic medication. RESULTS After 20 sessions of treatment (BPT/DMT or TAU), patients receiving movement therapy had significantly lower negative symptom scores (SANS total score, blunted affect, attention). Effect sizes were moderate and mean symptom reduction in the treatment group was 20.65%. CONCLUSION The study demonstrates that embodied therapies, such as BPT/DMT, are highly effective in the treatment of patients with schizophrenia. RESULTS strongly suggest that BPT/DMT should be embedded in the daily clinical routine.
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Affiliation(s)
- Lily A. L. Martin
- Department of Educational Science and Psychology, Free University BerlinBerlin, Germany
- Department of Arts Therapies and Therapy Science, Alanus University AlfterAlfter, Germany
| | - Sabine C. Koch
- Department of Arts Therapies and Therapy Science, Alanus University AlfterAlfter, Germany
- Department of Dance and Movement Therapy, School of Therapeutic Sciences, SRH University HeidelbergHeidelberg, Germany
| | - Dusan Hirjak
- Department of General Psychiatry, Centre for Psychosocial Medicine, Academic Medical Center, University of HeidelbergHeidelberg, Germany
| | - Thomas Fuchs
- Department of General Psychiatry, Centre for Psychosocial Medicine, Academic Medical Center, University of HeidelbergHeidelberg, Germany
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13
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Tajima-Pozo K, de Castro Oller MJ, Lewczuk A, Montañes-Rada F. Understanding the direct and indirect costs of patients with schizophrenia. F1000Res 2015; 4:182. [PMID: 26339474 PMCID: PMC4544407 DOI: 10.12688/f1000research.6699.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Schizophrenia is a disabling mental disorder with high prevalence and that usually requires long-term follow-up and expensive lifelong treatment. The cost of schizophrenia treatment consumes a significant amount of the health services' budget in western countries. OBJECTIVE The aim of the study was to find out about the costs related to schizophrenia across different european countries and compare them. RESULTS Schizophrenia treatment costs an estimated 18 billion euros annually worldwide. The direct costs associated with medical help are only part of the total expenditure. The indirect costs are an equally (or even more)important part of the total cost. These expenses are related to the lack of productivity of schizophrenic patients and the cost that relatives have to bear as a result of taking care of their affected relatives. CONCLUSIONS Although data on the cost of schizophrenia may vary slightly between different european countries, the general conclusion that can be drawn is that schizophrenia is a very costly disorder. Not only because of direct costs related to medical procedures, but also due to the non-medical (indirect) costs. Together this suggests the need to investigate cost-efficient strategies that could provide a better outcome for schizophrenic patients, as well as the people who care for them.
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Affiliation(s)
| | | | - Adrian Lewczuk
- Universidad Rey Juan Carlos de Madrid, Madrid, 28933, Spain
- Medical University of Warsaw, Warsaw, 61, Poland
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14
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Tajima-Pozo K, de Castro Oller MJ, Lewczuk A, Montañes-Rada F. Understanding the direct and indirect costs of patients with schizophrenia. F1000Res 2015; 4:182. [PMID: 26339474 PMCID: PMC4544407 DOI: 10.12688/f1000research.6699.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 11/20/2022] Open
Abstract
Background : Schizophrenia is a disabling mental disorder with high prevalence and that usually requires long-term follow-up and expensive lifelong treatment. The cost of schizophrenia treatment consumes a significant amount of the health services' budget in western countries. Objective : The aim of the study was to find out about the costs related to schizophrenia across different european countries and compare them. Results : Schizophrenia treatment costs an estimated 18 billion euros annually worldwide. The direct costs associated with medical help are only part of the total expenditure. The indirect costs are an equally (or even more)important part of the total cost. These expenses are related to the lack of productivity of schizophrenic patients and the cost that relatives have to bear as a result of taking care of their affected relatives. Conclusions : Although data on the cost of schizophrenia may vary slightly between different european countries, the general conclusion that can be drawn is that schizophrenia is a very costly disorder. Not only because of direct costs related to medical procedures, but also due to the non-medical (indirect) costs. Together this suggests the need to investigate cost-efficient strategies that could provide a better outcome for schizophrenic patients, as well as the people who care for them.
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Affiliation(s)
| | | | - Adrian Lewczuk
- Universidad Rey Juan Carlos de Madrid, Madrid, 28933, Spain
- Medical University of Warsaw, Warsaw, 61, Poland
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15
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Abstract
The glutamate and dopamine hypotheses are leading theories of the pathoaetiology of schizophrenia. Both were initially based on indirect evidence from pharmacological studies supported by post-mortem findings, but have since been substantially advanced by new lines of evidence from in vivo imaging studies. This review provides an update on the latest findings on dopamine and glutamate abnormalities in schizophrenia, focusing on in vivo neuroimaging studies in patients and clinical high-risk groups, and considers their implications for understanding the biology and treatment of schizophrenia. These findings have refined both the dopamine and glutamate hypotheses, enabling greater anatomical and functional specificity, and have been complemented by preclinical evidence showing how the risk factors for schizophrenia impact on the dopamine and glutamate systems. The implications of this new evidence for understanding the development and treatment of schizophrenia are considered, and the gaps in current knowledge highlighted. Finally, the evidence for an integrated model of the interactions between the glutamate and dopamine systems is reviewed, and future directions discussed.
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Affiliation(s)
- Oliver Howes
- Psychiatric Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK Institute of Psychiatry, King's College London, London, UK
| | - Rob McCutcheon
- Psychiatric Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK Institute of Psychiatry, King's College London, London, UK
| | - James Stone
- Psychiatric Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK Institute of Psychiatry, King's College London, London, UK
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Anh NQ, Linh BN, Ha NT, Phanthunane P, Huong NT. Schizophrenia interventions in Vietnam: primary results from a cost-effectiveness study. Glob Public Health 2014; 10 Supppl 1:S21-39. [PMID: 25482499 DOI: 10.1080/17441692.2014.986158] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Schizophrenia is a highly disabling mental health disorder that imposes a considerable economic burden on a health care system. This paper aimed to examine the cost and effectiveness of alternative pharmaceutical interventions and the effects of family intervention (FI) for schizophrenia from the government perspective in order to introduce the most cost-effective intervention applicable to Vietnam. A Markov model was developed to estimate costs and health outcome over patients' lifetimes when using typical and atypical antipsychotic drugs, alone or in combination with family intervention. Health outcome was measured in terms of disability-adjusted life years averted. Monte Carlo simulation was used for uncertainty analysis. According to our findings, interventions using typical or atypical drugs combined with FI were found to be the most effective and least costly compared to a 'do-nothing' scenario. Interventions using atypical drugs alone were estimated to be much less favourable due to a considerably higher cost. This is a very first attempt on cost-effectiveness analysis of interventions for schizophrenia in Vietnam, and recommendations are made for future research to determine the most cost-effective intervention.
