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Biomedical subjects

S J Keith

Publications and source records attributed to S J Keith.

At least 37 records · Page 2Linked to original sources

The costs of schizophrenia. Assessing the burden.

Much has been learned about the costs of schizophrenia during the last three decades. Assessing the costs is a challenging task given the complexity of the disease. Much can be done to refine the methodologies of cost of schizophrenia studies based on the human capital approach and to develop the conceptual framework for a consistent account of the income distribution effects of the disease. The knowledge base, however, is quite extensive and data presented here indicate that although people with schizophrenia account only for about 1% of the adult population, they consume about 2.5% of total annual health care expenditures, they constitute about 10% of the totally and permanently disabled population, and comprise as high as about 14% of the homeless population in some large urban areas. These data clearly indicate the negative economic consequences of the disease: People with schizophrenia tend to be high users of medical care and tend to concentrate in subpopulations that are highly dependent on public assistance funds as a result of the disabling nature of the disease. These negative economic consequences of schizophrenia provide a powerful economic case for developing strategies to improve treatment effectiveness through biomedical and services research.

Cost of Illness↗

Research on first-episode psychosis: report on a National Institute of Mental Health Workshop.

The need to focus increased research on patients experiencing their first episode of psychosis was emphasized in A National Plan for Schizophrenia Research. To develop strategies for enhancing research in this area, a National Institute of Mental Health Workshop on First-Episode Psychosis was held in 1991. The topics discussed at that workshop are summarized, with key issues including the following: (1) the need for better operational definitions of onset, end of an episode, and relapse of psychosis; (2) careful consideration of inclusion and exclusion criteria related to age, gender, prior treatment, comorbid substance abuse, and similar issues; (3) the challenge of finding patients never exposed to neuroleptics and the value of entering first-episode patients into standardized treatment protocols; (4) the design of followup studies; (5) strategies to increase the pool of applicants; and (6) approaches for increasing power through data sharing and collaboration between groups.

Age Factors↗

The diagnosis of schizophrenia: a review of onset and duration issues.

The diagnosis of schizophrenia remains a topic of continuing dialogue both within the United States and internationally, as witnessed by the numerous revisions to the Diagnostic and Statistical Manual (i.e., DSM-I, DSM-II, DSM-III, and DSM-III-R) and the International Classification of Diseases (i.e., ICD-9, and ICD-10). At issue is how best to characterize patients suffering the debilitating symptoms and chronicity associated with the disease and, at the same time, arrive at a diagnosis that has specific clinical utility and can be reliably assessed. The purpose of the following report is to review three issues associated with the diagnosis of schizophrenia: the role of prodromal and residual symptoms, the duration of psychotic symptoms, and the 6-month versus 1-month time criterion. Our general recommendation, based on extant studies providing data related to various facets of the issues under debate, is to use diagnostic criteria that are consistent with the international diagnostic system. However, final decisions will depend on the outcome of the ongoing DSM-IV field trials.

Follow-Up Studies↗

Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study.

The prevalence of comorbid alcohol, other drug, and mental disorders in the US total community and institutional population was determined from 20,291 persons interviewed in the National Institute of Mental Health Epidemiologic Catchment Area Program. Estimated US population lifetime prevalence rates were 22.5% for any non-substance abuse mental disorder, 13.5% for alcohol dependence-abuse, and 6.1% for other drug dependence-abuse. Among those with a mental disorder, the odds ratio of having some addictive disorder was 2.7, with a lifetime prevalence of about 29% (including an overlapping 22% with an alcohol and 15% with another drug disorder). For those with either an alcohol or other drug disorder, the odds of having the other addictive disorder were seven times greater than in the rest of the population. Among those with an alcohol disorder, 37% had a comorbid mental disorder. The highest mental-addictive disorder comorbidity rate was found for those with drug (other than alcohol) disorders, among whom more than half (53%) were found to have a mental disorder with an odds ratio of 4.5. Individuals treated in specialty mental health and addictive disorder clinical settings have significantly higher odds of having comorbid disorders. Among the institutional settings, comorbidity of addictive and severe mental disorders was highest in the prison population, most notably with antisocial personality, schizophrenia, and bipolar disorders.

Adult↗

U.S. and Soviet perspectives on the diagnosis of schizophrenia and associated dangerousness.

During a visit of U.S. senior mental health and forensic experts to the Soviet Union to assess recent changes in Soviet psychiatry, a symposium was held to discuss the U.S. and Soviet concepts of the diagnosis of schizophrenia and dangerousness associated with psychiatric illness. The basic conclusion from this exchange was that significant differences exist between the countries in both areas, as the U.S. conceptualization of schizophrenia and associated dangerousness is considerably narrower than that of Soviet practice. Clearly, future scientific exchange is warranted to examine these conceptual differences in an effort to establish a better empirical basis for assessing the most appropriate medical treatment and legal disposition for patients.

Cross-Cultural Comparison↗

Integrating treatments in schizophrenia.

Schizophrenia is a common and severe illness found throughout the world. Onset is usually in adolescence and young adulthood, and many individuals have illness-related impairments for life. Schizophrenia assaults the very essence of what is distinctly human. The personality is devastated, subjective experience and thought distorted, and the psychological building blocks of everyday life torn asunder. This article discusses diagnostic and conceptual considerations, pharmacotherapy, and interpersonal strategies of integrating therapeutics for schizophrenics.

Antipsychotic Agents↗

A team approach to pharmacologic treatment of chronic schizophrenia.

The authors describe a therapeutic approach to the pharmacologic treatment of the schizophrenic patient. This team approach relies on interaction between the patient, the patient's family, and the clinician, and helps to eliminate blaming behavior that often demoralizes all parties involved. The authors maintain that neuroleptic therapy can control the positive symptoms of schizophrenia. However, they point out that neuroleptics may cause side effects and may interfere with improvement in negative symptoms and interpersonal relationships. The authors suggest that reduced-dosage strategies may prove the most effective way to prevent relapse, while minimizing the side effects of neuroleptics.

Antipsychotic Agents↗

What is schizophrenia?

One of the main questions related to schizophrenia is, naturally enough, what is it? Such a question may seem obvious, naive, impossible, or any combination of these. And certainly it is a bit demanding to expect that anyone could say what schizophrenia is in 1,000 words. On the other hand, we felt that it was worth the effort. We hope that presenting these brief discussions on "what is schizophrenia" by persons who have worked extensively in the field will allow the reader to note areas of overlap and disagreement as well as variations in emphasis. Although no one may yet be able to provide the definitive answer, at least this collection of informed opinions may help clarify the major questions. The group of essays by Solomon H. Snyder, Seymour S. Kety, and Michael J. Goldstein is the second in this series. Further collections of these statements will be presented in subsequent issues. Readers' responses and comments are cordially invited.

Antipsychotic Agents↗

Psychosocial treatment: individual, group, family, and community support approaches.

The authors present an overview of research on psychosocial treatments for schizophrenia. Findings from studies of four therapeutic approaches--individual psychotherapy, group psychotherapy, family therapy, and community support systems--are discussed in detail. The usefulness of each type of therapy is critically assessed on the basis of available data from controlled outcome studies. The authors make recommendations regarding high-priority areas to be addressed in future studies of psychosocial treatments.

Antipsychotic Agents↗

Research on the psychosocial treatment of schizophrenia: a summary report.

The authors present an overview of research on psychosocial treatments for schizophrenia. Findings from studies of five therapeutic approaches--individual psychotherapy, group psychotherapy, family therapy, milieu therapy, and community support systems--are discussed in detail. The usefulness of each type of therapy is critically assessed on the basis of available data from controlled outcome studies. The authors make recommendations regarding high-priority areas to be addressed in future studies of psychosocial treatment.

Aftercare↗