摘要:

Despite a wealth of national treatment guidelines, algorithms, and clinical literature detailing the successful treatment of patients with depressive disorders, there remains a large gap between what is known to be ideal treatment of depression and the reality of current practice. Depression in primary care settings continues to be under-recognized, and when diagnosed, is often inadequately treated. A host of factors contribute to this concern, including both patient and clinician factors. The fundamental approach to narrowing this gap and improving treatment outcome in patients with depressive disorders is one of education.Public education initiatives have sought to lessen the stigma associated with depression and its treatment. Professional education efforts have been primarily directed toward improving diagnostic skills and increased use of screening tools. Individual patient education approaches focus on specific information such as onset of antidepressant effect, expected duration of therapy, identification and correction of patients’ misconceptions about depression and antidepressants, and discussion of what to do if adverse effects occur. Such interventions can all contribute to a more successful treatment outcome for depressive disorders.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

There is abundant evidence for the incapacity and reduction in quality of life experienced by individuals with migraine and also for a somewhat unsympathetic attitude from the 80% or so of the population who do not experience recurrent incapacitating headaches. The burden of migraine is reviewed and it is noted that despite the manifest difficulties faced by those with the disease, there appears to be a reluctance to consult physicians about the problem and a disinclination of many physicians to take recurrent headaches seriously. The role of the patient is therefore to conduct a personal evaluation as to the effects of the headache; to learn about what is known of the causes, triggers and management options in migraine; and to feel empowered enough to consult a primary care physician and, if necessary, a neurologist when the debilitating effect of the syndrome is recognized.It is appropriate to teach individuals with migraine about the more characteristic features of the condition, so that they will embrace the diagnosis and be content to forego fruitless investigations. They should also be aware of the frequent concurrence of other headache types, of the dangers of over-frequent medication, of the necessity of following a drug regimen (as well as dietary and other lifestyle changes) and of the value of prophylactic medications. Patients should also be proactive in educating the rest of the public, in order to create an understanding environment for those developing this condition in the future.With regard to the treatments that can be employed, patients should become educated about the indications for prophylaxis, the nature of the agents available and their potential unwanted effects and about the delay before any response is seen in many cases. It is useful for those with migraine to go to one of the websites where the impact of their disorder can be pointed out to them by means of tests such as the Headache Impact Test or the Migraine Disability Assessment Scale.Differentiation of oncoming severe from milder headaches is valuable if the patient learns the signs that indicate one or the other type; again, patients must know something of the nature of the various agents available, including their benefits and their limitations. They should also be keenly aware of the causes and characteristics of medication-induced headaches, and of the other unwanted effects of frequent ingestion of analgesics. While the new and effective medications for migraine have provided huge relief from this disorder worldwide, there is much more to migraine therapy than drugs, and it is especially in the non-pharmacological field that patients themselves must assume responsibility for the management of their disorder. Education is thus the key to effective migraine care.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

ObjectiveTo determine whether the increased acquisition costs associated with the atypical antipsychotic risperidone are offset by reductions in other mental health care utilisation and expenditure.Design and settingThe study was population-based and used South Carolina Medicaid claims data to determine changes in mental healthcare utilisation and expenditures related to schizophrenia. Changes in mental health−related utilisation and expenditures over time were calculated; total mental health−related expenditures and utilisation were disaggregated into pharmaceuticals, inpatient hospitalisations, and ambulatory and inpatient physician services [Health Care Financing Administration (HCFA) 1500 claims]. Groups of patients were compared for two 6-month periods preceding the initial prescription (pre1 and pre2), and two 6-month periods following the initial prescription (post1 and post2). Costs were discounted to the index date.PerspectivePayor (South Carolina Medicaid).PatientsThose patients with schizophrenia who received initial prescriptions for risperidone (n = 862), haloperidol (n = 325) or clozapine (n = 66) between February 1994 and June 1995 (index date).Main outcome measures and resultsThe mean increase in level of expenditure per person for pharmaceuticals from the pre- to the post-treatment period was significantly greater in the risperidone [751 US dollars ($US)] and clozapine ($US1423) groups than in the haloperidol group ($US6). However, the change in mean level of total mental healthcare expenditure per person was not significantly different for the risperidone group ($US832) compared with the haloperidol group ($US540) over the same time period, but the increase in the clozapine group was significantly higher ($US2500.23; p < 0.0001 for clozapinevsrisperidone and clozapinevshaloperidol).As the difference between the risperidone and haloperidol groups in pharmaceutical expenditures was not reflected in total mental healthcare expenditures, the remaining component costs were investigated to identify where the difference was offset. Compared with haloperidol, risperidone had a significantly smaller change in per person mean level of ambulatory and inpatient physician services claims for expenditure ($US692vs$US269, p = 0.01) and utilisation (+1.70vs−0.21, p < 0.0001).ConclusionsBased on these findings, we conclude that, in this population of patients with schizophrenia increased costs associated with risperidone were offset by decreases in other mental healthcare utilization. Risperidone is a technical substitute for ambulatory healthcare services.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

According to the WHO, approximately 350 million people have chronic hepatitis B. Individuals with chronic hepatitis B have a highly variable and unpredictable clinical course and are at risk for developing cirrhosis and hepatocellular carcinoma. Lamivudine is the only oral antiviral agent approved for the treatment of patients with chronic hepatitis B.Lamivudine is useful in a wide range of patients with chronic hepatitis B and ongoing viral replication. In patients with compensated liver disease treated for 52 weeks in multicenter randomized, double-blind clinical studies, lamivudine 100 mg/day inhibited hepatitis B virus (HBV) replication, normalized ALT levels, produced significant reductions in hepatic necroinflammatory activity and halted the progression of fibrosis compared with placebo. Hepatitis B e antigen (HBeAg) seroconversion rates were also increased during treatment with the drug compared with placebo.In patients who continued to receive the drug after the completion of these trials, improvements in liver histology were maintained and HBeAg seroconversion rates increased in proportion to the duration of treatment.Pretreatment ALT levels were predictive of HBeAg seroconversion. In patients with baseline ALT levels ≥2-fold higher than the upper limit of normal, seroconversion rates were significantly higher than in those with lower baseline values.Data from 2 randomized studies indicate that sequential therapy with lamivudine for 8 weeks and then lamivudine plus interferon-α for 16 weeks provides no greater benefit than that of monotherapy with lamivudine for 52 weeks or interferon-α for 16 weeks.According to data from noncomparative studies, lamivudine 100 or 150 mg/day resulted in clinical stabilization, significant reductions in Child-Pugh-Turcotte scores and loss of HBeAg in many patients with decompensated liver disease. Moreover, some patients have been placed on inactive status for liver transplantation after treatment with the drug.Lamivudine-resistant HBV variants have been isolated from patients with chronic hepatitis B during treatment with lamivudine. The prevalence of these variants increases with the duration of treatment; however, their long term clinical significance has not been established.Lamivudine is well tolerated. The frequency of adverse events in lamivudine or placebo recipients was similar in a pooled analysis of clinical trial data. Nonetheless, patients must be monitored for the emergence of lamivudine-resistant variants and elevated liver enzyme levels (ALT flares).In a series of economic models, use of lamivudine was predicted to reduce the cost per case of cirrhosis prevented and increase mean life expectancy compared with use of interferon-α in the US. Other analyses, which incorporated a fixed drug budget scenario, concluded that use of lamivudine would increase the number of successfully treated patients by 2- to 3-fold compared with interferon-α, because of lower acquisition costs.In conclusion, lamivudine is useful in a wide range of patients with chronic hepatitis B and ongoing viral replication.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS