Cost-effectiveness and budget impact of long-acting risperidone in Portugal: a modeling exercise.

BACKGROUND: Previous analyses have shown that long-acting risperidone (LAR) is cost-effective in several Western countries. In Portugal, however, the costs of key services are lower. Therefore, available evidence in other countries may have limited relevance. OBJECTIVE: To estimate costs and effects of LAR versus a conventional depot and a short-acting oral atypical antipsychotic over a 5-year period in Portugal. METHODS: An existing discrete event model was adapted to reflect the Portuguese healthcare setting, based on expert opinion, clinical, epidemiological, and cost data. The model compares three scenarios. In scenario 1, patients start with a conventional depot; in scenario 2, with LAR; and in scenario 3, with oral risperidone. The model simulates individual patient histories while taking into account patient characteristics such as risk to society and side-effects. Subsequently, the model simulates patient histories in terms of outpatient appointments, psychotic episodes, treatment, compliance, symptom scores, lack of ability to take care presenting an actual risk, and treatment setting. Outcomes were number of psychotic episodes, cumulative symptom score and direct medical costs. Univariate sensitivity analyses were carried out. RESULTS: Compared to a conventional depot and an oral atypical, LAR was estimated to save approximately euro 3603 and euro 4682 per patient (respectively) and avoid 0.44 and 0.59 relapses per patient in 5 years. Sensitivity analyses showed that the outcome of dominance was only sensitive to estimates about unit costs of hospital/institutionalization, potential risk, and to the reduction in symptoms by use of atypicals. CONCLUSION: Based on this modeling exercise, it could be expected that LAR may be a cost-effective treatment with limited budget impact in Portugal. However, further studies are required to test the generalizability of the results of the present modeling study to the larger population of Portugal.

[Response to electroconvulsive therapy in a case of erotomania]. / Respuesta a la terapia electroconvulsiva en un caso de erotomanía.

Secondary erotomania has mainly been associated with functional psychosis (especially schizophrenia) and bipolar disorder. Traditionally, erotomania has been considered chronic and refractory to treatment, although cases of secondary erotomania with response to benzodiazepines, lithium, anticonvulsivants, antipsychotic drugs and electroconvulsive therapy have been described. In this paper, we present a clinical case of secondary erotomania related to paranoid schizophrenia with good response to electroconvulsive therapy and neuroleptics. Actas Esp Psiquiatr 2003;31(6):361-363

[Interface neurology/psychiatry: a case report of neurosyphilis]. / Interfaz neurología/psiquiatría: un caso de neurosífilis.

Organic diseases can occur with different psychiatric symptoms. Neurosyphilis was considered to be a landmark in the history of organic mental syndromes. The complexity of its clinical picture decreases the boundaries between Neurology and Psychiatry and requires a multidisciplinary approach. We report a case of neurosyphilis that began with psychiatric symptoms in a twenty five years old male.

The origin of dementia praecox.

Throughout history, insanity--including dementia praecox--has been a complex problem. In the search for a better understanding of dementia praecox, several theories arose from the pre-Kraepelinian concept of human madness that led to the proposal of a new definition in anatomicoclinical terms. This short historical review begins in classical times and ends with the formulation of the concept of dementia praecox in 1896 by Emil Kraepelin (1856 1926).

[Rheumatoid arthritis: various psychosomatic aspects]. / Artritis reumatoide: algunos aspectos psicosomáticos.

The rheumatoid arthritis has been considered as a model for the psychosomatic approach in Medicine. The authors present a research in this perspective, trying to evaluate some psychological variables using appropriated rating scales: the self concept, the coping mechanisms and some symptoms like anxiety and depression. A group of diabetics insulin-dependents was the control group.

A double-blind trial comparing mianserin and maprotiline in depressed inpatients.

The antidepressant effects and side effects of mianserin and maprotiline were assessed in a double-blind trial in 62 inpatients (34 men and 28 women; mean age, 43.6 years) with primary depressive illness. For the first week of the trial, 32 patients received 30 mg/day of mianserin and 30 patients received 75 mg/day of maprotiline; for the next three weeks, the dosage of each drug was doubled. According to scores on the Hamilton Psychiatric Rating Scale for Depression, administered on days 0, 7, 14, 21, and 28, the antidepressant effects of the two drugs were virtually identical. Results of electrocardiographic and vectorcardiographic recordings and other measurements indicated that by day 28 the QRS duration was significantly longer (P less than 0.05) in the maprotiline group. On days 14 and 28, mean systolic blood pressure was significantly higher (P less than 0.05) in the maprotiline group. By day 28, the incidence of anticholinergic side effects--constipation and dry mouth--was significantly higher (P less than 0.05) in the maprotiline group. Although maprotiline's effects on heart functions never reached clinical significance, its anticholinergic side effects could be bothersome, especially to older patients.