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Autism spectrum disorders (ASD) are associated with high services use, but European data on costs are scarce.
Utilisation and annual costs of 385 individuals with ASD (aged 4-67 years; 18.2% females; 37.4% IQ < 85) from German outpatient clinics were assessed.
Client Service Receipt Inventory
Average annual costs per person were 3287 EUR, with psychiatric inpatient care (19.8%), pharmacotherapy (11.1%), and occupational therapy (11.1%) being the largest cost components. Females incurred higher costs than males (4864 EUR vs. 2936 EUR). In a regression model, female sex (Cost Ratio: 1.65), lower IQ (1.90), and Asperger syndrome (1.54) were associated with higher costs.
In conclusion, ASD-related health costs are comparable to those of schizophrenia, thus underlining its public health relevance. Higher costs in females demand further research.
Schizophrenia patients exhibit impairments in facial affect recognition associated with neurophysiological abnormalities. Using the Training of Affect Recognition (TAR) developed by our group behavioural performance in facial affect recognition improved significantly in schizophrenia patients . Purpose of the presented work was to identify the underlying mechanisms and associated generators of neuroelectric activity.
In a randomized controlled (waiting group) design 19 schizophrenia patients received TAR. Concomitant to facial affect recognition performance, ERPs were recorded and analyzed with respect to underlying generators of cortical activity using low resolution brain electromagnetic tomography (LORETA) software.
Schizophrenia patients showed noticeable deviations in neuroelectric correlates of emotion recognition associated with poorer performance in the administered task. As a result of TAR treatment no significant changes in event related potentials were found. However, LORETA results showed a significant increase of activity within relevant brain areas, specific for the processing stages associated with facial emotion recognition (N170 and P240).
EEG findings of the present study indicate that neurophysiologic abnormalities corresponding with poorer performance in schizophrenia patients can be attenuated by training.
Impairments in facial emotion recognition have proven to be a trait-like characteristic in schizophrenia mostly unaffected by traditional treatment. This raised the question whether cognitive remediation strategies may be a treatment option for these impairments.
A special Training of Affect Recognition (TAR) was evaluated in three consecutive studies using pre-post-control group designs with either an active control treatment (studies 1 and 2), a „passivetreatment as usual group (study 1), or a waiting group (study 3). The active control treatment consisted of a Cognitive Remediation Training (CRT) aiming at improvement of basic neurocognitive functioning. Outcome measures comprised facial and prosodic affect recognition, basic cognitive functioning and social interaction.
Analyses revealed specific training effects in the form of a double dissociation both in studies 1 and 2: the TAR improved facial and prosodic affect recognition as well as understanding of social scenes, but had no effects on memory, attention and executive functioning. Patients under CRT and those without training did not show improvements in affect recognition, though patients under CRT improved in some memory functions. Positive effects of the TAR on facial affect recognition could also be replicated in forensic schizophrenia patients (study 3) and proved to be stable for at least 4–6 weeks after the end of training (studies 2, 3).
According to these results, improvements in disturbed facial affect recognition in schizophrenia patients are not obtainable with a traditional cognitive remediation program like CRT, but need a functional specific training like the newly developed TAR.
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