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Affiliation(s)
- Nguyen Quynh Anh
- a Department of Health Economics , Hanoi School of Public Health , Hanoi , Vietnam
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17
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Fiorillo A, Malik A, Luciano M, Del Vecchio V, Sampogna G, Del Gaudio L, Rojnic Kuzman M, Jovanovic N, Nawka A, Volpe U. Challenges for trainees in psychiatry and early career psychiatrists. Int Rev Psychiatry 2013; 25:431-7. [PMID: 24032498 DOI: 10.3109/09540261.2013.812960] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Psychiatry as a discipline will undergo major changes in the coming years. Although changes can be particularly stimulating and challenging from an intellectual, scientific and social viewpoint, the new generations of psychiatrists must be prepared to face these changes and deal with them appropriately. Paradigms which have represented the foundations of psychiatry in the last century now need a major revision. In particular, both trainees in psychiatry and early career psychiatrists need to (1) (re)discover psychopathology, (2) improve mental healthcare through integrated treatments, (3) identify and treat new syndromes, (4) promote an image of psychiatry with patients at the heart of care and as advocates for each other by fighting stigma and promoting the recruitment in psychiatry by medical students. These can be achieved by increasing involvement in institutions and organizations to influence the agenda. In this paper the possible contribution of trainees and early career psychiatrists is discussed and recommendations are made in order to set a new agenda for early career psychiatrists who will still be practising 2-3 decades from now.
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Affiliation(s)
- Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN , Naples , Italy
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18
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Psychosocial Correlates of Length of Stay of Institutionalized Patients with Mental Illness. ACTA ACUST UNITED AC 2013. [DOI: 10.4306/jknpa.2013.52.2.98] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Carr VJ, Whiteford H, Groves A, McGorry P, Shepherd AM. Policy and service development implications of the second Australian National Survey of High Impact Psychosis (SHIP). Aust N Z J Psychiatry 2012; 46:708-18. [PMID: 22563037 DOI: 10.1177/0004867412446488] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We consider insights from the second Australian National Survey of High Impact Psychosis (2010) in order to identify the key policy and service development implications. METHOD The Survey of High Impact Psychosis (SHIP) provides an updated description of the experiences of people living with psychosis in Australia. We discuss the SHIP survey participants' greatest challenges for the future in light of the strength of existing literature, highlighting prospective opportunities for policy and service planning. RESULTS Targets for future policy development and service initiatives are informed by the survey participants' leading challenges: financial difficulties, social isolation, lack of employment, physical and mental ill health, accommodation, and access to services. CONCLUSIONS Many of the areas of need identified by survey participants are supported by quality research that may be more widely translated into effective services. For areas of need where the evidence is lacking, more clinical research is urgently needed. A targeted approach is vital to secure necessary investment in the wider dissemination of efficacious interventions and their systematic evaluation in ordinary clinical practice, enabled by both research investment and active integration of the research effort within ordinary clinical settings.
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Affiliation(s)
- Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, Australia.
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McGrath JJ. The early intervention debate provides a distraction from another 'unspeakable truth'. Aust N Z J Psychiatry 2012; 46:681-2. [PMID: 22735639 DOI: 10.1177/0004867412442023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- John J McGrath
- Queensland Brain Institute, University of Queensland, St. Lucia, Australia
- Queensland Centre for Mental Health Research, University of Queensland, Wacol, Australia
- Discipline of Psychiatry, University of Queensland, St. Lucia, Australia
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Cheng JF, Huang XY, Hsu YS, Su CH. Influencing factors of community mental health nurses caring for people with schizophrenia in Taiwan. J Psychiatr Ment Health Nurs 2012; 19:319-26. [PMID: 22070523 DOI: 10.1111/j.1365-2850.2011.01795.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to explore the influencing factors in the substantive theory of home care for people with schizophrenia in Taiwan. The grounded theory of Strauss and Corbin approach was used. Semi-structured one-to-one in-depth interviews were utilized to collect data. Constant comparative analysis continued during the open, axial and selective coding processes until data saturation occurred. Participants were selected using theoretical sampling, and the final sample in this study consisted of a total of 29 community nurses (18 public health nurses and 11 home health nurses) who provided community mental health home-visiting services. The public health nurses and home health nurses both conducted a total of 16 (eight carers and eight clients) home visits. Four categories and 12 subcategories of influencing factors were identified; these factors have both positive and negative effects on nursing roles and the functions of public health nurses in the mental health home-visiting service in Taiwan. The influencing factors identified support the importance of home care services.
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Affiliation(s)
- J-F Cheng
- School of Nursing, Department of Nursing, China Medical University Hospital, Taichung, Taiwan
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22
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Waghorn G, Chant D. Receiving treatment, labor force activity, and work performance among people with psychiatric disorders: results from a population survey. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:547-558. [PMID: 22086163 DOI: 10.1007/s10926-011-9303-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Standard treatments for psychiatric disorders such as schizophrenia, depression and anxiety disorders are generally expected to benefit individuals, employers, and the wider community through improvements in work-functioning and productivity. METHODS We repeated a previous secondary investigation of receiving treatment, labor force activity and self-reported work performance among people with ICD-10 psychiatric disorders, in comparison to people with other types of health conditions. Data were collected by the Australian Bureau of Statistics in 2003 repeating a survey administered in 1998 using representative multistage sampling strategies. The 2003 household probability sample consisted of 36,241 working age individuals. RESULTS Consistent with the previous secondary investigation based on the 1998 survey administration, receiving treatment was consistently associated with non-participation in the labor force, and was negatively associated with work performance. CONCLUSIONS At a population level, receiving treatment was negatively associated with labor force activity and work performance. The stability of these results in two independent surveys highlights the need to investigate the longitudinal relationships between evidence-based treatments for psychiatric conditions as applied in real-world settings, and labor force participation and work performance outcomes.
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Affiliation(s)
- Geoffrey Waghorn
- Queensland Health, The Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Richlands, via Brisbane, QLD 4077, Australia.
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23
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Patel A, Knapp M, Romeo R, Reeder C, Matthiasson P, Everitt B, Wykes T. Cognitive remediation therapy in schizophrenia: cost-effectiveness analysis. Schizophr Res 2010; 120:217-24. [PMID: 20056391 DOI: 10.1016/j.schres.2009.12.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 10/26/2009] [Accepted: 12/03/2009] [Indexed: 12/26/2022]
Abstract
PURPOSE There is a lack of evidence on the cost-effectiveness of cognitive remediation therapy (CRT). METHODS Randomised controlled trial comparing usual care plus CRT with usual care alone. Participants had a diagnosis of schizophrenia and cognitive and social functioning difficulties. Health/social care and societal costs were estimated at 14 weeks (time 2) and 40 weeks (time 3) after randomisation. The outcome, proportion of participants improving their working memory since baseline, was combined with costs to explore cost-effectiveness. RESULTS 85 participants were recruited. There were no differences in total health/social care or societal costs between the two groups at either time 2 or time 3. An additional 21% of participants in the CRT group improved their working memory at both follow-ups. When placing these cost and outcomes in hypothetical scenarios concerning how much policy-makers would pay for another 1% of participants improving their working memory, there was more than an 80% chance that CRT would be cost-effective compared to usual care; at time 3, the likelihood of cost-effectiveness peaked at 30% even for investments up to pound 5000. CONCLUSIONS CRT can improve memory among people with schizophrenia and cognitive deficits at no additional cost. Although cost-effective in the short term, CRT may have limited potential to save costs in the medium term because it could increase take up of services. This could confer important longer term benefits for the patient group examined here, in terms of improved social functioning and less reliance on services. This can only be ascertained through longer follow-up.
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Affiliation(s)
- Anita Patel
- Centre for the Economics of Mental Health, Health Service and Population Research Department, Box 24, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom.
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Breitborde NJK, Woods SW, Srihari VH. Multifamily psychoeducation for first-episode psychosis: a cost-effectiveness analysis. Psychiatr Serv 2009; 60:1477-83. [PMID: 19880465 PMCID: PMC5594750 DOI: 10.1176/ps.2009.60.11.1477] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Family psychoeducation is considered part of optimal treatment for first-episode psychosis, but concerns about the cost of this intervention have limited its availability. Although evidence suggests that family psychoeducation is cost-effective, many cost-effectiveness analyses have suffered from limitations that reduce their utility in guiding decisions to incorporate this intervention within existing clinical services. These include not presenting results in present-day dollars and not examining whether the intervention would remain cost-effective in situations where the clinical benefits achieved were smaller than those reported in past studies. Thus the goal of this study was to investigate the cost of providing a specific psychoeducation program-multifamily group psychoeducation-to individuals with first-episode psychosis and their families. METHODS Statistical simulation was used to estimate the cost and burden of illness associated with usual treatment versus usual treatment plus multifamily group psychoeducation. In addition, the simulation model was rerun to test whether multifamily psychoeducation would remain cost-effective in situations where the clinical benefits achieved were smaller than those reported in past studies. RESULTS When provided for two years, multifamily group psychoeducation ranged from a cost-effective to a cost-saving intervention, depending on the clinical benefits achieved by staff delivering the intervention. When provided for longer durations (five, ten, or 20 years), multifamily psychoeducation was a cost-saving intervention even in scenarios where the clinical benefits of the intervention were reduced by 90%. CONCLUSIONS The results suggest that multifamily group psychoeducation may not only be a cost-effective intervention for first-episode psychosis but may often be a cost-saving intervention.
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Degenhardt L, Hall WD, Lynskey M, McGrath J, McLaren J, Calabria B, Whiteford H, Vos T. Should burden of disease estimates include cannabis use as a risk factor for psychosis? PLoS Med 2009; 6:e1000133. [PMID: 19787023 PMCID: PMC2741573 DOI: 10.1371/journal.pmed.1000133] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Louise Degenhardt and colleagues discuss the evidence and the debate about whether Global Burden of Disease estimates should include cannabis use as a risk factor for psychosis.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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Fitzgerald P, de Castella A, Arya D, Simons WR, Eggleston A, Meere S, Kulkarni J. The cost of relapse in schizophrenia and schizoaffective disorder. Australas Psychiatry 2009; 17:265-72. [PMID: 19585288 DOI: 10.1080/10398560903002998] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to quantify the costs and resource utilization associated with a relapse of schizophrenia or schizoaffective disorder. METHODS The study comprised a retrospective audit of data from 200 patients diagnosed with schizophrenia or schizoaffective disorder who were admitted to hospital for a relapse of their disorder in two mental health services in Australia between 1 June 2001 and 31 May 2002. Resource use and costing data were collected for 12 months before and 12 months after the hospitalization. RESULTS There was an increase in contacts per month and associated outpatient costs after the index admission which persisted for the full 12 month data collection period (total of AUD $637). There was also a total increase in hospital costs but this did not persist beyond the first 2 months of the follow-up period and is likely explained by the index admission. CONCLUSIONS Increased healthcare resource utilization and costs results from relapse in patients with schizophrenia or schizoaffective disorder. An increase in service use and costs persist for a considerable time period after an episode of relapse.
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Affiliation(s)
- Paul Fitzgerald
- The Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Prahran, VIC, Australia
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27
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Mojtabai R, Fochtmann L, Chang SW, Kotov R, Craig TJ, Bromet E. Unmet need for mental health care in schizophrenia: an overview of literature and new data from a first-admission study. Schizophr Bull 2009; 35:679-95. [PMID: 19505994 PMCID: PMC2696378 DOI: 10.1093/schbul/sbp045] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We present an overview of the literature on the patterns of mental health service use and the unmet need for care in individuals with schizophrenia with a focus on studies in the United States. We also present new data on the longitudinal course of treatments from a study of first-admission patients with schizophrenia. In epidemiological surveys, approximately 40% of the respondents with schizophrenia report that they have not received any mental health treatments in the preceding 6-12 months. Clinical epidemiological studies also find that many patients virtually drop out of treatment after their index contact with services and receive little mental health care in subsequent years. Clinical studies of patients in routine treatment settings indicate that the treatment patterns of these patients often fall short of the benchmarks set by evidence-based practice guidelines, while at least half of these patients continue to experience significant symptoms. The divergence from the guidelines is more pronounced with regard to psychosocial than medication treatments and in outpatient than in inpatient settings. The expansion of managed care has led to further reduction in the use of psychosocial treatments and, in some settings, continuity of care. In conclusion, we found a substantial level of unmet need for care among individuals with schizophrenia both at community level and in treatment settings. More than half of the individuals with this often chronic and disabling condition receive either no treatment or suboptimal treatment. Recovery in this patient population cannot be fully achieved without enhancing access to services and improving the quality of available services. The recent expansion of managed care has made this goal more difficult to achieve.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Laura Fochtmann
- Department of Psychiatry and Behavioral Sciences, State University of New York, Stony Brook, NY
| | - Su-Wei Chang
- Department of Psychiatry and Behavioral Sciences, State University of New York, Stony Brook, NY
| | - Roman Kotov
- Department of Psychiatry and Behavioral Sciences, State University of New York, Stony Brook, NY
| | | | - Evelyn Bromet
- Department of Psychiatry and Behavioral Sciences, State University of New York, Stony Brook, NY
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McGorry PD, Yung AR, Pantelis C, Hickie IB. A clinical trials agenda for testing interventions in earlier stages of psychotic disorders. Med J Aust 2009; 190:S33-6. [PMID: 19220171 DOI: 10.5694/j.1326-5377.2009.tb02372.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Accepted: 09/28/2008] [Indexed: 02/06/2023]
Abstract
A fundamental shift in the design of clinical trials for psychotic disorders is desirable and feasible. Priority should be placed on evaluation of the efficacy of interventions targeting different phases of illness. A range of traditional therapeutic approaches needs to be augmented by an increased emphasis on the potential benefits of informational, e-health, behavioural and neuroprotective strategies. A new national clinical trials platform, based on headspace, the National Youth Mental Health Foundation, is outlined. It provides the opportunity for conducting large multisite clinical trials in young people with emerging major mental disorders.
