[Comparison of efficacy of psychiatric treatment versus treatment in general medicine]. / Vergelijking van effectiviteit van psychiatrische behandelingen met die van somatische behandelingen.

BACKGROUND: There is increasing attention to the costs and efficacy of health care and in particular to psychiatry. To weigh the costs and benefits appropriately, it is important to be able to compare effects.
AIM: To describe the efficacy of psychiatric treatment compared to treatment in general medicine.
METHOD: Narrative review.
RESULTS: The average effect size of psychiatric treatment was 0.49 and that of general medicine treatment 0.45. The effect size of psychotherapy varied from 0.3 - 0.84, but in a meta-analysis, corrected for publication bias, the effect size average amounted to only 0.39.
CONCLUSION: The average efficacy of psychiatric treatments is similar to the efficacy of treatments in general medicine. However, there is a large variation in efficacy within the two treatment areas. The variation is even larger in the treatment results for individual patients. The main objective of 'personalised medicine' is to tailor the type of treatment to the particular symptoms of the individual patient so that he or she will not be exposed to types of treatment that are not strictly relevant to the patient's symptoms or illness. In view of the limited and less-than-perfect results of treatment and medication in the entire medical field, 'personalised medicine' seems to be a goal worth striving for in order to improve treatment outcomes.

Cross-elicitation responses to 2-methoxymethyl-p-phenylenediamine under hair dye use conditions in p-phenylenediamine-allergic individuals.

BACKGROUND: The factors influencing elicitation responses in individuals allergic to p-phenylenediamine (PPD) in hair dyes are not well understood. OBJECTIVES: Investigation of the elicitation response to the new, less-sensitizing PPD alternative 2-methoxymethyl-p-phenylenediamine (ME-PPD) under simulated hair dye use conditions. METHODS: The cross-elicitation response to ME-PPD (2% in a hair dye test product for 30 min on forearm then rinsing) was analysed at days 2 and 3 in 30 PPD-allergic individuals with diagnostic patch test grades +, ++ or +++ according to the classification of the International Contact Dermatitis Research Group. RESULTS: Cross-reactivity to the ME-PPD-containing hair dye test product was elicited in nine of 30 subjects (30%), while 70% were negative. Cross-reactivity was elicited in two of four cases with grade +++, three of 10 with grade ++ and four of 16 with grade +. Under identical conditions, PPD was previously found to elicit a response in 21 of 27 PPD-allergic individuals. In 18 of these 21 individuals, either the strength of the cross-elicitation response to ME-PPD was decreased or no response occurred. CONCLUSIONS: Under simulated hair dye use conditions, a significantly lower degree of cross-elicitation to ME-PPD (30%) was observed than previously reported for PPD (32 of 38, 84%). Additionally, a decreased cross-elicitation strength was observed across all three patch test grades, likely reflecting the reduced skin-sensitization properties of ME-PPD. Consequently, careful dermatological evaluation is required to assess cross-reactivity to ME-PPD in patients allergic to hair dyes.

Assessment of the elicitation response in subjects weakly sensitized to p-phenylenediamine.

BACKGROUND: A 30-min application of a hair dye product containing 2% p-phenylenediamine (PPD) to subjects diagnostically graded +, showed that 12 of 18 reacted; eight of 18 with a true + and four of 18 with a doubtful (?+) response, whereas six of 18 did not react at all. In vitro skin-binding experiments showed that for diagnostic patch test conditions the measured exposure level (MEL) is more than 10-fold higher than the MEL for hair dyeing conditions. OBJECTIVE: To further analyse the limited elicitation response of the diagnostically + graded subjects to a PPD hair dye product, under standardized test conditions mimicking product usage, by varying exposure time and dose. METHODS: A hair dye model formulation containing 2% PPD, applied for 30, 45 and 60 min and a diagnostic PPD TRUE test(®) were applied to assess elicitation responses to increasing PPD exposure levels. Grading was performed according to International Contact Dermatitis Research Group guidelines. RESULTS: Six subjects were available for this follow-up study. One of six subjects responded with a + elicitation response to the hair dye model applied for 60 min. Four of the five remaining subjects elicited a + response to the PPD TRUE test(®) applied subsequently, while one of five responded doubtfully. CONCLUSIONS: Increasing the PPD exposure time twofold--resulting in a 5-6% increase of sensitivity of this hair dye model test--or further extending the exposure time 48-fold, was found sufficient to increase the MEL above the thresholds needed to elicit individuals with a + diagnostic PPD patch test who did not react to typical hair dye use conditions with a MEL of about 6·8 µg cm⁻². This analysis confirms that consideration of the MEL is a useful tool to better characterize thresholds of elicitation than consideration of the applied dose alone.