bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilisation of mental health services and costs of patients with schizophrenia in three areas of Spain
Authors: Haro Josep Maria , Salvador-Carulla Luis , Cabasés Juan , Madoz Vicente , Vázquez-Barquero José Luis ,   PSICOST Group
Published: October 2008

BackgroundThe analysis of the costs of schizophrenia and its treatment under different mental health care structures will facilitate the improved allocation of the limited resources available for the treatment of schizophrenia. The research we present compares health service use and total health care costs of three cohorts of subjects with schizophrenia which are representative of three areas of Spain (Burlada in Navarra, Cantabria and the Eixample of Barcelona).MethodWe selected first-time contacts with any psychiatric service who received a diagnosis of schizophrenia. Subjects were evaluated in the third year after onset.ResultsThe mean number of out-patient visits per patient per year was 10.7 and the mean in-patient days were 9.5. The mean direct cost per patient in the third year of treatment was US$2243. Costs were higher for single subjects and for people who had a relapse. Costs of subjects with better functioning were lower than costs of subjects with a worse state.ConclusionsDirect costs of care in Spain were lower than the reported figures from other western European countries. Costs were greater in the two centres with greater community mental health service development. Some of the findings may be explained by service availability.
Long-term pharmacokinetics of clozapine
Authors: Kurz Martin , Hummer M. , Kemmler G. , Kurzthaler I. , Saria A. , Fleischhacker W. W. 
Published: October 2008

BackgroundPrevious studies of clozapine pharmacokinetics have shown a wide intra- and inter-individual variability of plasma levels in patients on stable clozapine doses. We investigated dose-plasma level relationships and intra-individual variability of plasma levels during maintenance treatment with clozapine.MethodForty-one patients on clozapine were followed for 26 weeks with repeated plasma level measurements and assessments of co-medication and clinical symptoms. In a second step, 15 patients on stable clozapine doses between treatment Weeks 12 and 52 were followed in the same way. Coefficient of variation was used as a parameter of plasma level deviation.ResultsDose-plasma level correlations stayed significant from Week 6 to Week 26 (n=41). The group of patients followed up to Week 52 showed a mean intra-individual coefficient of variation of 52.8% (s.d. =20.6), and remained stable psychopathologically.ConclusionsEven though clozapine plasma levels may show a significant degree of variation, this is not necessarily reflected in a change in psychopathology.
Evolving service interventions in Nunhead and Norwood
Authors: Becker Thomas , Holloway Frank , McCrone Paul , Thornicroft Graham 
Published: October 2008

BackgroundService evaluation requires a detailed understanding of the services studied.MethodCommunity mental health services evaluated in the PRiSM Psychosis Study in south London are described. The intensive sector and standard sector services are contrasted.ResultsThe intensive sector had two teams with extended opening hours: a psychiatric acute care and emergency (PACE) team, and a psychiatric assertive continuing care (PACT) team focusing on care for people with chronic illness. In the standard sector there was a generic community team providing office-hour assessments, case management of the severely mentally ill and close liaison with in-patient services. The team made use of the local psychiatric emergency clinic and of other local resources. The intensive sector was characterised by: more admissions to fewer beds, more non-hospital residential places, extended hours, on-call rota, wider range of interventions, more medical and nursing staff, a lower nursing grade mix and higher staff turnover. The standard sector had a less highly resourced generic community psychiatric service.ConclusionsChange in services has been more marked in the intensive sector.
Frequency and predictors of adverse events
Authors: Johnson Sonia , Leese Morven , Brooks Liz , Clarkson Paul , Guite Hilary , Thornicroft Graham , Holloway Frank , Wykes Til 
Published: October 2008

BackgroundCommunity care has been criticised as a hazardous policy associated with high rates of adverse events. There is little research evidence as to the truth of this claim.MethodBest available evidence from public records, interviews, case notes, key workers and general practitioners was assembled to establish: (a) which of the 514 subjects initially identified as having psychotic illnesses had died during an average follow-up of 4.9 years; (b) care currently received by all 286 subjects originally selected for interview; and (c) rates of major adverse events and of admission for these 286 individuals.ResultsTwenty-eight natural and 11 unnatural deaths had occurred. Among subjects still living at the end of the follow-up, 84% were in contact with specialist mental health services and 11% only with primary care services. Rates of serious violence, imprisonment and homelessness were relatively low. Forty-one per cent had been admitted at least once during a mean follow-up of 3.2 years and 20% at least once under the Mental Health Act. After adjustment, there were no significant differences between standard and intensive care sectors.ConclusionsRates of adverse events and slipping through the net’ are relatively low among individuals receiving community-based services, whether intensive or standard care.
Care-giving and the impact on carers of a community mental health service
Authors: Szmukler George I. , Wykes Til , Parkman Sue 
Published: October 2008

BackgroundWe examined: care-giving activities in a population-based sample of carers of sufferers from psychotic disorders; putative determinants of care-giving; and changes in care-giving in an intensive community psychiatric service.MethodsIn the PRiSM interview sample 170 people had a carer; 124 were interviewed. Care-giving activities, dissatisfaction with these, and carers General Health Questionnaire (GHQ) scores were measured. Patient and illness characteristics were examined as predictors of the carer measures. The carer measures were reassessed for 62 carers after two years in two service sectors, one with an intensive community service, the other with a standard service.ResultsOverall, 36% of carers were engaged in no, or only occasional care-giving activities. Fifty per cent expressed no dissatisfaction with their care-giving role. Patient and illness characteristics predicted care-giving poorly. Carers in the intensive community treatment sector did not experience significantly different care-giving demands or distress than those in the standard sector.ConclusionsA significant proportion of carers of sufferers from psychosis do not engage in common care-giving activities, and are not dissatisfied with their role. An intensive community service did not affect the impact of the illness on carers.
Impact of community mental health services on users' social networks
Authors: Becker Thomas , Leese Morven , McCrone Paul , Clarkson Paul , Szmukler George , Thornicroft Graham 
Published: October 2008

BackgroundSocial networks are important for people with severe mental illness, and services need to assess whether they succeed in improving social contacts.MethodIn a prospective controlled study, social network data were obtained in an epidemiologically representative sample of people with psychotic disorders both before (Time I) and two years after (Time 2) the introduction of two sectorised community mental health services in south London (one intensive service with two specialist teams, one standard service with a generic team).ResultsThere were significant baseline differences between sectors with social networks being smaller in the sector later served by the intensive service. Social network size increased within the intensive service sector, but not in the standard service sector. There was a significant sector effect for the network component of relatives (intensive > standard) and in the other (‘non friends’) component (standard > intensive) after adjusting for baseline differences.ConclusionsThe findings suggest that the intensive sector community mental health service enhanced peoples social networks with their relatives, relative to the standard service. The reverse is the case for other contacts.
Quality of life outcomes for intensive versus standard community mental health services
Authors: Taylor Ruth E. , Leese Morven , Paul Clarkson , Holloway Frank , Thornicroft Graham 
Published: October 2008

BackgroundWe report the impact on the quality of life (QOL) of people with psychosis of an intensive compared with a standard model of community care.MethodPeople with psychosis, in two sectors in south London, were interviewed with a variety of measures at baseline, and at two-year follow-up (n=138). After baseline, services within one sector were reorganised, and a more intensive model of community care was introduced. QOL was measured using the Lancashire Quality of Life Profile.ResultsThe two overall QOL measures, global QOL and the average of the domain-specific scores, were remarkably stable over time. There was weak evidence for an improvement in living situation domain in the intensive sector; this may be accounted for by a large drop in in-patient admissions. In both sectors objective QOL was poor, and there was little change in any of the objective indicators except in-patient admissions, and a suggestion of increased social activity in the intensive sector.ConclusionsWe failed to find an effect of intensive community care on QOL in people with psychosis. This may indicate an insensitivity to change in QOL measures, or that the intervention failed to produce the kind of changes in mental health and functioning which would be reflected in improved QOL.
Epidemiology of self-injurious behaviour in adults with learning disabilities
Authors: Collacott Richard A. , Cooper Sally-Ann , Branford David , McGrother Catherine 
Published: October 2008

