1,721,041 research outputs found
Cost and outcome implications of using typical and atypical antipsychotics in ordinary practice in Italy
No full textBackground: It is uncertain whether atypical antipsychotic agents, as prescribed in ordinary practice, are a cost-effective alternative to conventional agents. This study examined the financial and clinical implications of using atypical antipsychotics in the context of community psychiatric care in Italy. Method: Service costs and outcome data over a 24-month period (June-November 1999 to June-November 2001) were compared between 2 cohorts of ICD-10-diagnosed subjects, the first including patients receiving atypical and the second typical antipsychotics, according to the type of treatment received at the beginning of the study. Results: At baseline, 183 subjects were under treatment with antipsychotic drugs, of whom 73 were treated with atypical agents. Most patients had a diagnosis of schizophrenia and only a minority were first-contact patients. Conventional antipsychotics were used in more chronic and elderly patients, while atypicals were prescribed in more severe and recently diagnosed cases. After background group differences were controlled for, the use of atypical agents was neither predictive of higher total health care costs nor of better patient outcome. Predictors of higher costs and better outcome were severity of illness at baseline and first-contact patients. Conclusions: The introduction of atypical agents had a small impact in terms of total health care costs and outcome, and more important than the agent prescribed was the severity of illness
Epidemiological impact of antidepressant and antipsychotic drugs on the general population
No full textPURPOSE OF REVIEW: To analyse the prevalence of and sex and age distribution associated with antidepressant and antipsychotic drug exposure in the general population and to highlight recent epidemiological findings concerning specific adverse outcomes associated with drug exposure. RECENT FINDINGS: Epidemiological studies indicate high rates of second-generation antidepressant and antipsychotic drug use in the general population. The use is more prevalent among women than among men, and in older rather than in younger age groups. A new pattern of adverse outcomes has been described in individuals exposed to newer agents, including a possible risk of suicidal acts in adults receiving second-generation antidepressants, the risk of cerebrovascular events in older individuals receiving second-generation antipsychotics and the risk of metabolic disturbances in individuals exposed to specific second-generation antipsychotics. SUMMARY: The assessment of, and attention to, the development of specific adverse reactions in individuals exposed to second-generation psychotropic drugs may improve treatment outcomes. © 2006 Lippincott Williams & Wilkins
Economic evaluation of antidepressive agents: a systematic critique of experimental and observational studies
No full textThe purpose of this study was to examine whether experimental and observational pharmacoeconomic analyses of antidepressant drugs support the choice of one of the selective serotonin reuptake inhibitors or newer antidepressants as first-line treatment for patients with major depression. We systematically reviewed economic evaluations of two or more antidepressants completed in clinical practice. A systematic electronic search yielded 38 studies meeting the inclusion criteria, of which 23 were administrative database analyses, 12 were observational studies, and 3 were randomized clinical trials. Experimental data indicated that tricyclic antidepressants are equivalent to selective serotonin reuptake inhibitors in terms of total expenditure. While the database analyses are susceptible to bias and confounding variables, they provided an added dimension based on observations from everyday clinical practice. The majority of these studies failed to show any significant difference. Taken together, available pharmacoeconomic studies indicate that tricyclic drugs and selective serotonin reuptake inhibitors have similar cost effectiveness in the health care systems where these comparisons have been made
Head-to-head economic comparisons between atypical antipsychotics: are there any relevant differences? A systematic review
No full textMental Health Services in Lombardy during COVID-19 outbreak
No full textLombardy is the Region in Italy the most heavily affected by coronavirus disease (COVID-19) contagion. The Regional Health Authority mandates that mental health services should be guaranteed, identifying mental health as a priority for their citizens. Recommendations for occupational and health safety have been provided to patients and hospital staff, including support for telemedicine activities and remote psychosocial interventions. Services of the Mental Health Departments of Milano “Niguarda” and Brescia “Spedali Civili” Hospitals are providing continued care at a community, residential and hospital level, and to positive COVID-19 psychiatric patients in need of hospitalization
Past use of selective serotonin reuptake inhibitors and the risk of cerebrovascular events in the elderly
No full textTreatment with selective serotonin reuptake inhibitors (SSRIs) has been associated with intracranial bleeding abnormalities. We investigated the relationship between past exposure to SSRIs and occurrence of cerebrovascular accidents in the elderly. From the regional database of hospital admissions of Lombardy, Italy, we extracted all patients aged 65 years or above with cerebrovascular-related outcomes for the year 2002. From the regional database of prescriptions reimbursed by the National Health Service, we extracted all patients aged 65 years or above who received antidepressant prescriptions during 2001. The two databases were linked anonymously using the individual patient code. The analysis showed that the proportion of cerebrovascular events in those exposed to SSRIs was 135/66 335 [0.20%, 95% confidence interval (Cl) 0.17-0.24], whereas the proportion of cerebrovascular accidents in those exposed to tricyclic antidepressants (TCAs) was 28/18 620 (0.15%, 95% Cl 0.09-0.21). After background group differences were controlled for, exposure to SSRIs did not increase the risk of accidents (adjusted odds ratio 1.31, 95% Cl 0.87-1.97). Although the risk of cerebrovascular accidents is a rare but serious event that should carefully be monitored during antidepressant therapy, this study indicated an absence of difference between TCAs and SSRIs. © 2005 Lippincott Williams & Wilkins
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