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2.
Artigo em Russo | MEDLINE | ID: mdl-31089103

RESUMO

AIM: To evaluate clinical and biological efficacy and safety of electroconvulsive therapy (ECT) in patients with treatment-resistant paranoid schizophrenia. MATERIAL AND METHODS: Determination of CNS specific biological markers (BDNF, NSE, S100B), together with markers of inflammation and CNS alteration (IL-2, CPK, CPK-MB), and clinical evaluation were performed in two groups of patients: the ECT + antipsychotic treatment group (n=66) and the antipsychotic treatment group (n=32). RESULTS AND CONCLUSION: In the ECT + antipsychotic treatment group, the more pronounced reduction of psychotic symptoms has been revealed compared with subjects on antipsychotic treatment as monotherapy. Patients receiving ECT showed no increase in plasma levels of inflammation and CNS alteration biomarkers (NSE, S100B, CPK, CPK-MB, IL-2). The plasma level of BDNF, capable to characterize both the efficacy and safety of antipsychotic therapy, had a more pronounced upward trend in subjects with combined electroconvulsive and antipsychotic treatment, which may indicate good tolerability and high effectiveness of ECT.


Assuntos
Antipsicóticos , Biomarcadores , Eletroconvulsoterapia , Esquizofrenia Paranoide , Antipsicóticos/uso terapêutico , Biomarcadores/sangue , Humanos , Transtornos Psicóticos , Esquizofrenia Paranoide/sangue , Esquizofrenia Paranoide/terapia , Resultado do Tratamento
3.
Asian J Psychiatr ; 39: 98-100, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30599452

RESUMO

Lesion-based investigations of psychopathology have preceded contemporary network-neuroscience initiatives. However, brain-lesions detected in routine psychiatric practice are often considered incidental and therefore ignored. Here, we illustrate a strategy to combine individual subject-level lesion information with open-source normative functional-connectomics data to make putative, neuroscience-informed symptom interpretation. Specifically, we report a patient with left precuneus granulomatous lesion and seizures followed by two distinct symptoms - kinetopsia and delusions of nihilism and guilt - which had a differential treatment response. The lesion-based brain-mapping approach could identify correlated (default-mode) and anti-correlated (temporo-parieto-occipital) networks, which enabled a neurobiological formulation of these diverse clinical manifestations.


Assuntos
Neoplasias Encefálicas/complicações , Transtorno Depressivo Maior/complicações , Granuloma/complicações , Imagem por Ressonância Magnética/métodos , Lobo Parietal/diagnóstico por imagem , Esquizofrenia Paranoide/complicações , Anticonvulsivantes/uso terapêutico , Antidepressivos de Segunda Geração/uso terapêutico , Antipsicóticos/uso terapêutico , Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/terapia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Diagnóstico Diferencial , Eletroconvulsoterapia , Feminino , Fluoxetina/uso terapêutico , Granuloma/diagnóstico por imagem , Granuloma/terapia , Humanos , Pessoa de Meia-Idade , Fenitoína/uso terapêutico , Fumarato de Quetiapina/uso terapêutico , Esquizofrenia Paranoide/psicologia , Esquizofrenia Paranoide/terapia , Convulsões/complicações , Convulsões/tratamento farmacológico
5.
Eur Psychiatry ; 55: 52-60, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30388425

RESUMO

BACKGROUND: Even if neurocognition is known to affect functional outcomes in schizophrenia, no previous study has explored the impact of cognition on functionality in delusional disorder (DD). We aimed to assess the effect of clinical characteristics, symptom dimensions and neuropsychological performance on psychosocial functioning and self-perceived functional impairment in DD. METHODS: Seventy-five patients with a SCID-I confirmed diagnosis of DD underwent neurocognitive testing using a neuropsychological battery examining verbal memory, attention, working memory and executive functions. We assessed psychotic symptoms with the Positive and Negative Syndrome Scale, and calculated factor scores for four clinical dimensions: Paranoid, Cognitive, Affective and Schizoid. We conducted hierarchical linear regression models to identify predictors of psychosocial functioning, as measured with the Global Assessment of Functioning scale, and self-perceived functional impairment, as measured with the Sheehan's Disability Inventory. RESULTS: In the final linear regression models, higher scores in the Paranoid (ß= 0.471, p < .001, r2 = 0.273) and Cognitive (ß = 0.325, p < .001, r2 = 0.180) symptomatic dimensions and lower scores in verbal memory (ß = -0.273, p < .05, r2 = 0.075) were significantly associated with poorer psychosocial functioning in patients with DD. Lower scores in verbal memory (ß= -0.337, p < .01, r2 = 0.158) and executive functions (ß= -0.323, p < .01, r2 = 0.094) were significantly associated with higher self-perceived disability. CONCLUSIONS: Impaired verbal memory and cognitive symptoms seem to affect functionality in DD, above and beyond the severity of the paranoid idea. This suggests a potential role for cognitive interventions in the management of DD.