BackgroundThere have been few epidemiological studies of the disabling and poorly understood disorder self-injurious behaviour among adults with learning disabilities.MethodInterviews were undertaken with the carers of adults known to the Leicestershire Learning Disabilities Register (n=2277). The Disability Assessment Schedule was used and information was also collected on demographic characteristics, developmental and physical status.ResultsSelf-injurious behaviour was present in 17.4% of the population. In 1.7% self-injurious behaviour occurred frequently and was severe. There was no gender difference between those with and without self-injurious behaviour. Both the chronological age and developmental quotient of individuals with self-injurious behaviour were lower than those of individuals without self-injurious behaviour. Autistic symptoms were more common among those with self-injurious behaviour. The association of self-injurious behaviour with a wide range of other maladaptive behaviours was highly significant. Logistic regression analysis retained age, developmental quotient, hearing status, immobility and number of autistic symptoms as explanatory variables for self-injurious behaviour.ConclusionsSelf-injurious behaviour is a prevalent and disabling disorder among adults with learning disabilities.
Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever
Authors: White P. D. , Thomas J. M. , Amess J. , Crawford D. H. , Grover S. A. , Kangro H. O. , Clare A. W. 
Published: October 2008

BackgroundThe role of viruses in the aetiology of both chronic fatigue syndrome (CFS) and depressive illness is uncertain.MethodA prospective cohort study of 250 primary care patients, presenting with glandular fever or an ordinary upper respiratory tract infection (URTI).ResultsThe incidence of an acute fatigue syndrome was 47% at onset, after glandular fever, compared with 20% with an ordinary URTI (relative risk 2.3, 95% CI 1.3–4.1). The acute fatigue syndrome lasted a median (interquartile range) of eight weeks (4–16) after glandular fever, but only three weeks (2–4) after an URTI. The prevalence of CFS was 9–22% six months after glandular fever, compared with 0–6% following an ordinary URTI, with relative risks of 2.7–5.1. The most conservative measure of the incidence of CFS was 9% after glandular fever, compared with no cases after an URTI. A conservative estimate is that glandular fever accounts for 3113 (95% C11698–4528) new cases of CFS per annum in England and Wales. New episodes of major depressive disorder were triggered by infection, especially the Epstein – Barr virus, but lasted a median of only three weeks. No psychiatric disorder was significantly more prevalent six months after onset than before.ConclusionsGlandular fever is a significant risk factor for both acute and chronic fatigue syndromes. Transient new major depressive disorders occur close to onset, but are not related to any particular infection if they last more than a month.
Psychiatric disorders in adolescents in primary care
Authors: Kramer Tami , Garralda M. Elena 
Published: October 2008

BackgroundLittle is known about psychiatric disorders in adolescents who attend primary care.MethodProspective study of 13- to 16-year-olds consecutively attending general practice. Information was obtained from adolescents, parents and general practitioners, using questionnaires and research interviews.Results136/200 (68%) of adolescent attenders took part. Two per cent presented with psychiatric complaints. From research interviews with adolescents, psychiatric disorder in the previous year was found in 38%, with moderate impairment of functioning in over half (according to Children's Global Assessment Scale scores). Most disorders (42/50, 84%) were emotional (‘internalising’) disorders. Psychiatric disorders were significantly associated with high levels and intensity of physical symptoms and with increased health risks. General practitioner assessment of psychiatric disorders was low on sensitivity (20.8%) but high on specificity (90.7%). Doctors identified most severely affected adolescents.ConclusionsDepressive and anxiety disorders are common among adolescent general practice attenders and linked to increased physical symptoms; general practitioner recognition is limited.
Olanzapineversushaloperidol in the treatment of schizoaffective disorder
Authors: Tran Pierre V. , Tollefson Gary D. , Sanger Todd M. , Lu Yili , Berg Paul H. , Beasley Charles M. 
Published: October 2008