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Abstract
Schizophrenia epidemiology can provide us with valuable information to guide research directions. However, while epidemiology is useful for generating candidate risk factors, it can not always deliver studies that prove causality. We argue that the field needs more translational research that links schizophrenia epidemiology with molecular, cellular, and behavioral neuroscience. Cross-disciplinary projects related to candidate genetic or nongenetic risk factors not only can address the biological plausibility of these factors, but they can serve as catalysts for discovery in neuroscience. This type of cross disciplinary research is likely to be more efficient compared to clinically dislocated basic neuroscience. Examples of this type of translational research are provided based on (a) the impact of prenatal nutrition and prenatal infection on brain development and (b) understanding the causes and consequences of agenesis of the corpus callosum. We need to build shared discovery platforms that encourage greater cross-fertilization between schizophrenia epidemiology and basic neuroscience research.
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Affiliation(s)
- John J. McGrath
- Queensland Brain Institute, University of Queensland, St Lucia 4076, Australia,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland 4076, Australia,Department of Psychiatry, University of Queensland,To whom correspondence should be addressed; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland 4076, Australia; tel: +61-7-3271-8694, fax: +61-7-3271-8698, e-mail:
| | - Linda J. Richards
- Queensland Brain Institute, University of Queensland, St Lucia 4076, Australia,School of Biomedical Sciences, University of Queensland, St Lucia 4076, Australia
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Chisholm D, Gureje O, Saldivia S, Villalón Calderón M, Wickremasinghe R, Mendis N, Ayuso-Mateos JL, Saxena S. Schizophrenia treatment in the developing world: an interregional and multinational cost-effectiveness analysis. Bull World Health Organ 2008; 86:542-51. [PMID: 18670667 PMCID: PMC2647485 DOI: 10.2471/blt.07.045377] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 10/05/2007] [Accepted: 10/05/2007] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Schizophrenia is a highly disabling disease and is costly to treat. We set out to establish what are the most cost-effective interventions applicable to developing regions and countries. METHODS Analysis was undertaken at the level of three WHO subregions spanning the Americas, Africa and South-East Asia, and subsequently in three member states (Chile, Nigeria and Sri Lanka). A state transition model was used to estimate the population-level health impact of older and newer antipsychotic drugs, alone or in combination with psychosocial intervention. Total population-level costs (in international dollars or local currencies) and effectiveness (measured in disability-adjusted life years averted) were combined to form cost-effectiveness ratios. FINDINGS The most cost-effective interventions were those using older antipsychotic drugs combined with psychosocial treatment, delivered via a community-based service model (I$ 2350-7158 per disability-adjusted life year averted across the three subregions, I$ 1670-3400 following country-level contextualisation within each of these subregions). The relative cost-effectiveness of interventions making use of newer, "atypical" antipsychotic drugs is estimated to be much less favourable. CONCLUSION By moving to a community-based service model and selecting efficient treatment options, the cost of substantially increasing treatment coverage is not high (less than I$ 1 investment per capita). Taken together with other priority-setting criteria such as disease severity, vulnerability and human rights protection, this study suggests that a great deal more could be done for persons and families living under the spectre of this disorder.
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Affiliation(s)
- Dan Chisholm
- Department of Health Systems Financing, World Health Organization, Geneva, Switzerland.
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BECKER THOMAS, KILIAN REINHOLD. Experience base and system context in mental health care reform. World Psychiatry 2008; 7:96-7. [PMID: 18560481 PMCID: PMC2408395 DOI: 10.1002/j.2051-5545.2008.tb00165.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- THOMAS BECKER
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ludwig Heilmeyer Strasse 2, D-89312 Günzburg, Germany
| | - REINHOLD KILIAN
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ludwig Heilmeyer Strasse 2, D-89312 Günzburg, Germany
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Thomas P. Psychosocial and economic issues related to physical health in psychiatric illness. Eur Neuropsychopharmacol 2008; 18 Suppl 2:S115-20. [PMID: 18346599 DOI: 10.1016/j.euroneuro.2008.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As well as the obvious medical consequences associated with physical health problems in individuals with schizophrenia, physical health problems lead to a number of psychosocial consequences--further contributing to the existing burden of schizophrenia itself. Weight gain can seriously impair quality of life through decreased functioning, social stigmatization, discrimination and potential financial consequences. However, patients with schizophrenia may be less capable of managing their weight via exercise and dietary interventions compared with the general population, and may, therefore, be more prone to non-compliance with a medication that induces weight gain. This may lead to exacerbation of the mental illness. Patients' perceptions and experience of antipsychotic treatments are also important as these can further impact on overall patient wellbeing. It is hoped that by increasing awareness of the psychosocial consequences of physical health impairment, we can move towards reducing the burden that patients face.
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Affiliation(s)
- Pierre Thomas
- Service de Psychiatrie, Hopital M. Fontan CHRU de Lille, 6, rue Veraeghe, 59037 Lille, France.
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Lee IH, Chen PS, Yang YK, Liao YC, Lee YD, Yeh TL, Yeh LL, Cheng SH, Chu CL. The functionality and economic costs of outpatients with schizophrenia in Taiwan. Psychiatry Res 2008; 158:306-15. [PMID: 18243334 DOI: 10.1016/j.psychres.2006.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 07/12/2006] [Accepted: 10/02/2006] [Indexed: 11/27/2022]
Abstract
The aims of this study were to investigate the economic costs of outpatients with schizophrenia in Taiwan, and to survey factors that influence the costs. The direct costs were defined as the costs associated with psychiatric services and other medical treatment. The indirect costs were estimated using the Human Capital Method. Patients' characteristics, including sex, age, duration of education, duration of illness, frequency of hospitalization, type of antipsychotic medication, severity of extrapyramidal side effects caused by antipsychotic medication, and global functions, were used to estimate the costs. The average annual total cost was approximately US$16,576 per patient. The direct and indirect costs were 13% and 87% of the total costs, respectively. Among the direct costs, folk therapy ranked third, just behind prescription drugs and acute ward hospitalization. The productivity loss of both the patients and their caregivers was the major component of the indirect costs. The patient's age and global functions had a significantly negative relationship with the direct costs. The severity of extrapyramidal side effects, type of antipsychotic medication, and the patient's illness duration correlated positively with the indirect costs, while the patient's global function correlated negatively with the indirect costs. Overall, the indirect costs of treating schizophrenia were higher than the direct costs. Improving patients' functionality and decreasing caregivers' burden are essential to reducing costs.
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Affiliation(s)
- I Hui Lee
- Department of Psychiatry, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan 70428, Taiwan
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Kulkarni J, de Castella AR, Filia KM, Filia SL, Marston N, Montgomery W, Christova L, Fitzgerald PB. Australian Schizophrenia Care and Assessment Programme: real-world schizophrenia: outcomes. Aust N Z J Psychiatry 2007; 41:969-79. [PMID: 17999269 DOI: 10.1080/00048670701689410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE It has been increasingly recognized that there is need to assess patient outcomes in schizophrenia across a broad range of dimensions. But few studies have attempted to do this in clinical populations and no systematic study has broadly assessed outcomes in schizophrenia in Australia using a longitudinal design. Thus, a real-world study, the Schizophrenia Care and Assessment Programme (SCAP), was structured to collect comprehensive information over time to inform policy debate and extend current knowledge about the course of schizophrenia in an Australian context. METHODS A cohort of 347 patients with schizophrenia was followed up over 3 years. Clinical outcomes, occupational and psychosocial functioning and quality of life were assessed at 6 monthly intervals, and resource utilization and costing data were collected continuously from internal and external databases as well as from participants directly. RESULTS The participants as a group experienced an overall decline in positive and negative symptoms of schizophrenia, a reduction in general psychopathology and a reduction in severity of depression. There was an improvement in functioning, a reduction in mental health-related disability and an improvement in patient- and observer-rated quality of life. Change of severity within the variously assessed domains over time appeared to be relatively independent. CONCLUSIONS In the present sample of schizophrenia patients treatment was associated with positive health outcomes; but outcomes across assessment domains did not closely correlate across time. The scrutiny of a broad range of patient outcomes will assist with the assessment of new treatment modalities and with service planning.
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Affiliation(s)
- Jayashri Kulkarni
- Alfred Psychiatry Research Centre, Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Alfred Hospital, Melbourne, Vic, Australia.
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35
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Wheeler A. Sociodemographic, functional and clinical correlates in outpatients with schizophrenia: comparison with affective disorders. Aust N Z J Psychiatry 2007; 41:809-18. [PMID: 17828654 DOI: 10.1080/00048670701579066] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To describe the demographic, social and functional characteristics and service utilization of people with schizophrenia attending four public psychiatric services in New Zealand and to compare this with (i) people with severe affective disorders attending the same four services and (ii) the New Zealand general population; and to examine conformity with evidence-based pharmacological treatment of schizophrenia. METHODS Clinical files for all adult outpatients attending the four specialist services were reviewed in October 2004 (n =6164). Patient characteristics, social and functional indicators, diagnosis, duration of illness, and admission information were recorded and analysed for schizophrenia, bipolar disorder and depression (n =5032). Antipsychotic treatment was recorded for those with schizophrenia. RESULTS Outpatients with schizophrenia made up 47% of the outpatient population; 66% were male, the mean age 39 years and the mean illness duration was 14 years. Sixty-seven percent of schizophrenia outpatients had never been married, 69% had no regular occupational activity, 49% had no formal qualifications, 24% were living in group homes and 26% were treated compulsorily. These characteristics were consistently different compared to outpatients with severe affective disorders and the general population; schizophrenia patients were the most impaired, depression the least and the bipolar group in between. The majority of schizophrenia patients received evidence-based antipsychotic treatment; 84% received monotherapy; 81% prescribed an atypical; 33% prescribed clozapine. CONCLUSIONS The study shows significant impairment for schizophrenia patients in areas of intimate relationships, occupational activity, living situation, qualifications and specialist mental health service use despite evidence-based pharmacological treatment. To improve outcome optimal care must incorporate existing evidence-based, cost-effective interventions that focus on both symptoms and function. More effective treatments also need to be developed.
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Affiliation(s)
- Amanda Wheeler
- Clinical Research and Resource Centre, Snelgar Building, Waitakere Hospital, Auckland, Waitakere, New Zealand.
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McGrath JJ, Saha S. Thought experiments on the incidence and prevalence of schizophrenia "under the influence" of cannabis. Addiction 2007; 102:514-5; discussion 516-8. [PMID: 17362286 DOI: 10.1111/j.1360-0443.2007.01755.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- John J McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD 4076, Australia.
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Gutierrez-Recacha P, Chisholm D, Haro JM, Salvador-Carulla L, Ayuso-Mateos JL. Cost-effectiveness of different clinical interventions for reducing the burden of schizophrenia in Spain. Acta Psychiatr Scand 2006:29-38. [PMID: 17087813 DOI: 10.1111/j.1600-0447.2006.00917.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of interventions for reducing the burden of schizophrenia in Spain. METHOD The study examined the cost-effectiveness of seven different types of clinical interventions at the level of Spanish population: i) current situation; ii) older antipsychotics alone; iii) new antipsychotics alone (risperidone); iv) older antipsychotics plus psychosocial treatment; v) new antipsychotics plus psychosocial treatment; vi) older antipsychotics plus case management and psychosocial treatment; vii) new antipsychotics plus case management and psychosocial treatment. RESULTS Interventions based on the combination of haloperidol with psychosocial treatment or psychosocial treatment plus case management proved to be the most efficient strategies. CONCLUSION The relatively modest additional cost of concurrent psychosocial treatment has significant health gains, thereby making such a combined strategy for schizophrenia more cost-effective than pharmacology alone.
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Affiliation(s)
- P Gutierrez-Recacha
- Department of Psychiatry, Hospital Universitario de la Princesa, Autónoma University, Madrid, Spain
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Abstract
OBJECTIVE Recent generalized cost-effectiveness analyses contrasting schizophrenia with high prevalence mental disorders have noted a need to investigate the mechanisms by which the tensions between equity and efficiency can be reconciled and inform priority setting in resource allocation. This paper explores and illustrates some possible strategies for valuing mental health states, with the broad goal of improving resource allocation decisions. METHOD Health utility gains derived for current and optimal treatments for schizophrenia, depression and anxiety disorders, potential societal preference weightings, and annual costs per treated case, are used to illustrate the magnitude of the impacts on relative cost-efficiency and societal welfare estimates. These estimates are based on costs per additional quality adjusted life year (QALY) and costs per additional S-QALY (i.e. QALYs adjusted for societal value of health gains) respectively. RESULTS When broader societal preferences are ignored, current and optimal treatments for depression and anxiety are around 10 times more efficient than those for schizophrenia, but treatments for all three disorders appear to give rise to similar levels of societal welfare when weighting factors reflecting equity concerns are incorporated. CONCLUSIONS There is manifest inequality in health between individuals with schizophrenia and those with high prevalence mental disorders, even with optimal treatment. Schizophrenia is much more costly to treat but other factors require consideration. Inclusion of societal preferences should lead to more rational decision-making and improved societal welfare. In turn, greater effort needs to be given to the development and validation of appropriate weighting factors reflecting distributive preferences in mental health.