Assuntos
Atenção , Cognição , Função Executiva , Transtornos Paranoides , Transtornos Psicóticos , Esquizofrenia Paranoide , Adulto , Terapia Cognitivo-Comportamental/métodos , Avaliação da Deficiência , Feminino , Humanos , Masculino , Memória , Pessoa de Meia-Idade , Testes Neuropsicológicos , Transtornos Paranoides/diagnóstico , Transtornos Paranoides/etiologia , Transtornos Paranoides/terapia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/terapia , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/psicologia , Esquizofrenia Paranoide/terapia , Autoavaliação , Habilidades Sociais
7.
Z Kinder Jugendpsychiatr Psychother ; 46(6): 536-541, 2018 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-30084713

RESUMO

Electroconvulsive Therapy (ECT) of a 15-year-old female patient suffering from a severe delusional depression: a case report Abstract. OBJECTIVE: Electroconvulsive Therapy (ECT) is a modern therapy of severe psychiatric disorders. However, ECT is rarely used in treating children and adolescents with psychiatric disorders. This case report refers about a 15-year-old female patient suffering from severe depressive episodes with psychotic symptoms treated with ECT. METHOD: After unsuccessful combined behavioral therapy and medication, the patient received a total of 11 ECT treatments with right unilateral electrode placement. The severity of depressive symptoms was assessed by self (BDI-II) and external (HDRS21) scores before, during and after treatment. RESULTS: A rapid decline of depressive symptoms was observed. CONCLUSION: ECT provides a safe and effective method for the treatment of severe depressive disorders in childhood and adolescence and should be included earlier than usual into the standard therapeutic concepts.


Assuntos
Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia , Esquizofrenia Paranoide/terapia , Adolescente , Terapia Combinada , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Seguimentos , Humanos , Olanzapina/uso terapêutico , Admissão do Paciente , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/psicologia , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia
8.
J Behav Ther Exp Psychiatry ; 61: 14-23, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29883776

RESUMO

BACKGROUND AND OBJECTIVES: The Threat Anticipation Model (Freeman, 2007) implicates social anxiety, jumping to conclusions (JTC) and belief inflexibility in persecutory delusions. We investigated whether Cognitive Bias Modification for Interpretation (CBM-I; Turner et al., 2011) improves social anxiety by targeting negative interpretation bias of ambiguous social information. We determined whether the Maudsley Review Training Programme (MRTP; Waller et al., 2011) improves JTC, belief inflexibility and paranoia. We also explored effects of CBM-I on JTC/belief inflexibility and paranoia, as well as the MRTP on social anxiety. METHODS: Twelve participants from Early Intervention and Recovery Services in East Anglia completed measures of social anxiety, paranoia, JTC and belief inflexibility. A concurrent multiple baseline case series design was used. RESULTS: Three of twelve participants improved in social anxiety following CBM-I, paranoia improved in 6/12 cases. CBM-I had no effect on JTC/belief inflexibility. The MRTP improved JTC and/or belief inflexibility in 9/12 cases, while improving paranoia for 6/12 individuals. The MRTP improved social anxiety in one case. LIMITATIONS: The small sample size and large effects necessary for single case series designs limit the generality of findings. These are discussed in more detail. CONCLUSIONS: This study suggests that whilst both CBM-I and the MRTP may have a positive impact on paranoia and social anxiety, the effects on JTC/belief inflexibility are largely specific to the MRTP. Relationships between social anxiety, JTC, belief inflexibility and paranoia existed in 10/12 individuals, supporting the Threat Anticipation Model.


Assuntos
Ansiedade/fisiopatologia , Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Transtornos Paranoides/fisiopatologia , Transtornos Paranoides/terapia , Desenvolvimento de Programas , Esquizofrenia Paranoide/fisiopatologia , Esquizofrenia Paranoide/terapia , Pensamento/fisiologia , Adulto , Serviços Comunitários de Saúde Mental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
9.
Psychiatriki ; 29(1): 15-18, 2018.
Artigo em Inglês, Grego Moderno | MEDLINE | ID: mdl-29754115

RESUMO

The Delusional Misidentification Syndromes (DMSs) are characterized by defective integration of the normally The Delusional Misidentification Syndromes (DMSs) are characterized by defective integration of the normally fused functions of perception and recognition. The classical sub-types are: the syndromes of Capgras, Fregoli,Intermetamorphosis (mentioned in 3) and Subjective doubles. These syndromes occur in a clear sensorium and shouldbe differentiated from the banal transient misidentifications occurring in confusional states and in mania and from thenon-delusional misidentifications (e.g. prosopagnosia). Joseph Capgras, who described the best-known sub-type, was indecisive on its pathogenesis. In his original report he defined the syndrome as "agnosia of identification" produced by a conflict between affective accompaniments ofsensory and mnemonic images. In his subsequent two publications, he considered the syndrome as a restitution delusionand as a psychopathological mechanism to hide incestuous desires. For more details see the chapter by J.P. Luaute in avolume on DMS. Psychodynamic approaches are, essentially, variants of the formulation that DMSs result from ambivalent feelings resolvedby directing hate feelings onto an imagined double in order to retain the original intact (and thus avoid guilt).These views have been voiced by David Enoch [relevant chapter in (3)] and with variations by many other investigatorsreviewed by Oyebode. Regression to archaic modes of thought (like thinking in terms of doubles and dualisms) due to personality disintegrationproduced by psychotic illness is a fascinating hypothesis by John Todd [mentioned in (1)]. However, if this was thecase, DMS should be much more frequent. Mayer-Gross and Ackner (mentioned in 9) had observed that when there is a delusional development, depersonalization-derealization experiences tend to be included within the delusional system. Such experiences usually precede orcoincide with the onset of DMS. In view of this, Christodoulou suggested that DMSs may represent delusional evolutions of depersonalization-derealization experiences. Similar mechanisms were proposed for false memories of familiarity,reduplicative paramnesia and autoscopy. Cerebral "dysrhythmia" has also been noted in patients with DMS. In view of clinical and prognostic similarities of DMSpatients with patients suffering from psychotic states occurring in an epileptic setting, many of these patients have beenconsidered as suffering from broadly speaking "epileptic" psychoses. Joseph [mentioned in (6)] suggested that organiccauses produce disconnection between right and left cortical areas that decode afferent sensory information. This resultsin the creation of a separate image in each hemisphere leading to an awareness of two, physically identical images. Ellis and Young [mentioned in (1) and (6)] have maintained that DMS may result from defects at different stages of aninformation processing chain. More specifically, the Capgras Syndrome appears when the route for unconscious recognitionis damaged. Similar mechanisms have been proposed for the rest of the subtypes. Margariti and Kontaxakis8 have considered that in DMS there is disruption of the ability to recognize identities ratherthan superficial appearance. Others have maintained that DMSs are multimodal neuropathologies and cannot be linkedto a single cognitive defect. Lastly, in view of the marked organic abnormalities detected in all DMS subtypes, DMSs have been linked with a greatnumber of organic conditions [reviewed in detail by Oyebode (5)]. According to Greek mythology, Procrustes was a bandit who stretched or amputated the limbs of his guests to fit hisiron bed. The DMSs do not deserve such treatment. Submitting them to the procrustean bed of uniformity should be avoided. People develop DMS for a variety of reasons. Most subjects have right hemisphere dysfunction but not exclusively.Their condition is associated not with one but with diverse phenomena (depersonalization - derealization, prosopagnosia,false memories of familiarity, autoscopy, reduplicative paramnesia etc.) similarities with psychotic phenomena associatedwith epilepsy have been suggested but this refers to some patients only. Additionally, the charged emotionalrelationship of the patient with the misidentified person(s) is neither necessary nor sufficient. Diagnostically speaking, many roads lead to DMS, ranging from the monosymptomatic and monothematic one (consideredas par excellence DMS) to that associated with disorders mainly of the schizophrenic or organic spectrum. DMScan also be reached by a more "superficial" road, the one of depression, in which the delusion is secondary and often dependenton the self-depreciation ideation. Speculating on these syndromes is a fascinating journey in psychopathologybut, although in most cases an organic contributor is present, yet the great diversity of conditions in the setting of whichDMSs occur renders the possibility of a unifying hypothesis unlikely.


