Patients initiated on PP3M demonstrated decreased HRU and increased adherence in quarters closer to PP3M initiation, and were persistent on their PP3M treatment.

After transitioning to PP3M treatment, veterans had significantly reduced use of oral antipsychotics, HRU, and costs. Although generalizability may be limited due to the veteran population and to those who transitioned according to PP3M prescribing guidelines, future studies in other patient populations may be used to extend these conclusions.

Reasons for disagreement varied by level of experience and calibration. Experienced and uncalibrated raters should focus on establishing common conventions, whereas experienced and calibrated raters should focus on fine tuning judgment calls on different thresholds of symptoms. Calibration training seems to improve reliability over experience alone. Experienced raters without cohort calibration had lower reliability than inexperienced raters.

Sines (6) used the Pearson correlation coefficient t o measure reliability of the individual five point sub-scales in the L-M Fergus Falls Behavior Rating Scale(3-4 , (hereafter referred to as the L-M Scale). His conclusion was that, although the total or average score on the L-M Scale had satisfactory reliability, as reported by Lucero and M e~e r (~9 4), the reliability of the individual five point sub-scales was too low for them to be used individually. The purpose of this note is to demonstrate that a five point scale will result in such a coarse grouping of the information, and/or such a limitation in the range of responses of the raters, that the Pearson correlation coefficient will cause erroneous assessment of the reliability of the sub-scales.Table 1 summarizes data that would be typically gathered to assess the reliability of the individual five point sub-scales for the L-M Scale. Two raters independently rated 94 patients in a convalescent ward, and two other raters rated 109 patients in a regressed ward. Note first that, whatever the final decision as to the appropriate measure of reliability for the several individual scales, for each scale the reliability is such that the averages for the two wards are significantly different.In fact the ward means differ by more than one point for every sub-scale except E and G, and it can be seen that the per cent agreement is high enough so that it might be expected that the individual scales are reliable enough to be of some use in classifying individual patients when the discrimination required is on the level of convalescent versus regressed.In Table 1, the reliability of the individual scales is described in two ways: by the per cent agreement between the two raters, and also by the Pearson correlation coefficient between the two raters for the whole ward. The per cent agreement is the measure that seems most directly related to the basic concept of reliability for a ranked, classificatory variable such as the rating scale variable. It is the measure most consistent with Technical Recommendations") and is the only measure of reliability proposed by Goodman and Kruskal@) in their general discussion of measures of correlation for classificatory variables. Since the per cent agreement is not commonly used to describe reliability, and also necessitates a definition of 'agreement' in terms of the amount of discrepancy on the scale if a single percentage is to be used, it is tempting to use instead the Pearson correlation coefficient. However, it can be seen in Table 1 that there is no correspondence between the correlation coefficients and the per cent agreement. The most outstanding disagreement between the two is on the K scale. The per cent perfect agreement is 82 in the convalescent ward and 38 in the regressed ward, while the corresponding correlations are -.090and .722 respectively.The discrepancies between the two measures of reliability should not be surprising. The meaningfulness of the correlation coefficient is lost if the measurements are coarsely grou...

Aim This exploratory post hoc analysis of a randomized, double‐blind (DB), multicentre, non‐inferiority study (NCT01515423) evaluated the effects of the long‐acting injectable antipsychotic therapies once‐monthly paliperidone palmitate (PP1M) and once‐every‐3‐months paliperidone palmitate (PP3M) on symptom severity and functional remission in patients with schizophrenia with differing durations of illness (≤5, 6‐10 and >10 years). Methods Endpoints included Personal and Social Performance (PSP) scale and Positive and Negative Syndrome Scale (PANSS) total scores during the DB phase (DB baseline and DB endpoint) and the proportion of patients meeting PSP or PANSS remission criteria at any time during the open‐label (OL) or DB phases that were maintained for ≥3, ≥6, ≥9 or ≥12 months. Results In both the OL and DB phases, significant improvements in PSP scale and PANSS scores were observed from baseline in all duration‐of‐illness groups, with significantly greater improvements observed in the ≤5‐year and 6‐10‐year groups compared with the >10‐year group. The proportion of patients who maintained PSP or PANSS remission criteria for ≥3, ≥6, ≥9 and ≥12 months was higher in the ≤5‐year and 6‐10‐year groups than in the >10‐year group. Safety profiles were similar across duration‐of‐illness groups in the DB phase. Conclusions Symptomatic and functional improvements were observed with PP1M/PP3M in patients with differing durations of schizophrenia, but the magnitude of the effects was greater in those with early illness vs chronic illness. These findings advocate implementation of PP1M and PP3M in all stages of schizophrenia, including early illness.