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Affiliation(s)
- Vaughan J Carr
- Centre for Mental Health Studies, University of Newcastle and Hunter New England Mental Health, Callaghan, New South Wales, Australia.
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Abstract
OBJECTIVE To report on economic studies of Australian mental health issues. CONCLUSION Although the international literature on the economics of mental health issues is increasing, and although many Australian studies exist on one comorbid condition of mental illness, namely substance abuse, there are very few empirical studies by economists of Australia's mental health issues.
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Affiliation(s)
- Ruth Williams
- School of Applied Economics and Centre for Strategic Economic Studies, Victoria University, Melbourne, Australia.
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Heller RF, Gemmell I, Patterson L. Helping to prioritise interventions for depression and schizophrenia: use of Population Impact Measures. Clin Pract Epidemiol Ment Health 2006; 2:3. [PMID: 16553956 PMCID: PMC1475571 DOI: 10.1186/1745-0179-2-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Accepted: 03/22/2006] [Indexed: 11/12/2022]
Abstract
BACKGROUND To demonstrate the potential of Population Impact Measures in helping to prioritise alternative interventions for psychiatry, this paper estimates the number of relapses and hospital readmissions prevented for depression and schizophrenia by adopting best practice recommendations. The results are designed to relate to particular local populations. METHODS Literature-based estimates of disease prevalence, relapse and re-admission rates, current and best practice treatment rates, levels of adherence with interventions and relative risk reduction associated with different interventions were obtained and calculations made of the Number of Events Prevented in your Population (NEPP). RESULTS In a notional population of 100,000 adults, going from current to 'best' practice for different interventions, the number of relapses prevented in the next year for schizophrenia were 6 (increasing adherence to medication), 23 (family intervention), 43 (relapse prevention), and 44 (early intervention); and for depression the number of relapses prevented in the next year were 100 (increasing care management), 227 (continuing treatment with antidepressants), 279 (increasing rate of diagnosis), and 325 (Cognitive Behaviour Therapy). Hospital re-admissions prevented in the next year for schizophrenia were 6 (increasing adherence to medication), 36 (relapse prevention) and 40 (early intervention). CONCLUSION Population Impact measures provide the possibility for a policy-maker to see the impact of a new intervention on the population as a whole, and to compare alternative interventions to best improve psychiatric disease outcomes. The methods are much simpler than others, and have the advantage of being transparent.
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Affiliation(s)
- Richard F Heller
- Evidence for Population Health Unit, Division of Epidemiology and Health Sciences, University of Manchester, Manchester M13 9PT, UK
| | - Islay Gemmell
- Evidence for Population Health Unit, Division of Epidemiology and Health Sciences, University of Manchester, Manchester M13 9PT, UK
| | - Lesley Patterson
- Evidence for Population Health Unit, Division of Epidemiology and Health Sciences, University of Manchester, Manchester M13 9PT, UK
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Perini SJ, Slade T, Andrews G. Generic effectiveness measures: sensitivity to symptom change in anxiety disorders. J Affect Disord 2006; 90:123-30. [PMID: 16337690 DOI: 10.1016/j.jad.2005.10.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 10/18/2005] [Accepted: 10/19/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to compare a newly developed screening measure of disability, the WHODAS II, to three established generic effectiveness measures in terms of its sensitivity to symptom change in people with anxiety disorders. METHOD Patients who had undergone treatment for social phobia or panic disorder/agoraphobia at an anxiety disorders clinic were administered generic effectiveness measures and symptom measures before and after treatment. The design was naturalistic and observational. Data analysis included correlations between generic effectiveness and symptom measures; and effect size calculations regarding the ability of each generic effectiveness measure to discriminate between patients whose symptoms improved and patients whose symptoms did not improve over the course of treatment. RESULTS The WHODAS II was consistently the most sensitive generic effectiveness measure in its capacity to detect symptom changes in patients with social phobia. The SF-12 and K-10 also showed moderate sensitivity to symptom change. In the sample of patients with panic disorder/agoraphobia, the SF-12 was the most sensitive measure overall, closely followed by the K-10 and WHODAS II. The NCS Disability Days were the least sensitive to symptom change in both samples. CONCLUSION The WHODAS II is at least as sensitive as other generic effectiveness measures to anxiety symptom changes, and is particularly sensitive to changes in social anxiety symptoms. It may prove to be a valuable measurement tool for informing public health policy in relation to anxiety disorders.
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Affiliation(s)
- Sarah J Perini
- Clinical Research Unit for Anxiety and Depression, University of New South Wales at St Vincent's Hospital, Sydney, Australia.
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Abstract
Many challenging ethical questions come with the scientific efforts to understand the nature and treatment of schizophrenia. The empirical study of ethical aspects of schizophrenia research has sought to clarify and resolve many of these questions. In this article we provide an overview of the existing data-based literature on schizophrenia research ethics and outline directions for future inquiry. We examine 5 broad categories of inquiry into the ethics of schizophrenia research: (1) Scientific designs (eg, placebo-controlled studies and medication-free intervals, prodromal and high-risk research, and genetics research); (2) informed consent and decision-making capacity, including assessment of decisional abilities, as well as intervention studies; (3) understanding and perceptions of risk and benefit (including the therapeutic misconception); (4) influences on research participation (including voluntarism, altruism, and other motivations); and (5) key participant safeguards, such as protocol review and participant advocates. We discuss how empirical work in each of these areas answers certain questions and raises new ones. Finally, we highlight important gaps in our understanding of ethically relevant aspects of schizophrenia research and offer a specific research agenda for empirical ethics.
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Affiliation(s)
- Laura B Dunn
- Department of Psychiatry, University of California, San Diego, USA.
