摘要:

The consequences of psychotic relapse have been found to be damaging to both psychiatric clients and their families, as well as having a detrimental effect on the financial resources of mental health services. As a result of these findings, it is viewed that effective relapse prevention should form an integral component of standard psychiatric care.The prodromal phase of psychosis offers an important window of opportunity for such intervention, and also appears to contain a predictive feature in the progression of an individual's psychosis. The prodromal phase is perhaps best viewed as the emergence of early signs, and signifies the onset of psychotic relapse.A number of techniques have been developed to address the issue of relapse prevention, including pharmacological and cognitive-behavioral therapy (CBT) approaches. However, it is viewed that incorporating patient self-monitoring may result in more effective relapse prevention.The early intervention Back In The Saddle (BITS) approach is based on educating clients about early signs, and helping them to develop skills in self-monitoring. This collaborative therapeutic technique is aimed at constructing a relapse signature, developing a relapse drill, and helping the client to achieve a greater sense of understanding and control over their illness.It is concluded that relapse prevention is vitally important to the recovery process. By involving clients and educating them to use self-monitoring techniques, we can influence the progression of psychosis and the impact it makes upon peoples' lives. Ultimately, it is hoped that effective relapse prevention will reduce hospitalization, and consequentially decrease the financial demands upon mental health trusts.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

This article describes the issues associated with the development of services for people with intellectual disabilities (ID) and mental disorders [including challenging behavior (CB)] and reviews the evidence for providing effective community mental health services.Despite the fact that deinstitutionalization has been on the forefront of policies to improve social care for individuals with ID in the community, there has not been an equivalent drive to offer appropriate and effective interventions for the treatment of mental illness in this population. Evidence-based practice is still in its infancy and mental health outcomes are just beginning to emerge. The mental health component of existing specialist services is not fully integrated in many localities and mental health input is even considered stigmatizing to people with ID. Yet, people with ID have a higher prevalence of mental disorders, including schizophrenia and CB, and are vulnerable to overmedication and abuse. Furthermore, there has been more research on service models for CB than for mental health services. However, there is a need for further investigations of outcomes and of the application of such well known examples of community care as assertive community treatment, intensive case management and crisis resolution. People with ID deserve robust services to manage mental illness in this population.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

ObjectiveTo examine the different combinations of health insurance and types of payments, and their influence on physicians' prescribing of antihypertensive drug therapy.DesignThe study was based on information collected in physicians' practices, obtained from medical records and physician visits. The analysis uses simple logistic and ordinal logistic regressions in order to test the influence of different combinations of insurance profiles and types of payments on antihypertensive drug prescribing. Special attention was given to Medicare patients due to the lack of coverage for prescription drugs in this program.Patients and ParticipantsA sample of 1844 individuals diagnosed with hypertension was extracted from the 1996 US National Ambulatory Care Survey, a national probability sample survey conducted among physicians.ResultsThere was a significant reduction in the likelihood of access to drug therapy for patients insured with Medicare only compared to those patients with other types of insurance. Patients with Medicare cover only that were in a Health Maintenance Organization or had a prepaid type of payment were twice as likely to be prescribed antihypertensive drug therapy than patients with Medicare cover only and whom had other forms of payment such as fee for service or payment within a Preferred Prescriber Organization.ConclusionsThe results suggest that the health insurance status of patients does have some influence on physician prescribing decisions for patients with hypertension, especially for patients covered by Medicare alone. This indicates that the lack of additional coverage for prescription drugs in the US health insurance system may limit access to antihypertensive drug therapy.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Erectile dysfunction (ED) affects many men and, as the elderly population grows, the incidence of ED and demand for treatment will increase. Many organic and/or psychogenic factors cause or worsen ED. For healthcare providers and insurers, the treatment of ED involves direct medical costs (e.g. drug costs and physician visits). Indirectly, the effects of ED on the overall health and mental status of the patient may affect medical and societal costs.Management of ED should include alteration of modifiable risk factors (e.g. lifestyle and psychosocial factors); however, these modifications are frequently insufficient to completely reverse ED. Oral sildenafil 25 to 100mg is considered first-line direct therapy for ED and is effective in ≈70% of men with ED. A selective phosphodiesterase type 5 (PDE5) inhibitor, sildenafil improves the ability to attain and maintain erections and increases the rate of successful sexual intercourse in men with ED regardless of their age, presence of other medical conditions and concomitant antihypertensive or antidepressant medications. Sildenafil treatment may be initiated by primary care physicians instead of by specialists, which decreases costs to healthcare payors. Sildenafil treatment significantly improves quality-of-life related to sexual function and general well being; potential healthcare savings may result as these effects trickle down.Commonly reported adverse events are predominantly transient, mild and dose-related and include headache, flushing, dyspepsia, nasal congestion and abnormal vision. Concurrent administration of sildenafil and organic nitrates is contraindicated because marked hypotension may occur.Sublingual apomorphine (not currently available in the US) and vardenafil and tadalafil (PDE5 inhibitors in late stages of development) are other potential oral treatments for ED. Second-line pharmacological therapies include intracavernosal injections (alprostadil, papaverine, phentolamine and combinations of these agents) and intraurethral alprostadil. Non-pharmacological treatments include vacuum constrictor devices and, rarely, vascular surgery or penile implants.In economic models, sildenafil is cost effective compared with no treatment or papaverine/phentolamine injections. The cost-effectiveness of sildenafil compares favorably with that of accepted therapies for other medical conditions. Overall healthcare costs for health plan organizations did not increase significantly with the addition of sildenafil coverage. Seeking medical attention for ED may contribute to the early detection of serious concomitant conditions and result in long-term reductions in healthcare costs.In conclusion, sildenafil is an effective oral therapy for men with ED of various etiologies. Its efficacy in improving erectile function, ease-of-use and good tolerability profile make sildenafil first-line treatment for men with ED who do not have contraindications to its use.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS