Past clinical research has identified depression as the most common psychiatric disorder associated with cervical dystonia (CD). The purpose of our study is to document different patterns of psychopathology, the frequency of psychiatric disorders, and possible correlation with the neurological disorder in patients with CD. Forty patients with CD were investigated to assess levels of psychopathology on two self-rated scales: the Beck Depression Inventory (BDI) and Symptom Check List (SCL-90). To determine the presence of psychiatric disorders, the patients were evaluated using the standard instrument in the DSM-III-R (Structured Clinical Interview Schedule, SCID). A small group of dystonic patients (12%) had higher levels of psychopathology, with significant amounts of concomitant anxiety and depression on the BDI and SCL-90. SCID criteria for at least one psychiatric disorder were fulfilled in 22 patients (55%), including both the lifetime and current diagnoses. The most frequent diagnostic categories were anxiety (40%) and major depressive disorders (37.5%). In 17 patients (42.5%), criteria for at least one lifetime diagnosis were fulfilled prior to the onset of CD. Psychiatric evaluation does not indicate one specific disorder associated with CD. The presence of anxiety and depression symptoms before and during the course of dystonia, without a possible causal relationship, could mean that the alteration of a chain of physiological events in the central nervous system may not lead to a single clinical picture. The relatively high overall lifetime prevalence of anxiety and depressive disorders may indicate the need for a broader diagnostic and therapeutic approach to patients with focal dystonia.
Ideomotor apraxia has been defined as a failure to produce either a correct movement on verbal cornmand or to imitate correctly a movement performed by the examiner when the incorrect performance cannot be explained by weakness, incoordination, akinesia, abnormal reflexes, impaired auditory comprehension, or impaired visual or tactile perception.1 This had led to the conclusion that ideomotor apraxia is an inaccurate term to associate with Parkinson's disease because the patients manifest motor deficits.2With regard to the examination of motor behaviour the distinction between apraxic errors and lower level deficits of motor control has been expressed as follows: "The diagnosis of ideomotor apraxia is not made if a patient fails to carry out certain movements at all, nor is mere clumsiness of movement sufficient to consider a patient apraxic. The diagnosis is made when a patient is impaired in the proper selection of the motor elements which constitute a movement and in the correct ordering of these elements in a motor sequence".
Background Long-acting injectable (LAI) antipsychotics can reduce relapse, hospitalization, and costs in patients with schizophrenia. However, real-world evidence assessing the impact of treatment with LAIs in Germany is limited. Objective To provide updated evidence on the impact of LAI initiation on hospitalization rates and therapy costs. Methods Using a mirror-image design, claims data of 850 German patients with schizophrenia who initiated treatment with LAIs during 2013-2015 was retrospectively analyzed. For the included patients, costs and resource utilization were compared for the 12 months before the index date (first initiation of LAI) and the 12 months after the index date. Annual treatment costs, hospitalization rates, ambulatory visits, sick leaves and medical aids were assessed. Two models were used to evaluate hospitalization and its costs. In model 1, hospitalization during the index date (first LAI prescription in 2013-2015) was allocated to the "pre-" time interval, while in model 2 it was neither attributed to the pre-nor to the post-index date. Regression analysis was performed to identify patients who benefited the most in terms of cost reduction from LAI initiation. Results Medication costs were significantly higher post-switching to LAI compared with pre-switching period (€3832 vs €799; p < 0.001). In model 1, number of hospitalizations, days hospitalized, and associated costs were significantly lower post-switching compared with pre-switching (2.3 vs 2.6; 59.2 vs 73.4; and €5355 vs €11,908, respectively; all p < 0.001). Similar results were obtained for costs in model 2 (€5355 vs €10,276; p < 0.001). Mean total costs reduced significantly from pre-switching to post-switching period in model 1 (€13,776 vs €10,418; p < 0.001). Patients with characteristics such as higher number of non-psychiatric and psychiatric inpatient stays during the pre-index period (all p < 0.05) benefited the most from cost reduction after LAI initiation. Conclusion In this cohort of German patients with schizophrenia, treatment initiation with LAI resulted in reduced hospitalization rates and total costs.
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