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Vos T, Haby MM, Magnus A, Mihalopoulos C, Andrews G, Carter R. Assessing cost-effectiveness in mental health: helping policy-makers prioritize and plan health services. Aust N Z J Psychiatry 2005; 39:701-12. [PMID: 16050924 DOI: 10.1080/j.1440-1614.2005.01654.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We assessed, from a health sector perspective, options for change that could improve the efficiency of Australia's current mental health services by directing available resources toward 'best practice' cost-effective services. METHOD We summarize cost-effectiveness results of a range of interventions for depression, schizophrenia, attention deficit hyperactivity disorder and anxiety disorders that have been presented in previous papers in this journal. Recommendations for change are formulated after taking into account 'second-filter criteria' of equity, feasibility of implementing change, acceptability to stakeholders and the strength of the evidence. In addition, we estimate the impact on total expenditure if the recommended mental health interventions for depression and schizophrenia are to be implemented in Australia. RESULTS There are cost-effective treatment options for mental disorders that are currently underutilized (e.g. cognitive-behavioural therapy (CBT) for depression and anxiety, bibliotherapy for depression, family interventions for schizophrenia and clozapine for the worst course of schizophrenia). There are also less cost-effective treatments in current practice (e.g. widespread use of olanzapine and risperidone in the treatment of established schizophrenia and, within those atypicals, a preference for olanzapine over risperidone). Feasibility of funding mechanisms and training of staff are the main second-filter issues for CBT and family interventions. Acceptability to various stakeholders is the main barrier to implementation of more cost-effective drug treatment regimens. More efficient drug intervention options identified for schizophrenia would cost 68 million Australian dollars less than current practice. These savings would more than cover the estimated 36M Australian dollars annual cost of delivering family interventions to the 51% of people with schizophrenia whom we estimated to be eligible and this would lead to an estimated 12% improvement in their health status. Implementing recommended strategies for depression would cost 121M Australian dollars annually for the 24% of people with depression who seek care currently, but do not receive an evidence-based treatment. CONCLUSIONS Despite considerable methodological problems, a range of cost-effective and less cost-effective interventions for major mental disorders can be discerned. The biggest hurdle to implementation of more efficient mental health services is that this change would require reallocation of funds between interventions, between disorders and between service providers with different funding mechanisms.
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Affiliation(s)
- Theo Vos
- School of Population Health, University of Queensland, Herston Road, Herston, Queensland 4006, Australia.
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Abstract
Schizophrenia is a severe mental disorder characterised by fundamental disturbances in thinking, perception and emotions. More than 100 years of research have not been able to fully resolve the puzzle that schizophrenia represents. Even if schizophrenia is not a very frequent disease, it is among the most burdensome and costly illnesses worldwide. It usually starts in young adulthood. Life expectancy is reduced by approximately 10 years, mostly as a consequence of suicide. Even if the course of the illness today is considered more favourable than it was originally described, it is still only a minority of those affected, who fully recover. The cumulative lifetime risk for men and women is similar, although it is higher for men in the age group younger than 40 years. According to the Global Burden of Disease Study, schizophrenia causes a high degree of disability, which accounts for 1.1% of the total DALYs (disability-adjusted life years) and 2.8% of YLDs (years lived with disability). In the World Health Report [The WHO World Health Report: new understanding, new hope, 2001. Geneva], schizophrenia is listed as the 8th leading cause of DALYs worldwide in the age group 15-44 years. In addition to the direct burden, there is considerable burden on the relatives who care for the sufferers. The treatment goals for the moment are to identify the illness as early as possible, treat the symptoms, provide skills to patients and their families, maintain the improvement over a period of time, prevent relapses and reintegrate the ill persons into the community so that they can lead as normal a life as possible.
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Affiliation(s)
- Wulf Rössler
- Psychiatric University Hospital, Militärstrasse 8, CH-8021 Zurich, Switzerland.
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Abstract
BACKGROUND From the vantage point of fifty years after the introduction of antipsychotics to clinical practice, this article examines the social context and health consequences of their introduction. METHODS Historical review of literature sources with commentary. CONCLUSIONS The availability of antipsychotics over nearly half a century has powerfully influenced concepts of mental illness, dominant models of care versus control, health outcomes and side effect burdens. The large demand and economic success of antipsychotic medications is an important driver for research and development as well as sophistication in marketing. Regulatory agencies, funders and clinicians are faced with a moving target as indications for use of antipsychotics move well beyond the traditional core of schizophrenia and acute mania into depression, anxiety, behavioral disturbance with dementia and some forms of personality disturbance. The history of antipsychotics and mental illness is arguably being written as forcefully now, in an environment of rapid scientific change, as was the case in the 1960s era of rapid social change when chlorpromazine prompted a shift of emphasis from asylum to community. Psychosis is a challenge to how we interpret and approach our inner experiences and societal structures. Accordingly, it is not surprising that the history of antipsychotic drugs resonates with a lively interplay of social, health and economic issues and an ongoing quest to comprehend mental phenomena and their variants.
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Affiliation(s)
- Kenneth C Kirkby
- Psychiatry, University of Tasmania, Hobart, Tasmania, Australia.
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Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med 2005; 2:e141. [PMID: 15916472 PMCID: PMC1140952 DOI: 10.1371/journal.pmed.0020141] [Citation(s) in RCA: 1260] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 03/29/2005] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Understanding the prevalence of schizophrenia has important implications for both health service planning and risk factor epidemiology. The aims of this review are to systematically identify and collate studies describing the prevalence of schizophrenia, to summarize the findings of these studies, and to explore selected factors that may influence prevalence estimates. METHODS AND FINDINGS Studies with original data related to the prevalence of schizophrenia (published 1965-2002) were identified via searching electronic databases, reviewing citations, and writing to authors. These studies were divided into "core" studies, "migrant" studies, and studies based on "other special groups." Between- and within-study filters were applied in order to identify discrete prevalence estimates. Cumulative plots of prevalence estimates were made and the distributions described when the underlying estimates were sorted according to prevalence type (point, period, lifetime, and lifetime morbid risk). Based on combined prevalence estimates, the influence of selected key variables was examined (sex, urbanicity, migrant status, country economic index, and study quality). A total of 1,721 prevalence estimates from 188 studies were identified. These estimates were drawn from 46 countries, and were based on an estimated 154,140 potentially overlapping prevalent cases. We identified 132 core studies, 15 migrant studies, and 41 studies based on other special groups. The median values per 1,000 persons (10%-90% quantiles) for the distributions for point, period, lifetime, and lifetime morbid risk were 4.6 (1.9-10.0), 3.3 (1.3-8.2), 4.0 (1.6-12.1), and 7.2 (3.1-27.1), respectively. Based on combined prevalence estimates, we found no significant difference (a) between males and females, or (b) between urban, rural, and mixed sites. The prevalence of schizophrenia in migrants was higher compared to native-born individuals: the migrant-to-native-born ratio median (10%-90% quantile) was 1.8 (0.9-6.4). When sites were grouped by economic status, prevalence estimates from "least developed" countries were significantly lower than those from both "emerging" and "developed" sites (p = 0.04). Studies that scored higher on a quality score had significantly higher prevalence estimates (p = 0.02). CONCLUSIONS There is a wealth of data about the prevalence of schizophrenia. These gradients, and the variability found in prevalence estimate distributions, can provide direction for future hypothesis-driven research.