Assuntos
Delusões/psicologia , Esquizofrenia Paranoide/psicologia , Transtornos Cognitivos/psicologia , Transtornos Cognitivos/terapia , Delusões/terapia , Humanos , Testes Neuropsicológicos , Psicoterapia Psicodinâmica , Esquizofrenia Paranoide/terapia
10.
Psychother Res ; 28(3): 457-469, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-27687477

RESUMO

OBJECTIVE: We sought to assess the efficacy of a manualized body-oriented psychotherapy (BPT) intervention for schizophrenia, by focusing on improvement of negative symptoms and on changes in interactional synchrony. We also explored aspects of a phenomenological theory of schizophrenia, which states that negative symptoms should be understood within an encompassing disturbance of subjectivity and intersubjectivity. METHOD: Sixteen persons with schizophrenia participated in 10 weeks of BPT. General psychiatric symptomatology and negative symptoms were assessed before and after therapy. Interactional synchrony was assessed via cross-correlations of movements between patient and interviewer in interviews conducted before and after therapy. RESULTS: Psychiatric symptomatology and negative symptoms significantly improved with a medium effect size. We also demonstrated a significant increase in interactional synchrony with a strong effect size. Post hoc analyses showed a significant increase only with open-ended interviews conducted by the same interviewer. Furthermore, we explored the correlation between negative symptoms and interactional synchrony, finding a large inverse relationship. CONCLUSIONS: BPT for schizophrenia may effectively reduce patients' negative symptoms and psychiatric symptomatology. Moreover, it may yield some recovery of pre-reflective social relations. Further evidence of the specific relation between negative symptoms and interactional synchrony would support a phenomenologically informed holistic view of schizophrenia.


Assuntos
Terapias Mente-Corpo/métodos , Relações Profissional-Paciente , Psicoterapia/métodos , Transtornos Psicóticos/terapia , Esquizofrenia Paranoide/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Z Evid Fortbild Qual Gesundhwes ; 126: 13-22, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29029972

RESUMO

PURPOSE: This paper describes the development of quality indicators for an external statutory and cross-sectoral quality assurance (QA) procedure in the context of the German health care system for adult patients suffering from schizophrenia, schizotypal and delusional disorders (F20-F29). METHODS: Indicators were developed by a modified RAND/UCLA Appropriateness Method with 1) the compilation of an indicator register based on a systematic literature search and analyses of health care claims data, 2) the selection of indicators by an expert panel that rated them for relevance and for feasibility regarding implementation. Indicators rated positive for both relevance and feasibility formed the final indicator set. RESULTS: 847 indicators were identified by different searches. Out of these, 56 were selected for the indicator register. During the formal consensus process the expert panel recommended another 45 indicators so that a total of 101 indicators needed to be considered by the panel. Of these, 27 indicators rated both relevant and feasible were included in the final set of indicators: this set included 4 indicators addressing structures, 19 indicators addressing processes and 4 indicators addressing outcomes. 17 indicators of the set will be reported by hospitals and 8 by psychiatric outpatient facilities. Two indicators considered to be cross-sectoral will be reported by both sectors. DISCUSSION: F20-F29 and its treatment show some specific features which so far have not been addressed by any procedure within the statutory QA program of the German health care system. These features include: Schizophrenia and related disorders a) are potentially chronic conditions, b) are mainly treated in outpatient settings, c) require a multi-professional treatment approach and d) are treated regionally in catchment areas. These specific features in combination with the peculiarities of some legal, political and organizational characteristics of the German health care system and its statutory QA program have strongly influenced the development of indicators. The result was a seemingly "imbalanced" set of indicators with a greater number of indicators for inpatient than for outpatient care despite the fact that clinical reality is otherwise. CONCLUSIONS: The circumstances of the German health care system that restricted the development of this cross-sectoral QA procedure addressing care for F20-F29 are also most likely to emerge with the development of cross-sectoral QA procedures for other (potentially) chronic conditions that are mainly treated in the outpatient setting by multi-professional teams or by networks of different providers. In order to be able to develop a QA procedure that mirrors the reality of service provision for (potentially) chronic diseases such as F20-F29 we need to explore further current and new data sources, diminish sectoral borders, and implement health care responsibility on the level of catchment areas.


