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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Schizophrenia is a chronic disease that places tremendous costs and burden on patients, families, and communities. The purpose of this study was to compare the cost and effectiveness of a hospital-based home care model and a traditional community care model for schizophrenia in Taiwan using six principles of cost-effectiveness analysis. Based on the health care provider's analytic perspective, four effectiveness indicators and four service costs were identified and measured, and the ratio of average cost value to effectiveness score for each patient was calculated. According to that ratio, the hospital-based home care model was more cost-effective. The results suggest that the hospital-based outreach home care model is a cost-effective way to care for patients and their family in the community.
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PMID:A comparison of effectiveness and cost between two models of care for individuals with schizophrenia living in Taiwan. 1173 78

An overview of schizophrenia is presented, including diagnostic criteria, etiology, neurologic findings, pharmacotherapy options, quality-of-life issues, and the financial impact of the disease. Schizophrenia is a chronic disease characterized by positive symptoms, negative symptoms, mood symptoms, and cognitive deficits. Often comorbid substance abuse is present. Schizophrenia accounts for 20% of all hospital bed-days and over 50% of all psychiatric beds in the United States. There is a strong genetic component to schizophrenia, and other possible contributing factors are explored. The diagnostic workup should include a detailed longitudinal history, mental status exam, physical and neurologic exams, and laboratory tests. A magnetic resonance imaging scan can rule out structural causes of psychosis and should be considered at the time of diagnosis. Treatment is based on a biopsychosocial model including pharmacotherapy in combination with individual, group, and family therapies. Rather than classifying antipsychotics as typical or atypical, a new classification scheme has been proposed based on risk of causing extrapyramidal symptoms and tardive dyskinesia (TD), effect on prolactin level, and efficacy profile: first-generation or traditional agents (e.g., chlorpromazine and haloperidol); second-generation agents (e.g., risperidone and ziprasidone); and third-generation agents (e.g., clozapine, olanzapine, and quetiapine). The binding affinities of antipsychotics in the brain help explain the mechanisms by which different antipsychotics alleviate specific symptoms of schizophrenia, as well as cause specific adverse effects. Improved cognition, fewer depressive and mood symptoms, and decreased risk of TD associated with third-generation antipsychotics have improved the quality of life for patients with schizophrenia.
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PMID:Comprehensive understanding of schizophrenia and its treatment. 1222 84

Antipsychotic drugs have been available for more than 40 years. The invention of neuroleptics changed the overall treatment of schizophrenia dramatically. Nevertheless, the discussion on the importance and role of antipsychotic therapy still goes on. In the public as well as in the media, there remains a great deal of scepticism about the role of psychopharmacotherapy in the treatment of schizophrenia. The best way to handle this is an evidence-based approach. The efficacy of neuroleptic treatment has been proven in over 150 double-blind, controlled clinical trials. The second generation of antipsychotic drugs show similar antipsychotic properties as the classical agents, but with fewer side-effects such as extrapyramidal symptoms (EPS). The atypical antipsychotic agents have improved the quality of therapy and can also improve and support other aspects of treatment. When used with other treatment strategies, atypical antipsychotic agents could improve the overall outcome of this usually chronic disease. It is now necessary to implement these strategies as effectively as possible.
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PMID:Efficacy review of antipsychotics. 1241 6

Manic-depressive (bipolar) disorder is a severe, relapsing mental illness that shares characterstics both with major depressive disorder and with serious mental illnesses such as schizophrenia. Like schizophrenia, it is a chronic disorder, and is treated primarily in the specialty mental health sector. Rates of appropriate treatment are low. Functional outcome is compromised for the majority of individuals who have this disorder. Societal costs are exceeded only by those for schizophrenia. Existing cost calculations likely underestimate societal costs because of underestimating functional impact and neglecting to account for the substantial proportion of individuals who are institutionalized outside of the health care system (e.g., in prison). Little is known as yet regarding manic-depressive disorder in historically underserved groups and in vulnerable groups such as the elderly. There are major lacunae with regard to this disorder in the grant portfolios of all federal agencies mandated to address the needs of Americans with serious mental illnesses. The authors in the context of the Wider NIMH Affective Disorders Workgroup propose several specific recommendations to address the needs of this costly and underresearched disorder.
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PMID:Bipolar disorder. 1255 8

Schizophrenia is a chronic disorder that is associated with increased mortality. Although traumatic deaths account for most of this increase, there is also an increased rate of natural deaths in this population. Altered autonomic physiology in this group might contribute to death. To determine if there are schizophrenics in whom, after a complete autopsy, no recognizable cause of death other than schizophrenia is established, the records of the Office of Chief Medical Examiner of the City of New York were reviewed for deaths associated with schizophrenia and a natural manner of death. Six such decedents were identified, and their histories and autopsy results are described. We believe that schizophrenia per se is a potentially lethal disorder. Autonomic irregularities and their interactions with psychotropic drugs deserve further attention.
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PMID:Schizophrenia as a cause of death. 1257 Feb 20

Schizophrenia is a chronic disorder that begins in adolescence or in early adulthood. In schizophrenic disorder there are relevant deficits in social interaction. The aim of this study was to evaluate the efficacy of atypical antipsychotic drugs compared to a conventional antipsychotic in the treatment of psychotic symptoms and on cognitive functions of a group of people affected by schizophrenia. Effects of novel antipsychotic drugs on social functioning improvement, regarded as improvement in the ability to represent mental states, were thoroughly assessed. Our study was conducted in the form of naturalistic observation of a sample of 45 people affected by schizophrenia treated with haloperidol, clozapine and risperidone. Our results show that after one year of treatment there were significant positive results in social competence abilities in the group of people being treated with risperidone. Theses results may have a relevant impact on the improvement of quality of life in people affected by schizophrenia.
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PMID:[Social cognition and atypical antipsychotic agents in the treatment of persons with schizophrenia: preliminary data from a naturalistic study]. 1285 65

In this study, the foundations of long-acting antipsychotics development, the adherence to treatment, the factors that make difficult the following of the prescription and their consequences, the benefits and acceptance of long-acting antipsychotics are revised. Based on the data obtained from the first part of this study, the following issues must be highlighted: the non-adherence treatment level in schizophrenia is about 60%. Considering schizophrenia a chronic disease with high relapse risk, the maintenance treatment helps its control. The long-acting antipsychotics were developed exactly for the purpose of guaranteeing the administration of the medication and its regularity, which are essential requirements in preventing a relapse. In spite of the immensurable benefits of the long-acting antipsychotics, several factors have contributed to their usage below their potential.
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PMID:[Long-acting antipsychotics in the maintenance treatment of schizophrenia: Part I. Foundations of its development, benefits and acceptance level in different countries and cultures]. 1295 39

Spectral and coherence characteristics of the beta 2 rhythm (20-40 Hz) were compared in patients with acute schizophrenia (the first episode), patients with chronic schizophrenia (disease duration more than two years), and healthy subjects (control group) during cognitive task performance. Examination showed the "excessive" spectral power of this rhythm in the prefrontal cortical areas in patients with acute schizophrenia and its "insufficient" spectral power in all derivations of the right hemisphere in patients with the chronic form as compared to the controls. The similarity of the beta 2 spectral power distribution in different cortical areas measured by covariance method decreased with increase in psychopathologic manifestations. Coherent analysis revealed a substantially lower number of cortico-cortical functional connections in schizophrenic patients than in healthy subjects, absence of interhemispheric connections in patients with acute schizophrenia, and a slight increase in their number if patients with the chronic disease. However, as distinct from the controls revealing many inter- and intrahemispheric connections in all cortical areas, in schizophrenics the interhemispheric connections were observed only in the posterior cortical regions. The results point to a disorder of interhemispheric interaction in schizophrenia.
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PMID:[Spectral power and cortical interactions in the beta2 rhythm in normal subjects and schizophrenic patients]. 1517 69

Schizophrenia is a chronic disease associated with a significant and long-lasting health, social, and financial burden, not only for patients but also for families, other caregivers, and the wider society. Many national and local studies have sought to estimate the societal burden of the illness--or some components of it--in monetary terms. Findings vary. We systematically reviewed the literature to locate all existing international estimates to date. Sixty-two relevant studies were found and summarized. Within- and between-country differences were analyzed descriptively. Despite the wide diversity of data sets and methods applied, all cost-of-illness estimates highlight the heavy societal burden of schizophrenia. Such information helps us to understand the health, health care, economic, and policy importance of schizophrenia, and to better interpret and explain the large within- and across-country differences that exist.
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PMID:The global costs of schizophrenia. 1527 46

The administration of more than one drug for a single medical condition is considered to be polypharmacy. There are many possible reasons for polypharmacy: (1) psychosis is a chronic disease that cannot be cured; (2) expectations to improve patients' quality of life beyond what drugs can actually do is high; (3) the lack of side effects and interactions can cause physicians to be more daring in terms of potential complications; (4) information from the Internet may cause patients and their families to demand medications; (5) the diluted mental health system allows legal guardians and other mental health professionals to force physicians to provide multiple drugs; (6) many new drugs are available; and (7) physicians are forced to shorten hospitalization days. The 1997 American Psychiatric Association Practice Research Network found that 17% of 146 patients with schizophrenia were treated concurrently with more than one antipsychotic medication. Polypharmacy may increase the risk of adverse effects, drug interactions, noncompliance, and medication errors. It is not wise to use polypharmacy only to prevent side effects and drug and interactions. Our attempts to reduce polypharmacy may fail, as academicians also propagate polypharmacy, and all of the algorithms indicate polypharmacy as an option, putting physicians in a legal and ethical bind. Techniques such as experimental ward, peer review, computer information feedback, and comparing different techniques may temporarily reduce polypharmacy but long-term outcome is not affected. Scientific data on the efficacy of polypharmacy is needed in order to sort out good and bad polypharmacy.
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PMID:Antipsychotic polypharmacy. 1528 98


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