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Affiliation(s)
- Sukanta Saha
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
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Abstract
OBJECTIVE Science needs to constantly match research models against the data. With respect to the epidemiology of schizophrenia, the widely held belief that the incidence of schizophrenia shows little variation may no longer be supported by the data. The aims of this paper are (i) to explore data-vs.-belief mismatch with respect to the incidence of schizophrenia, and (ii) to speculate on the causes and consequences of such discrepancies. METHOD Based on a recently published systematic review of the incidence of schizophrenia, the distribution of incidence rates around the world was examined. In order to examine if the incidence of schizophrenia differed by sex, male vs. female risk ratios were generated. RESULTS The distribution of incidence rates for schizophrenia is asymmetrical with many high rates skewing the distribution. Based on the central 80% of rates, the incidence of schizophrenia varies in a five-fold range (between 7.7 and 43.0 per 100,000). Males have a significantly higher incidence of schizophrenia compared with females (median male to female risk ratio = 1.4), and this difference could not be accounted for by diagnostic criteria or age range. CONCLUSION The beliefs that (i) the incidence of schizophrenia does not vary between sites and (ii) males and females are equally affected, may have persisted because of an unspoken deeper belief that schizophrenia is an egalitarian and exceptional disorder. Our ability to generate productive hypotheses about the aetiology of schizophrenia rests on an accurate appraisal of the data. Beliefs not supported by data should be identified and relabelled as myths.
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Affiliation(s)
- J J McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD 4076, Australia.
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Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Aust N Z J Psychiatry 2005; 39:1-30. [PMID: 15660702 DOI: 10.1080/j.1440-1614.2005.01516.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority. This paper presents CPGs for schizophrenia and related disorders. Over the past decade schizophrenia has become more treatable than ever before. A new generation of drug therapies, a renaissance of psychological and psychosocial interventions and a first generation of reform within the specialist mental health system have combined to create an evidence-based climate of realistic optimism. Progressive neuroscientific advances hold out the strong possibility of more definitive biological treatments in the near future. However, this improved potential for better outcomes and quality of life for people with schizophrenia has not been translated into reality in Australia. The efficacy-effectiveness gap is wider for schizophrenia than any other serious medical disorder. Therapeutic nihilism, under-resourcing of services and a stalling of the service reform process, poor morale within specialist mental health services, a lack of broad-based recovery and life support programs, and a climate of tenacious stigma and consequent lack of concern for people with schizophrenia are the contributory causes for this failure to effectively treat. These guidelines therefore tackle only one element in the endeavour to reduce the impact of schizophrenia. They distil the current evidence-base and make recommendations based on the best available knowledge. METHOD A comprehensive literature review (1990-2003) was conducted, including all Cochrane schizophrenia reviews and all relevant meta-analyses, and a number of recent international clinical practice guidelines were consulted. A series of drafts were refined by the expert committee and enhanced through a bi-national consultation process. TREATMENT RECOMMENDATIONS This guideline provides evidence-based recommendations for the management of schizophrenia by treatment type and by phase of illness. The essential features of the guidelines are: (i) Early detection and comprehensive treatment of first episode cases is a priority since the psychosocial and possibly the biological impact of illness can be minimized and outcome improved. An optimistic attitude on the part of health professionals is an essential ingredient from the outset and across all phases of illness. (ii) Comprehensive and sustained intervention should be assured during the initial 3-5 years following diagnosis since course of illness is strongly influenced by what occurs in this 'critical period'. Patients should not have to 'prove chronicity' before they gain consistent access and tenure to specialist mental health services. (iii) Antipsychotic medication is the cornerstone of treatment. These medicines have improved in quality and tolerability, yet should be used cautiously and in a more targeted manner than in the past. The treatment of choice for most patients is now the novel antipsychotic medications because of their superior tolerability and, in particular, the reduced risk of tardive dyskinesia. This is particularly so for the first episode patient where, due to superior tolerability, novel agents are the first, second and third line choice. These novel agents are nevertheless associated with potentially serious medium to long-term side-effects of their own for which patients must be carefully monitored. Conventional antipsychotic medications in low dosage may still have a role in a small proportion of patients, where there has been full remission and good tolerability; however, the indications are shrinking progressively. These principles are now accepted in most developed countries. (vi) Clozapine should be used early in the course, as soon as treatment resistance to at least two antipsychotics has been demonstrated. This usually means incomplete remission of positive symptomatology, but clozapine may also be considered where there are pervasive negative symptoms or significant or persistent suicidal risk is present. (v) Comprehensive psychosocial interventions should be routinely available to all patients and their families, and provided by appropriately trained mental health professionals with time to devote to the task. This includes family interventions, cognitive-behaviour therapy, vocational rehabilitation and other forms of therapy, especially for comorbid conditions, such as substance abuse, depression and anxiety. (vi) The social and cultural environment of people with schizophrenia is an essential arena for intervention. Adequate shelter, financial security, access to meaningful social roles and availability of social support are essential components of recovery and quality of life. (vii) Interventions should be carefully tailored to phase and stage of illness, and to gender and cultural background. (viii) Genuine involvement of consumers and relatives in service development and provision should be standard. (ix) Maintenance of good physical health and prevention and early treatment of serious medical illness has been seriously neglected in the management of schizophrenia, and results in premature death and widespread morbidity. Quality of medical care for people with schizophrenia should be equivalent to the general community standard. (x) General practitioners (GPs)s should always be closely involved in the care of people with schizophrenia. However, this should be truly shared care, and sole care by a GP with minimal or no specialist involvement, while very common, is not regarded as an acceptable standard of care. Optimal treatment of schizophrenia requires a multidisciplinary team approach with a consultant psychiatrist centrally involved.
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Sanderson K, Andrews G, Corry J, Lapsley H. Using the effect size to model change in preference values from descriptive health status. Qual Life Res 2004; 13:1255-64. [PMID: 15473504 DOI: 10.1023/b:qure.0000037482.92757.82] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This pilot study describes a modelling approach to translate group-level changes in health status into changes in preference values, by using the effect size (ES) to summarize group-level improvement. METHODS ESs are the standardized mean difference between treatment groups in standard deviation (SD) units. Vignettes depicting varying severity in SD decrements on the SF-12 mental health summary scale, with corresponding symptom severity profiles, were valued by a convenience sample of general practitioners (n = 42) using the rating scale (RS) and time trade-off methods. Translation factors between ES differences and change in preference value were developed for five mental disorders, such that ES from published meta-analyses could be transformed into predicted changes in preference values. RESULTS An ES difference in health status was associated with an average 0.171-0.204 difference in preference value using the RS, and 0.104-0.158 using the time trade off. CONCLUSIONS This observed relationship may be particular to the specific versions of the measures employed in the present study. With further development using different raters and preference measures, this approach may expand the evidence base available for modelling preference change for economic analyses from existing data.
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Affiliation(s)
- Kristy Sanderson
- Centre for Health Research, School of Public Health, Queensland University of Technology, Australia.
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