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Interferon research abs 1 || Hemoglobin research abs || Stem cell research abs || Nucleic acid research abs || Herpes research abs || Bronchitis research abs || Schizophrenia research abs

Med Care. 2002 Aug;40(8):630-9.
Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission.

Valenstein M, Copeland LA, Blow FC, McCarthy JF, Zeber JE, Gillon L, Bingham CR, Stavenger T.

From the Department of Veterans Affairs, Serious Mental Illness Treatment, Research, and Evaluation Center (SMITREC), Health Services Research and Development (HSR&D) Center for Excellence, Ann Arbor, MI 48113-0170, USA. marciamich.edu

BACKGROUND: Health care organizations may be able to use pharmacy data to identify patients with schizophrenia and poor antipsychotic adherence. OBJECTIVE: To determine whether a pharmacy-based measure of outpatient adherence, the medication possession ratio (MPR), is associated with adverse outcomes among patients with schizophrenia, as evidenced by increased psychiatric admission. RESEARCH DESIGN: Cohort study linking pharmacy and utilization data for veterans with schizophrenia. MPRs were calculated by dividing the number of days' supply of antipsychotic medication the veteran had received by the number of days' supply they needed to receive to take their antipsychotic continuously. Using multivariate regression, the relationship between MPRs and psychiatric admission was examined. SUBJECTS: Sixty-seven thousand seventy-nine veterans who received a diagnosis of schizophrenia and had outpatient antipsychotic medication fills between October 1, 1998 and September 30, 1999. RESULTS: Patients with MPRs close to 1.0 had the lowest rates of admission. As patients secured progressively smaller proportions of required antipsychotic medication (and had smaller MPRs), rates of admission climbed. Among patients on one antipsychotic (n = 49,003), patients with poor adherence (MPRs < 0.8) were 2.4 times as likely to be admitted as patients with good adherence (MPRs from 0.8-1.1). 23% of poorly adherent patients but only 10% of adherent patients were admitted. Once admitted, poorly adherent patients had more hospital days. Patients who received excess medication also had higher admission rates. CONCLUSIONS: Many health care systems may be able to use pharmacy data to identify poorly adherent patients with schizophrenia. These patients are at-risk for admission and may benefit from intervention.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12187177&dopt=Abstract

Soc Sci Med. 2003 Jan;56(2):299-312.
Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals.

Schulze B, Angermeyer MC.

University of Leipzig, Department of Psychiatry, Johannisallee 20, 04317 Leipzig, Germany. BeateMSchulzeb.de

Schizophrenia has been found to be one of the most stigmatising conditions. To the present, most research on stigma related to mental illness has drawn conclusions on the adverse reactions faced by people with schizophrenia from studies on public attitudes or analogue behavioural studies. The views of those exposed to the stigmatising reactions, however, has largely been absent. Aiming to explore stigma from the subjective perspective of people with schizophrenia, a focus group study was carried out at the four centres involved in the WPA Global Programme against Stigma and Discrimination because of Schizophrenia in Germany. In order to get a comprehensive picture of how stigma affects the lives of schizophrenic patients, collateral information was sought from relatives and mental health professionals. The focus groups enquired about concrete stigmatisation experiences of the patients and incidences of stigma witnessed by the other two groups. Focus group sessions were tape-recorded and transcripts were coded using an inductive method. Results reveal four dimensions of stigma: interpersonal interaction, structural discrimination, public images of mental illness and access to social roles. Examples are given for the views of patients, relatives and mental health professionals on each of the four stigma types. The consequences for conceptualisations of stigma and the development of effective strategies to reduce stigma and discrimination because of schizophrenia are discussed. 2002 Elsevier Science Ltd.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12473315&dopt=Abstract

J Med Philos. 2002 Jun;27(3):287-96.
The molecular turn in psychiatry: a philosophical analysis.

Rudnick A.

Department of Behavioral Sciences, Tel Aviv University School of Medicine, Tel Aviv 69978, Israel.

Biological psychiatry has been dominated by a psychopharmacologically-driven neurotransmitter dysfunction paradigm. The objective of this paper is to explore a reductionist assumption underlying this paradigm, and to suggest an improvement on it. The methods used are conceptual analysis with a comparative approach, particularly using illustrations from the history of both biological psychiatry and molecular biology. The results are that complete reduction to physicochemical explanations is not fruitful, at least in the initial stages of research in the medical and life sciences, and that an appropriate (non-reducible) integrative principle--addressing a property of the whole system under study--is required for each domain of research. This is illustrated in Pauling's use of a topological integrative principle for the discovery of the functioning of proteins and in Watson and Crick's use of the notion of a genetic code as an integrative principle for the discovery of the structure of genes. The neurotransmitter dysfunction paradigm addresses single molecules and their neural pathways, yet their interactions within the CNS as a whole seem most pertinent to mental disorders such as schizophrenia. The lack within biological psychiatry of an integrative principle addressing a property of the CNS as a whole may be responsible for the empirical failure of orthomolecular psychiatry, as well as for the central role that serendipity has played in the study of mental disorders, which is dominated by the neurotransmitter paradigm. The conclusion is that research in biological psychiatry may benefit from using, at least initially, some integrative principle(s) addressing a property of the CNS as a whole, such as connectionism or a hierarchical notion.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12187435&dopt=Abstract

Prog Neuropsychopharmacol Biol Psychiatry. 2002 May;26(4):651-61.
The effects of benzodiazepines on event-related potential indices of automatic and controlled processing in schizophrenia: a preliminary report.

Murakami T, Nakagome K, Kamio S, Kasai K, Iwanami A, Hiramatsu K, Fukuda M, Hata A, Honda M, Watanabe A, Kato N.

Department of Neuropsychiatry, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.

The effects of benzodiazepines on cognitive function in schizophrenic patients were investigated using event-related potential (ERP) measurement during an auditory selective attention task. In this study, the authors compared the mismatch negativity (MMN) and N2b components between two subgroups of schizophrenic patients: one is comprised of patients who received no benzodiazepines (NT group, n = 7) and the other is comprised of those administered benzodiazepines in the daytime (T group, n = 7). There were no significant differences in MMN and N2b amplitudes between the two subgroups, whereas the N2b latency was significantly prolonged in the T group relative to the NT group. This suggested that benzodiazepines induce delayed stimulus classification processing in schizophrenic patients.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12188096&dopt=Abstract

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