BackgroundThe effectiveness of antipsychotic monotherapy in schizoaffective disorder is limited, and further constrained by safety concerns.AimsWe aimed to compare the efficacy, tolerability and safety profile of the new pharmaceutical, olanzapine, with haloperidol.MethodData were assessed from 300 DSM – III – R schizoaffective subjects from a larger double-blind prospective international study. Subjects were randomly allocated to six weeks of olanzapine (5–20 mg) or haloperidol (5–20 mg) treatment; responders were followed for up to one year of double-blind, long-term maintenance therapy.ResultsOlanzapine-treated patients achieved a statistically significant greater improvement than haloperidol-treated patients on overall measures of efficacy, including clinical response. Significantly fewer olanzapine patients left the study early, and fewer adverse events were observed among those receiving olanzapine. During maintenance, olanzapine-treated patients continued to experience additional improvement, with fewer EPS but more weight gain than those on haloperidol.ConclusionsOlanzapine demonstrated substantial advantages over the conventional antipsychotic haloperidol in the management of schizoaffective disorder.
Economic impact of Alzheimer's disease in the United Kingdom
Authors: Souêtre E. , Thwaites R. M. A. , Yeardley H. L. 
Published: October 2008

BackgroundWhile the costs associated with Alzheimer's disease have been shown to be significant, there are few data relating cost of care to severity of the disease.AimsWe aimed to compare the costs associated with different severities of Alzheimer's disease with those incurred by control subjects over a three-month period.MethodIn this cross-sectional, multicentre, naturalistic analysis, non-institutionalised patients with Alzheimer's disease (128), their care-givers (128), and 56 matched controls were interviewed once to establish resource use over the previous three months. Patients were stratified into three severity groups according to their Mini Mental State Examination score. Costs were calculated from the perspective of society as a whole.ResultsOver the three-month period, total mean cost per control subject (£387) was minor compared with mean cost incurred by patients with mild (£6616), moderate (£10 250) and severe (£13 593) Alzheimer's disease. Indirect cost, mainly time spent by care-givers, was the main cost component in all groups (68.6%), followed by direct medical costs (24.7%)ConclusionsThe cost of care for an Alzheimer's disease patient is directly related to the severity of the patient's illness.
Cost-effectiveness analysis of a home-based social work intervention for children and adolescents who have deliberately poisoned themselves
Authors: Byford Sarah , Harrington Richard , Torgerson David , Kerfoot Michael , Dyer Elizabeth , Harrington Val , Woodham Adrine , Gill Julia , McNiven Faye 
Published: October 2008

BackgroundLittle evidence exists regarding the effectiveness or cost-effectiveness of alternative treatment services in the field of child and adolescent psychiatry.AimsTo assess the cost-effectiveness of a home-based social work intervention for young people who have deliberately poisoned themselves.MethodChildren aged ⩽16 years, referred to child mental health teams with a diagnosis of deliberate self-poisoning were randomly allocated to either routine care (n=77) or routine care plus the social work intervention (n=85). Clinical and resource-use data were assessed over six months from the date of trial entry.ResultsNo significant differences were found between the two groups in terms of the main outcome measures or costs. In a sub-group of children without major depression, suicidal ideation was significantly lower in the intervention group at the six-month follow-up (P=0.01), with no significant differences in cost.ConclusionsA family-based social work intervention for children and adolescents who have deliberately poisoned themselves is as cost-effective as routine care alone.
Difficulties in family functioning and adolescent anorexia nervosa
Authors: Gowers Simon G. , North Clive 
Published: October 2008

