Trajectories of symptom reduction and engagement during treatment for childhood behavior disorders: differences across settings. (57/129)

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The prospective relationships among intrinsic motivation, neurocognition, and psychosocial functioning in schizophrenia. (58/129)

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Case managers discovering what recovery means through an HIV prevention intervention. (59/129)

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The General Practitioner Experiences Questionnaire (GPEQ): validity and reliability following the inclusion of new accessibility items. (60/129)

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An audit to compare discharge rates between antidepressant monotherapies prescribed for pure unipolar depression versus depression in the presence of other indications. (61/129)

INTRODUCTION: It has been demonstrated that there are differences in the efficacy and acceptability of commonly prescribed antidepressants (Cipriani et al. 2009). This meta-analysis showed that escitalopram, sertraline, venlafaxine and mirtazapine were the most effective in the acute treatment of unipolar depression in adults. In this audit, these most effective antidepressants will be referred to as 'the four', whilst other antidepressants will be referred to as 'the others'. We aimed to analyse prescribing patterns of antidepressant monotherapies in Bedford East Community Mental Health Team. We also aimed to compare the efficacy of antidepressant monotherapies in patients with unipolar depression or patients with depressed mood and also other psychiatric indications within Bedford East Community Mental Health Team, using discharge rates from the out-patient clinic as the outcome measure. We aimed to compare the efficacy of 'the four' versus 'the others' in patients with unipolar depression patients with depressed mood and also other psychiatric indications at within Bedford East Community Mental Health Team , using discharge rates from the out-patient clinic as the outcome measure. SUBJECTS AND METHODS: We included all patients on an antidepressant monotherapy in Bedford East Community Mental Health Team in our analysis (206 patients in total) (Figure 1). We examined the clinical notes for each patient to assess whether they were diagnosed with unipolar depression or another psychiatric condition, and whether they had been discharged from the out-patient clinic after being prescribed the antidepressant. This allowed us to calculate discharge rates for each antidepressant monotherapy. RESULTS: For patients with unipolar depression, discharge rates were higher when they were prescribed one of 'the four' and highest when prescribed escitalopram. For patients with other indications, discharge rates were higher for 'the others' and highest for fluoxetine . DISCUSSION: A greater percentage of patients with unipolar depression were discharged from clinic compared with patients treated with antidepressant monotherapy for depressed mood and also other psychiatric indications. CONCLUSION: These results suggest that co-morbid undiagnosed other mental illness may be a cause of 'resistant depression'.  (+info)

An audit to compare discharge rates and suicidality between antidepressant monotherapies prescribed for unipolar depression. (62/129)

INTRODUCTION: It has been demonstrated that there are differences in efficacy and acceptability of commonly prescribed antidepressants (Cipriani et al. 2009). This meta-analysis showed that escitalopram, sertraline, venlafaxine and mirtazapine were the most effective antidepressant monotherapies in the acute treatment of unipolar depression in adults. We aimed to analyse prescribing patterns of antidepressant monotherapies in Bedford Hospital. We intended to compare the efficacy of antidepressant monotherapies in patients with unipolar depression at Bedford East CMHT, using discharge rates and rates of reduced suicidality (including suicidal ideation and Behaviour) after treatment by the CMHT as the outcome measure. We also decided to compare the efficacy of 'the four' versus 'the others' in patients with unipolar depression in Bedford East CMHT, using discharge rates and rates of reduced suicidality (including suicidal ideation and Behaviour) after treatment by the CMHT as the outcome measures. SUBJECTS AND METHODS: We identified and included all patients with unipolar depression prescribed an antidepressant monotherapy in Bedford East CMHT. We identified patients who were discharged after treatment, as well as patients who were suicidal before treatment, and after treatment. Hence we could work out discharge rates and reduction in suicide rates for each antidepressant monotherapy. These were then compared, using graphs. RESULTS: The most frequently prescribed antidepressant monotherapy was citalopram. Prescription of 'the four' was associated with a greater percentage of patients discharged from the clinic than 'the others'. Sertraline was the antidepressant most likely to reduce suicidality in our sample. DISCUSSION: This audit in a small group of patients suggests that prescription of 'the four' leads to a higher discharge rate than 'the others'. Regarding suicidality, this audit in a small group of patients suggests that sertraline is the most effective antidepressant monotherapy in reducing suicidality in patients with unipolar depression. CONCLUSION: The study has several limitations, however it does appear that the antidepressants identified by Cipriani are effective compared with other monotherapies. We recommend that all CMHTs should carry out audits of their prescribing practice.  (+info)

Suicide risk and choice of antidepressant. (63/129)

INTRODUCTION: There is presently concern that patients treated for depression with venlafaxine have a higher suicide rate than those treated with other antidepressants, based on results from observational studies. The aim of this study was to determine whether higher suicide risk, defined as previous suicide attempt or suicidal ideation, influenced the choice of antidepressant prescribed in an outpatient mental health unit, the Bedford East Community Mental Health Team. SUBJECTS AND METHOD: A database held by a the Community Mental Health Team was used to identify patients with Depression who have been treated with Venlafaxine, Citalopram, and patients diagnosed with bipolar II affective disorder. The data was analysed in terms of presence of suicide risk, gender, and whether bipolar II patients on venlafaxine were treated with mood stabilisers. RESULTS: The results showed that a risk of suicide did not prevent the prescription of venlafaxine, that less venlafaxine was prescribed to male patients than females, and that bipolar II patients were indeed treated with mood stabilisers. DISCUSSION: It appears that in this Community Mental Health Team, the possibility of suicide risk with venlafaxine therapy is considered and appropriately managed. CONCLUSION: Early diagnosis and appropriate treatment of bipolar disorder is likely to be the most effective step that we can take to reduce the risk of suicide in patients with bipolar disorder .Appropriate care regarding the judicious use of Venlafaxine as a first line treatment in Unipolar Depression is secondary to this.  (+info)

Association of stigma, self-esteem, and symptoms with concurrent and prospective assessment of social anxiety in schizophrenia. (64/129)

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