Schizophrenia bulletin
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Schizophrenia bulletin · Jan 2004
Multicenter Study Clinical TrialEffectiveness of atypical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment.
This study prospectively compared the effectiveness of atypical antipsychotic medications to that of conventional neuroleptics in reducing violent behavior among patients with schizophrenia under "usual care" conditions in the community. Participants (n = 229) were adults with schizophrenia spectrum disorders receiving inpatient or outpatient services in public sector mental health systems in North Carolina. Subjects were followed for 2 years in an observational study using multiple methods of data collection at 6-month intervals to assess treatment, sociodemographic characteristics, clinical features, and violence outcomes. ⋯ A cumulative effect on reduced violence was attributable to consistent compliance with atypical antipsychotic medications over a 2-year period. Concurrent reductions in psychotic symptoms, substance abuse, and adverse medication side effects were found to mediate the association between adherence with atypicals and lower violence risk. Treatment with atypical antipsychotic medications should be considered as an important component of violence risk management for schizophrenia patients at risk for violent behavior.
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Schizophrenia bulletin · Jan 2004
Case ReportsAssisted and surrogate decision making for pregnant patients who have schizophrenia.
Because of a dearth of literature, we developed preventive ethics strategies for managing the pregnancies of patients with schizophrenia. Schizophrenia can chronically and variably impair a woman's decisions concerning the management of pregnancy, including the decision about whether to continue the pregnancy through to viability and term. The psychiatrist must balance autonomy-based and beneficence-based obligations to the pregnant woman with schizophrenia, and both the psychiatrist and pregnant woman have beneficence-based obligations to the fetus when the fetus is a patient. ⋯ This should be guided by the substituted judgment standard. When patients' values are not known or have not been consistently held over time, surrogate decision making should be guided by the best interests standard. These strategies should substantially enhance patients' autonomy in the psychiatrist-patient relationship and contribute to the quality of their psychiatric and obstetric care.
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Schizophrenia bulletin · Jan 2004
Current and future forecasts of service use and expenditures of Medicaid-eligible schizophrenia patients in the state of Georgia.
This study linked all claims data for reimbursable medical services and drugs of a cohort of 16,227 Medicaid-eligible recipients diagnosed with schizophrenia residing in the State of Georgia, with the treatment history file and Hospital Medical Information System file of each of the ten Georgia State psychiatric hospitals (Georgia Department of Human Resources [DHR]), which do not routinely bill Medicaid for services rendered. This provided a comprehensive picture of the medical resources consumed for each schizophrenia patient, allowing determination of expenditure use patterns, as well as forecast of future medical costs. Patient-level data were aggregated by category of service and reported as costs per member per month (PMPM). ⋯ Prescription expenditures increased from 50 dollars in 1990 to 100 dollars PMPM in 1997 and were projected to increase to 150 dollars in 2002. Expenditures were lower for persons continuously eligible for Medicaid than for the total cohort. Trends include a significant increase in prescription expenditures over time concurrent with decreases in inpatient expenditures and relatively stable changes in community mental health center expenditures.