Assuntos
Serviços de Saúde Mental/organização & administração , Programas Nacionais de Saúde , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Esquizofrenia Paranoide/terapia , Esquizofrenia/terapia , Transtorno da Personalidade Esquizotípica/terapia , Benchmarking/legislação & jurisprudência , Benchmarking/organização & administração , Benchmarking/normas , Documentação/métodos , Documentação/normas , Alemanha , Setor de Assistência à Saúde/legislação & jurisprudência , Setor de Assistência à Saúde/organização & administração , Setor de Assistência à Saúde/normas , Humanos , Serviços de Saúde Mental/legislação & jurisprudência , Serviços de Saúde Mental/normas , Programas Nacionais de Saúde/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/legislação & jurisprudência , Indicadores de Qualidade em Assistência à Saúde/normas , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/psicologia , Psicologia do Esquizofrênico , Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/psicologia
12.
Asian J Psychiatr ; 27: 113-114, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28558880

RESUMO

Culture plays an important role in the presentation, help seeking, treatment and outcomes of psychiatric illnesses like schizophrenia. We report a case of paranoid schizophrenia in a 35-year-old lady, from South India, whose clinical presentation was influenced by various sociocultural factors. These cultural constructs were taken into consideration to formulate an acceptable and effective management plan. A detailed case description using a cultural formulation to highlight the etic and emic perspectives and challenges in treatment and management are discussed.


Assuntos
Esquizofrenia Paranoide/etnologia , Adulto , Assistência à Saúde Culturalmente Competente , Feminino , Humanos , Índia/etnologia , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/terapia
14.
Transl Psychiatry ; 7(1): e1001, 2017 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-28094811

RESUMO

Little is known about the psychobiological mechanisms of cognitive behavioural therapy for psychosis (CBTp) and which specific processes are key in predicting favourable long-term outcomes. Following theoretical models of psychosis, this proof-of-concept study investigated whether the long-term recovery path of CBTp completers can be predicted by the neural changes in threat-based social affective processing that occur during CBTp. We followed up 22 participants who had undergone a social affective processing task during functional magnetic resonance imaging along with self-report and clinician-administered symptom measures, before and after receiving CBTp. Monthly ratings of psychotic and affective symptoms were obtained retrospectively across 8 years since receiving CBTp, plus self-reported recovery at final follow-up. We investigated whether these long-term outcomes were predicted by CBTp-led changes in functional connections with dorsal prefrontal cortical and amygdala during the processing of threatening and prosocial facial affect. Although long-term psychotic symptoms were predicted by changes in prefrontal connections during prosocial facial affective processing, long-term affective symptoms were predicted by threat-related amygdalo-inferior parietal lobule connectivity. Greater increases in dorsolateral prefrontal cortex connectivity with amygdala following CBTp also predicted higher subjective ratings of recovery at long-term follow-up. These findings show that reorganisation occurring at the neural level following psychological therapy can predict the subsequent recovery path of people with psychosis across 8 years. This novel methodology shows promise for further studies with larger sample size, which are needed to better examine the sensitivity of psychobiological processes, in comparison to existing clinical measures, in predicting long-term outcomes.


Assuntos
Encéfalo/fisiopatologia , Transtornos Psicóticos/terapia , Esquizofrenia Paranoide/terapia , Adulto , Sintomas Afetivos/psicologia , Tonsila do Cerebelo/diagnóstico por imagem , Tonsila do Cerebelo/fisiopatologia , Encéfalo/diagnóstico por imagem , Terapia Cognitivo-Comportamental , Reconhecimento Facial , Feminino , Neuroimagem Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiopatologia , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/fisiopatologia , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/fisiopatologia , Transtornos Psicóticos/diagnóstico por imagem , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/psicologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Esquizofrenia Paranoide/diagnóstico por imagem , Esquizofrenia Paranoide/fisiopatologia , Esquizofrenia Paranoide/psicologia , Percepção Social , Resultado do Tratamento
15.
Rev Esp Anestesiol Reanim ; 64(2): 105-107, 2017 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27424873

RESUMO

Neuroleptics are a group of drugs widely used in the treatment of psychotic symptoms. Among their adverse effects is the ability to trigger a neuroleptic malignant syndrome (NMS). The diagnosis of NMS is determined by exclusion, and its initial therapeutic management should be the withdrawal of neuroleptics, the administration of benzodiazepines, and electroconvulsive therapy (ECT). ECT is an effective treatment in these patients, and in those cases with a poor response to treatment with antipsychotic drugs. A review is presented on the treatment options and anaesthetic implications of ECT used to handle a patient diagnosed with paranoid schizophrenia in the context of NMS.