BackgroundDifficulties in family functioning are often evident when an adolescent has anorexia nervosa, and the possible causative or contributory role of such difficulties in the illness is unclear.AimsTo elucidate the relationship between severity of anorexia nervosa and difficulties in family functioning and whether clinical improvement results in diminution of self-rated family difficulties.MethodThirty-five adolescents with anorexia nervosa and their mothers completed the Family Assessment Device (FAD) while clinicians administered the McMaster's Structured Interview of Family Functioning (McSIFF). Severity of anorexia nervosa was rated at baseline and at one year follow-up using the Morgan–Russell Schedule.ResultsClinicians and patients were more critical of the families' functioning than parents. There was an inverse association between the extent of family difficulties and severity of anorexia nervosa. Over time subjects improved clinically but this was not matched by improvement in family functioning.ConclusionsDifficulties in family functioning do not appear to be directly associated with severity of anorexia nervosa nor do these difficulties reduce with clinical improvement, in the short term.
Neurodevelopmental antecedents of early-onset bipolar affective disorder
Authors: Sigurdsson Engilbert , Fombonne Eric , Sayal Kapil , Checkley Stuart 
Published: October 2008

BackgroundDevelopmental impairments have been identified as a risk factor for early-onset schizophrenia. Affective symptoms are more common in children and adolescents with disordered neurodevelopment than in healthy controls.AimsTo test the hypothesis that severe early-onset mood disorders are associated with developmental antecedents.MethodWe retrospectively identified 38 adolescent cases (15 female, 23 male; mean age 14.4 years, range 11–18) who met ICD–10 Research Diagnostic Criteria for a manic episode, bipolar affective disorder or psychotic depression, and 41 controls (25 female, 16 male, mean age 14.2 years, range 11–18) with depression but without psychotic features.ResultsCases were significantly more likely to have experienced delayed language, social or motor development (OR 5.5, 95% CI=1.4–21.6,P=0.01). in particular those who develop psychotic symptoms (OR 7.2, 95% CI=1.8–28.6,P=0.003).ConclusionsCompared to early-onset unipolar depression, neurodevelopmental antecedents are over-represented in early-onset bipolar disorder. The validity of this finding was supported by contemporaneous IQ scores that are not subject to the same potential biases as case-note ratings.
Coping strategies in relatives of people with schizophrenia before and after psychiatric admission
Authors: Scazufca Marcia , Kuipers Elizabeth 
Published: October 2008

BackgroundMost research on expressed emotion (EE) has used an empirical approach to describe relatives' ways of coping with people with schizophrenia.AimsTo use the stress and coping model proposed by Lazarus and Folkman to examine how relatives coped with patients.MethodPatients with DSM–III–R schizophrenia and their relatives were assessed just after hospitalisation of the patients and nine months after discharge. Both assessments included the symptoms of the patients and the coping strategies, burden, distress and levels of EE of the relatives.ResultsFifty patients and 50 relatives were assessed at inclusion, and 31 patients and 36 relatives at follow-up. Coping strategies were used more frequently at inclusion than at follow-up. Problem-focused coping was the strategy used more often at both assessments. Avoidance coping was strongly associated with burden, distress and high EE at both assessments.ConclusionsWays of coping are influenced by relatives' perceptions of the situation with patients. Avoidance strategies seem to be less effective in regulating the distress of care-givers than problem-focused strategies.
Limits to the value of mental health review tribunals for offender patients
Authors: Taylor Pamela J. , Goldberg Emma , Leese Morven , Butwell Martin , Reed Alison 
Published: October 2008

BackgroundReform of mental health legislation for England and Wales is due. MHRTs offer an important check in the balance between patient and public rights.AimsTo study the quantity and outcome of MHRTs in special (high-security) hospitals.MethodData were extracted from the records of 1670 patients detained under mental illness or psychopathic disorder classifications in special hospitals during 1992.ResultsThere were 661 MHRT hearings, mostly requested by patients. Forty-three (7%) discharges were ordered, often without key data about continuing care in the written evidence. There were 56 recommendations for transfer to lesser security. Correlates of MHRT discharge were: female gender, younger age (in women), a legal classification of psychopathic disorder and shorter length of stay. Conditional discharge did not necessarily mean departure from special hospital.ConclusionsSpecial hospital MHRTs result in few changes in patient status. A probable need for improvement in the evidence put before an MHRT was found. Legislation reformers should consider an extension of MHRT powers to order transfer between levels of security.