Structural asymmetries of the human brain and their disturbance in schizophrenia.
(17/7917)
Asymmetries of the brain have been known about for at least a century, but they have been explored in detail only relatively recently. It has become clear that, although different asymmetries are common throughout the animal kingdom, they are most marked in the human brain. Disturbances in asymmetry are particularly striking in patients with schizophrenia and perhaps all psychotic illnesses, and may provide the neurological substrate for the etiology and clinical manifestations of the illness. (+info)
Laterality in functional brain imaging studies of schizophrenia.
(18/7917)
Brain laterality in schizophrenia has been examined through the application of functional neuroimaging methods. These methods have included the 133Xenon technique for measuring cerebral blood flow (CBF); positron emission tomography for assessing rates of glucose metabolism, CBF, and neuroreceptor functioning; single photon emission computerized tomography for studying CBF and neuroreceptors; and functional magnetic resonance imaging for measuring changes attributable to CBF. This article highlights the application of this technology in schizophrenia research, emphasizing more recent studies that have evaluated hemispheric differences. There is evidence for lateralized abnormalities in some studies that have examined this dimension. In general, the results implicate abnormalities in left hemispheric activity. Recent advances in basic and clinical neuroscience provide an opportunity for focused application of functional imaging in neurobiological studies of schizophrenia. (+info)
Depression during the longitudinal course of schizophrenia.
(19/7917)
This prospective research investigated the occurrence and persistence of depression during the longitudinal course of schizophrenia. The research goals were to (1) compare depression in schizophrenia with that in schizoaffective and major depressive disorders, (2) assess whether some schizophrenia patients are vulnerable to depression, and (3) assess the relationship of depression to posthospital adjustment in schizophrenia. A total of 70 schizophrenia, 31 schizoaffective depressed, 17 psychotic unipolar major depressed, and 69 nonpsychotic unipolar major depressed patients were assessed during hospitalization and prospectively assessed for depression, psychosis, and posthospital functioning at 4.5- and 7.5-year followups. A large number (30% to 40%) of schizophrenia patients evidenced full depressive syndromes at each followup, including a subgroup of patients who evidenced repeated depression. Even when considering the influence of psychosis on outcome, depression in schizophrenia was associated with poor overall outcome, work impairment, lower activity, dissatisfaction, and suicidal tendencies. During the post-acute phase assessed, neither the rates nor the severity of depressive syndromes differentiated depression in schizophrenia from schizodepressive or major depressive disorders. However, the depressed schizophrenia patients showed poorer posthospital adjustment in terms of less employment, more rehospitalizations, and more psychosis than the patients with primary major depression. The high prevalence of depression in schizophrenia warrants its incorporation into theory about the disorder. A continuum of vulnerability to depression contributes to the heterogeneity of schizophrenia, with some schizophrenia patients being prone to depression even years after the acute phase. Depression in schizophrenia is one factor, in addition to psychosis, associated with poor outcome and requires specific attention to the treatment strategies by psychiatrists. (+info)
Drug-induced hyponatraemia in psychogenic polydipsia.
(20/7917)
Two patients with psychogenic polydipsia developed hyponatraemia, one in association with administration of hydrochlorothiazide and the other with that of tolbutamide. It is suggested that the increased fluid intake in such patients may make them more susceptible to the development of hyponatraemia from thiazide or sulphonylurea compounds. (+info)
Cost of illness studies for schizophrenia: components, benefits, results, and implications.
(21/7917)
Although schizophrenia affects only about 1% of the worldwide population, it is costly to patients, their families, community care centers, hospitals, and society. International cost of illness studies show a wide variation, with annual costs ranging from Australia's $139 million US dollars (1975) to the cost in the United States of $65.2 billion US dollars (1991). Since methodology and assumptions vary widely from study to study and country to country, it is a challenge to directly compare the results of these studies. Nevertheless, the published COI studies reveal several consistent trends. Inpatient care may be the largest cost driver for direct costs, suggesting that relapse prevention is key to reducing healthcare costs. Indirect costs resulting from the patient's and caregiver's inability to fully participate in the work force is extensive due to the debilitating nature of the disease and its early onset. Lastly, when prescription drug costs were reported, they represented no more than 3% of direct cost. (+info)
A cost-effectiveness clinical decision analysis model for schizophrenia.
(22/7917)
A model was developed to estimate the medical costs and effectiveness outcomes of three antipsychotic treatments (olanzapine, haloperidol, and risperidone) for patients with schizophrenia. A decision analytic Markov model was used to determine the cost-effectiveness of treatments and outcomes that patients treated for schizophrenia may experience over a 5-year period. Model parameter estimates were based on clinical trial data, published medical literature, and, when needed, clinician judgment. Direct medical costs were incorporated into the model, and outcomes were expressed by using three effectiveness indicators: the Brief Psychiatric Rating Scale, quality-adjusted life years, and lack of relapse. Over a 5-year period, patients on olanzapine had an additional 6.8 months in a disability-free health state based on Brief Psychiatric Rating Scale scores and more than 2 additional months in a disability-free health state based on quality-adjusted life years, and they experienced 13% fewer relapses compared with patients on haloperidol. The estimated 5-year medical cost associated with olanzapine therapy was $1,539 less than that for haloperidol therapy. Compared with risperidone therapy, olanzapine therapy cost $1,875 less over a 5-year period. Patients on olanzapine had approximately 1.6 weeks more time in a disability-free health state (based on Brief Psychiatric Rating Scale scores) and 2% fewer relapses compared with patients on risperidone. Sensitivity analyses indicated the model was sensitive to changes in drug costs and shortened hospital stay. Compared with both haloperidol and risperidone therapy, olanzapine therapy was less expensive and provided superior effectiveness outcomes even with conservative values for key parameters such as relapse and discontinuation rates. (+info)
Treatment of schizophrenia: let's talk dollars and sense.
(23/7917)
Schizophrenia is a major neurologic illness with an impact on public health that has been unappreciated. Newer and arguably more effective medication treatments are now available and hold considerable promise. The higher up-front cost of these drugs is, on current evidence, offset by other economic advantages and, from a humanitarian perspective, by the expectation of improved patient outcome with less drug toxicity. The extent to which these drugs replace older drug treatments will be determined by the relative influences of clinical, pharmacoeconomic, mental health administrative, and advocacy factors over the coming years. (+info)
Looking beyond the formulary budget in cost-benefit analysis.
(24/7917)
With the introduction of newer, more expensive psychotropic medications, healthcare providers and managed care administrators must consider whether these drugs offer "value for the money." A true picture of the benefits of these drugs emerges only when all the costs of treatment are considered. Focusing exclusively on the acquisition cost of the drug can result in a misleading impression of the drug's worth. Although the medication costs associated with treating a patient with a newer drug increase, use of these agents may actually result in an overall decrease in healthcare costs, through reductions in hospitalization and length of stay, use of mental health services, and prescriptions for adjunctive drugs. In one study of the newer antipsychotic agent risperidone, the overall annual costs of treating a patient with schizophrenia were reduced by nearly $8,000 (Canadian dollars), even though medication costs increased by approximately $1,200 (Canadian dollars). Retrospective and prospective pharmacoeconomic studies can provide valuable data on the cost effectiveness of treatment with newer psychotropic medications. (+info)