Assuntos
Androstanóis/administração & dosagem , Eletroconvulsoterapia , Síndrome Maligna Neuroléptica/terapia , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Esquizofrenia Paranoide/terapia , gama-Ciclodextrinas/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/farmacologia , Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Maligna Neuroléptica/etiologia , Monitoração Neuromuscular , Propofol/administração & dosagem , Propofol/farmacologia , Rocurônio , Esquizofrenia Paranoide/tratamento farmacológico , Sugammadex
19.
PLoS One ; 11(7): e0157635, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27391238

RESUMO

BACKGROUND: Schizophrenia spectrum disorders result in enormous individual suffering and financial burden on patients and on society. In Germany, there are about 1,000,000 individuals suffering from schizophrenia (SZ) or schizoaffective disorder (SAD), a combination of psychotic and affective symptoms. Given the heterogeneous nature of these syndromes, one may assume that there is a difference in treatment costs among patients with paranoid SZ and SAD. However, the current the national system of cost accounting in psychiatry and psychosomatics in Germany assesses all schizophrenia spectrum disorders within one category. METHODS: The study comprised a retrospective audit of data from 118 patients diagnosed with paranoid SZ (F20.0) and 71 patients with SAD (F25). We used the mean total costs as well as partial cost, i.e., mean costs for medication products, mean personal costs and mean infrastructure costs from each patient for the statistical analysis. We tested for differences in the four variables between SZ and SAD patients using ANCOVA and confirmed the results with bootstrapping. RESULTS: SAD patients had a longer duration of stay than patients with SZ (p = .02). Mean total costs were significantly higher for SAD patients (p = .023). Further, we found a significant difference in mean personnel costs (p = .02) between patients with SZ and SAD. However, we found no significant differences in mean pharmaceutical costs (p = .12) but a marginal difference of mean infrastructure costs (p = .05) between SZ and SAD. We found neither a common decrease of costs over time nor a differential decrease in SZ and SAD. CONCLUSION: We found evidence for a difference of case related costs of inpatient treatments for paranoid SZ and SAD. The differences in mean total costs seem to be primarily related to the mean personnel costs in patients with paranoid SZ and SAD rather than mean pharmaceutical costs, possibly due to higher personnel effort and infrastructure.


Assuntos
Custos de Cuidados de Saúde , Transtornos Psicóticos/economia , Transtornos Psicóticos/terapia , Esquizofrenia Paranoide/economia , Esquizofrenia Paranoide/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Registros Eletrônicos de Saúde , Feminino , Alemanha , Humanos , Masculino , Serviços de Saúde Mental/economia , Pessoa de Meia-Idade , Psiquiatria/economia , Transtornos Psicofisiológicos/economia , Estudos Retrospectivos , Adulto Jovem
20.
Rev Peru Med Exp Salud Publica ; 33(1): 100-5, 2016 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-27384628

RESUMO

With the purpose of describe the profile of use of electroconvulsive therapy (ECT) on hospitalized patients at "Honorio Delgado - Hideyo Noguchi" National Institute of Mental Health in Lima, Peru, the medical records of patients receiving ECT between 2001 and 2011 were reviewed. The main findings were: four hundred and nineteen ECT courses were applied to 372 patients, with a total of 5439 applications the most common diagnosis was paranoid schizophrenia (70.7%), the most common indication was resistance to treatment (80.7%), also the clinical response to ECT was good in 70.1% of cases while side effects were generally transient and mild. The use of ECT decreased over the period of the study but it was tolerable and safe, especially in the modified version, and it had a high response rate so remains as a first-line psychiatric treatment.


Assuntos
Eletroconvulsoterapia , Hospitais Públicos , Esquizofrenia Paranoide/terapia , Humanos , Peru
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