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The purpose of the present study has been to assess the societal cost of major depression and the distribution into different cost components. The impact of adherence and treatment response was also explored.
Data were collected from a randomized controlled trial of patients with major depressive disorder who were treated in a naturalistic primary care setting. Resource use and quality of life were followed during the two-year trial.
The mean total cost per patient during two years was KSEK 363 (EUR 38 953). Indirect costs were the most important component (87%), whereas the cost of drugs was minor (4.5%). No significant differences in costs or quality of life between treatment arms or between adherent and non-adherent patients were demonstrated. However, treatment responders had 39% lower total costs per patient and experienced a larger increase in quality of life compared to non-responders.
Major depression has high costs for society, primarily due to indirect costs. Treatment responders have considerably lower costs per patient and higher quality of life than non-responders. This indicates that measures to increase response rates are also important from an economic perspective.
In a community sample of 418 persons diagnosed with schizophrenia, subjective needs and perceived help was measured by the Camberwell Assessment of Need (CAN). The mean number of reported needs was 6.2 and the mean number of unmet needs 2.6. The prevalence of needs varied substantially between the need areas from 3.6% (‘telephone’) to 84.0% (‘psychotic symptoms’). The rate of satisfaction estimated as the percentage of persons satisfied with the help provided within an area varied between 20.0% (‘telephone’) and 80.6% (‘food’).
The need areas concerning social and interpersonal functioning demonstrated the highest proportion of unmet to total needs.
In a majority of need areas the patients received more help from services than from relatives, but in the areas of social relations the informal network provided substantial help. In general the patients reported a need for help from services clearly exceeding the actual amount of help received.
In a linear regression model symptom load (BPRS) and impaired functioning (GAF) were significant predictors of the need status, explaining 30% of the variance in total needs and 20% of the variance in unmet needs.
It is concluded that the mental health system fails to detect and alleviate needs in several areas of major importance to schizophrenic patients. Enhanced collaboration between the care system and the informal network to systematically map the need profile of the patients seems necessary to minimise the gap between perceived needs and received help.
The study investigates the prevalence of abuse in adulthood in female users of psychiatric services, self-reported consequences of abuse, and needs for support.
N=1382 women participated. A self-administrated anonymous questionnaire was used. Quantitative data was analysed by mainly descriptive statistics and quantitative data was analysed by content analysis.
46% (n=638) of the women had been exposed to emotional, sexual and/or physical abuse in adulthood. Twenty-eight percent (n=385) reported experiences of moderate physical abuse, 27% (n=373) reported threats of injury, and 20% (n=277) reported threats of being killed. Further, 19% (n=261) stated experience of sexual violence, and 12% (n=164) had experiences of serious physical violence. Women who had been abused rated lower self-esteem than those who were not abused. Self-reported consequences of abuse included intrapersonal and social problems, and disease-specific manifestations. 43% of the women stated that they were in need of additional support mainly such as support directed to the experiences of abuse by professionals trained in the area, but also family interventions, self-help groups, medical care, legal support, or practical help to find new housing situations.
It is concluded that female users of psychiatric care services constitute a vulnerable group with regard to abuse and that the women need to be cared for in a different way as they are today. The care and support system have to adopt an ecological perspective in order to target the problems connected with female abuse in women with mental illness.
Therapeutic Drug Monitoring (TDM) is a useful tool to survey individual patients for the correct prescription and dosing of neuroleptic drugs. Confounders for causal drug effect relations are both patient-related and drug-related. An example of a patient-related confounders is problems with compliance to prescribed medication that can be objectively identified or ruled out by TDM in cases of non-response or partial but insufficient clinical response. This problem may arise both in the acute phase of treatment as well as during long-term treatment. Examples of combined patient-related and drug-related confounders are the very individual pharmacokinetic (PK) handling of the drug once the patent has ingested a neuroleptic compound. All such drugs undergo significant metabolism in the body, which is subjected to major inter-individual variability to a large extent due to existence of polymorphic genetic expressions among enzymes responsible for drug detoxification processes in the liver. Moreover, each separate neuroleptic compound, whether its is a classical or an atypical agent, has different affinities for these drug catabolic enzymes. The entire picture of PK-variability existing for antipsychotic drugs is therefore in healthy young male volunteers about one order of magnitude. In real life, i.e. in the everyday naturalistic clinical setting where for example also polypharmacy is a common feature, this variation in the PK between individuals increase 10-fold to be about two orders in magnitude.
This presentation focus TDM-studies where PK-variability and drug PK-effect relations for traditional as well as atypical antipsychotic agents are scrutinized.
Many problems such as non-response, pharmacokinetic interactions with clinical consequences and adverse effects (pharmacovigilance) may be observed in patients submitted to psychopharmacotherapy. These risks are increased in patients belonging to the category of “special populations”: elderly patients, children and adolescents, patients with a genetic particularity of metabolism or suffering from somatic or psychic comorbidities. Pharmacokinetic and pharmacogenetic tests are useful to solve problems in psychopharmacotherapy and thus improve efficacy and safety. Therapeutic drug monitoring (TDM) is particularly recommended in situations presented above and in patients who are non-compliant. In addition, the use of generics has been shown to represent a source of unexpected treatment outcomes, and TDM may help to explain pharmacokinetic particularities after switching from an original to a generic preparation (or vice versa). Finally, the increasing knowledge of the metabolism of psychotropic drugs allows taking account of the pharmacogenetic status (e.g. cytochrome P-450, P-glycoprotein) of the patients not only in adapting their medication, but also for interpreting pharmacokinetic interactions with clinical consequences. In this respect, pharmacokinetic and pharmacogenetic tests have now also to be considered as a tool in pharmacovigilance programs.
Psychiatrists who already have experience in this field will have their knowledge updated: recent progress will be illustrated by clinical situations, which will be discussed in an interactive way. A consensus paper with recommendations on the optimal use of pharmacokinetic and pharmacogenetic tests will be summarized and submitted for discussion.
Research findings that link personality factors to functioning and symptoms in schizophrenia are inconsistent, and further studies are needed within the area. The purpose of this study was to investigate how personality, as measured by the Temperament and Character Inventory (TCI), was related to demographic factors, subtypes of diagnoses, level of functioning, and aspects of psychological health, including sense of coherence, perceived control, and self-esteem, among people with schizophrenia. Subjects were 104 individuals, aged 20–55 years, in psychiatric outpatient care. The results indicated that personality was not related to subtypes of diagnoses or demographic characteristics of the respondents, but to level of functioning and all aspects of psychological health. Especially self-directedness distinguished three groups of functioning and was highly correlated with the different aspects of psychological health. The article discusses how knowledge of schizophrenic patients’ personality structure might be used for tailoring psychiatric treatments.
The aims of this study were to assess the quality of life among 120 schizophrenic patients who were attending a psychiatric outpatient department and to investigate which socio-demographic and clinical factors influenced their subjective quality of life. Quality of life was assessed by the Lanchashire quality of life profile, social functioning was judged according to the Global Assessment of Functioning (GAF) scale, and psychopathology was rated by means of the Brief Psychiatric Rating Scale (BPRS). Both objective and subjective life conditions indicated an impaired quality of life for the patients. The areas of finance and work had the largest proportion of dissatisfied patients. Socio-demographic indicators showed to have a weak influence on the patient's self-assessed quality of life while clinical factors, such as psychopathology, strongly influenced the patient's life satisfaction. It is concluded that there is a need for further emphasise on the clinical, financial, and social interventions for this group of patients.
Using about 1,730 probate inventories, this article studies the wealth of peasant farmers in Sweden for the years 1750, 1800, 1850 and 1900. Average wealth grew rapidly, tripling over the nineteenth century, but it did not grow equally: the Gini coefficient for the farmers’ wealth grew from 0.46 in 1750 to 0.73 in 1900. Farmers who lived close to the major grain markets in Stockholm and the mining district of Bergslagen were wealthier than others, as were farmers on fertile plains and, in 1900, those living in coastal areas. Increased market access – in terms of cities and foreign demand – meant that farmers well placed in terms of geography and infrastructure benefited much more than farmers on what became the periphery. The diversity of farmers’ wealth grew, as did their financial sophistication.
Accurately and efficiently modeling the drain-lag effects is crucial in nonlinear large-signal modeling for Gallium Nitride high electron mobility transistors. In this paper, a simplified yet accurate drain-lag model based on an industry standard large-signal model, i.e., the Chalmers (Angelov) model, extracted by means of pulsed S-parameter measurements, is presented. Instead of a complex nonlinear drain-lag description, only four constant parameters of the proposed drain-lag model need to be determined to accurately describe the large impacts of the drain-lag effects, e.g., drain-source current slump, typical kink observed in pulsed IV curves, and degradation of the output power. The extraction procedure of the parameters is based on pulsed S-parameter measurements, which allow to freeze traps and isolate the trapping effects from self-heating. It is also shown that the model can very accurately predict the load pull performance over a wide range of drain bias voltages. Finally, the large-signal network analyzer measurements at low frequency are used to further verify the proposed drain-lag model in the prediction of the output current in time domain under large-signal condition.
This article studies the long-run relationship between the capital share in national income and top personal income shares. Using a newly constructed historical cross-country database on capital shares and top income data, we find evidence on a strong, positive link that has grown stronger over the past century. The connection is stronger in Anglo-Saxon countries, in the very top of the distribution, when top capital incomes predominate, when using distributed top national income shares, and when considering gross of depreciation capital shares. Out of-sample predictions of top shares using capital shares indicates several cases of over- or underestimation.