On the out come variables “relapse” and “rehospitalization,” significant predictor variables were found in several areas: neuroleptic treatment, onset and previous course (precipitating factors, first manifestation, hospitalization in the preceding year, suicide attempts), psychopathology (residual type, schizoaffective disorder), social adjustment (marital status, employment, intensity of life, Phillips score), previous life experiences (traumatic experiences and psychiatric or developmental disturbances in childhood), and biology (gender, age). 2003, 29 (2): 247-256. A priori covariates for calculating the logit score with this method were age; gender; race/ethnicity; illness duration; insurance status; a diagnosis of a schizoaffective disorder, comorbid substance use, personality disorder, or mental retardation; enrollment site; a binary indicator for psychiatric hospitalization at the time of enrollment into the US-SCAP study; and time elapsed between US-SCAP enrollment and the start date of each patient's study year. 10.1093/schbul/sbm061. Part of The 4 patient groups were also compared on total cost and cost components for the subsequent year (Additional file 2). All authors read and approved the final manuscript. Hsiao WC, Braun P, Dunn D, Becker ER: Resource-based relative values. Compared to patients without prior relapse who relapsed in the subsequent year (NR), the patients with both prior and subsequent relapse (RR) were significantly younger, had a psychiatric hospitalization in the year prior to study enrollment, had more severe symptoms on the PANSS and MADRS, had poorer physical health functioning, and were more likely to be nonadherent per self-report and per medication records (MPR). The data used in the present study were from a longitudinal observational study of persons treated for schizophrenia in usual-care settings in the United States. Enrollment was not contingent upon participants having been treated with any medication and was independent of concurrent psychiatric or medical conditions, use of concomitant medications, or substance use. The data collected were taken as a basis for the present predictor study. First is the potential for selection bias. In addition, the cost for the RN group was 1.5 times that of the NN group, demonstrating again the economic impact of prior relapse even when no subsequent relapse took place. 1998, 52 (52): 54-. Kay SR, Fiszbein A, Opler LA: The positive and negative syndrome scale (PANSS) for schizophrenia. Terms and Conditions, These relapse parameters, with the exception of suicide attempt, were based on information systematically abstracted from patients' medical records every 6 months, using an abstraction form developed for the study. JAMA. Predictors of Relapse Following Response From a First Episode of Schizophrenia or Schizoaffective Disorder April 1999 Archives of General Psychiatry 56(3):241-7 Relapse was associated with higher costs for inpatient services as well as for outpatient services and medication. Schizophr Bull. Most patients (258 of 310, or 83%) met 1 of these 4 criteria for relapse; 31 (10%) met 2; 21 (7%) met 3; and no participant met all 4. Privacy Cookies policy. tion of relapse is a major challenge in the care of patients with schizophrenia, numerous studies have investigated the value of socio-demographic, clinical, and medication factors in the prediction of relapse [1,2,5,7-9]. PubMed Central This information may also be applicable to risk adjustments of premiums under Medicare Part D plans because drug expenditures in the previous year generally had been found to be strongly predictive of current-year drug expenditures for individuals [23, 24]. Dr. Salkever has served as a paid consultant to Eli Lilly and was an investigator on the US Schizophrenia Care and Assessment Program (US-SCAP). Of 2,327 patients in the US-SCAP, 1,817 (78%) completed a 1-year follow-up interview. Therefore, the … Optimal Treatment of Schizophrenia: Take-Home Messages. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Findings highlight the economic impact of relapse and the importance of prior relapse as a predictor of subsequent relapse for clinicians and other health care decision makers. Patients with and without relapse in the prior 6 months were compared on total direct mental health costs and cost components in the following year using propensity score matching method. Now Playing . Future research is needed to evaluate the longer-term effects on patient outcomes and health care costs of targeting different interventions to patients at high risk of relapse. 2008, 69 (1): 47-53. Weiden PJ: Understanding and addressing adherence issues in schizophrenia: from theory to practice. Montgomery SA, Åsberg M: A new depression scale designed to be sensitive to change. J Clin Psychiatry. 2008, 34 (1): 173-180. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. 14. If more than 1 year of complete resource use information was available for a given patient, data from the earliest year were used. Second, the costs in this study only reflected direct mental health cost and not total health care costs because the US-SCAP study did not collect data on non-psychiatric resource utilization or indirect costs. Guidelines for Neuroleptic Relapse Prevention in Schizophrenia pp 67-77 ... are there predictors that can be used to monitor their risk for relapse? Med Care. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Indication-based analysis of patient outcomes following deep brain stimulation surgery. J Clin Psychiatry. 16. Participants were ages 18 or older and had been diagnosed with schizophrenia, schizoaffective, or schizophreniform disorder based on Diagnostic and Statistical Manual, Version 4 criteria. Effect of Therapeutic Interchange on Medication Changes Between Admission and Discharge. In addition to patient-reported adherence, medication adherence in the 6 months before the study year was measured by the Medication Possession Ratio (MPR) [2, 6]. Overcoming Obstacles to LAIs in Schizophrenia Management. Haya Ascher-Svanum. 1989, 10 (3): 41-54. OBJECTIVE: Relapse prevention is the main goal of maintenance treatment in schizophrenia. Baseline characteristics, total annual mental health costs, and cost components (in 2000 US dollars) by relapse status, Additional file 3: Table S3. PubMed This high specificity level was accompanied by moderate sensitivity (48.2%), high negative predictive value (86.4%), moderate positive predictive value (50.6%), and a high overall accuracy level (79.3%). Third, the study did not have complete mental health resources information for all patients across the 3-year study, thus curtailing the ability to assess change in costs over time. 2004, 161 (1): 692-699. As shown in Additional file 1, patients with prior relapse were significantly younger, with earlier age at illness onset, more severe schizophrenia symptoms and depressive symptoms, higher rates of psychiatric hospitalization in the year prior to enrollment in the study, substance use disorder, arrests, and victimization by others. Socio-demographic and clinical factors associated with relapse have been examined in previous research studies [2–4, 6–9]. Logistic regression analyses of relapse predictors for the 1,557 participants and by relapse status, http://creativecommons.org/licenses/by/2.0. Our opportunity to study relapse and its predictors arose in the context of a long-term study of first-episode schizophrenia and schizoaffective disorder. Standard psychiatric measures were used to assess participant sociodemographic, clinical, and functional status at baseline. (eds) New Family Interventions and Associated Research … Physical and Mental Health Summary Scales. J Nerv Ment Dis. Data were used from the US Schizophrenia Care and Assessment Program (US-SCAP), a large (N = 2,327) 3-year prospective, observational, noninterventional study of schizophrenia treatment in usual-care settings in the United States conducted between July 1997 and September 2003. Total 1-year direct mental health costs included the following cost components: costs of medications (antipsychotics, other psychotropics, such as mood stabilizers, anticholinergics, antidepressants, antianxiety, and sleep agents), psychiatric hospitalizations, day treatment, emergency services, psychosocial group therapy, medication management, individual therapy, and ACT/case management. Relapse prevention is a major challenge in the care of patients with schizophrenia. Marcus SC, Olfson M: Outpatient antipsychotic treatment and inpatient costs of schizophrenia. 1998, Lincoln, RI: QualityMetric, 3. Median time to relapse was 17.0 months in non-adherent patients and 40.0 months in adherent patients (log-rankχ 2: 51.36; p < 0.001). The first year of patients' participation in the study was often the study year. et al. 2006, 163 (12): 2080-2089. The cost of relapse and the predictors of relapse in the treatment of schizophrenia. Healthc Financ Manage. CAS The 6 participating regional sites represented large systems of care, including community mental health centers, university health care systems, community and state hospitals, and the Department of Veterans Affairs Health Services. The excluded patients differed significantly from the included patients on variables shown to be associated with relapse (e.g., younger age, prior hospitalizations, poorer adherence, and more severe symptoms), suggesting that the overall rate of relapse has likely been underestimated. 10.1185/030079907X226050. An MPR value of at least .80 is considered being adherent . Am J Psychiatry. 9, 6020 Innsbruck, Austria. Even with good management, most people with schizophrenia experience relapses over time. Costs of psychiatric hospitalization were based on daily per diem costs at each site. Tunis SL, Faries DE, Nyhuis AW, Kinon BJ, Ascher-Svanum H, Aquila R: Cost-effectiveness of olanzapine as first-line treatment for schizophrenia: results from a randomized, open-label, 1-year trial. Google Scholar. The results of the present study suggest that treatment compliance and early premorbid adjustment level seem to be important predictors of relapse rate in first episode schizophrenia. However, in recent years some prominent nonreplications of the EE-relapse relationship have been published. We wish to thank the site investigators and others who collaborated in the US-SCAP study: Barrio C, Ph.D., Center for Research on Child and Adolescent Mental Health Services, San Diego, CA; Dunn LA, M.D., Duke University Medical Center Department of Psychiatry, Durham, NC; Gallucci G, M.D., (previously) Johns Hopkins Bayview Medical Center and the University of Maryland Medical Systems, Baltimore, MD; Garcia P, Ph.D., Center for Research on Child and Adolescent Mental Health Services, San Diego, CA; Harding C, Ph.D., Boston University and Community Mental Health Centers in Denver, CO; Hoff R, Ph.D., M.P.H., West Haven Veterans Administration Medical Center (VAMC) and the Connecticut Mental Health Center (CMHC), West Haven, CT; Hough R, Ph.D., Center for Research on Child and Adolescent Mental Health Services, California, San Diego, CA; Lehman AF, M.D., Johns Hopkins Bayview Medical Center and the University of Maryland Medical Systems, Baltimore, MD; Palmer L, Ph.D., The Medstat Group, Inc., Washington, DC; Rosenheck RA, M.D., West Haven Veterans Administration Medical Center (VAMC) and the Connecticut Mental Health Center (CMHC), West Haven, CT; Russo P, Ph.D., M.S.W., R.N., (previously) The Medstat Group, Inc., Washington, DC; Salkever D, Ph.D., (previously) Johns Hopkins University, Department of Health Policy and Management, Baltimore, MD; Saunders T, M.S., Drug Abuse and Mental Health Program Office of District 7 and University of South Florida's Florida Mental Health Institute, Orlando, FL; Shern D, Ph.D., (previously) Drug Abuse and Mental Health Program Office of District 7 and University of South Florida's Florida Mental Health Institute, Orlando, FL; Shumway M, Ph.D., University of California at San Francisco, Department of Psychiatry, San Francisco, CA; Slade E, Ph.D., (previously) Johns Hopkins University, Department of Health Policy and Management, Baltimore, MD; Swanson J, Ph.D., Duke University Medical Center Department of Psychiatry, Durham, NC; Swartz M, M.D., Duke University Medical Center, Department of Psychiatry, Durham, NC. Of 1,557 participants with eligible data, 310 (20%) relapsed during the 6 months prior to the 1-year study period. Participants who reported they "never missed" taking their medication or "missed only a couple of times but basically took all medicine" were considered adherent, whereas all others ("took at least half," "took less than half," or "stopped taking medication") were considered nonadherent. HA-S conceived of the study, participated in its design, the analytical plan, the interpretation of the results, and helped write the manuscript. (2002) Predictors of Relapse in Recent-Onset Schizophrenia. Furthermore, to help assess whether knowledge about previous relapse improves the ability to predict subsequent treatment costs over and above potential associations with patients' current level of functioning and symptomatology, we have conducted a sensitivity analysis. 10.1001/jama.260.16.2347. The use of these predictors in clinical practice may help improve allocation of resources, such as active case management and adherence interventions, since these programs aim to prevent relapse and hospitalization. Consistent with prior research [1–3, 6, 9, 21, 22], the current analysis also found relapsed patients to have a more complex illness profile, which is not only associated with more severe symptomatology but also substance use, legal involvement, lower level of functioning, and poorer medication adherence. PubMed 10.4088/JCP.v69n0107. The predictors of relapse in the 1-year study for all patients and by prior relapse status are presented in Additional file 3. As a result, accurate prediction of risk of relapse is critical to identifying persons who may need these intensive outpatient interventions. BZ performed the initial statistical analyses and participated in the design of the study and the analytical plan. However, although these reports have provided a better understand-ing of factors that influence the course of schizophrenia, Patients could stay on medications received prior to enrollment, and decisions about medication changes, if any, were made by the physicians and their patients. Manage cookies/Do not sell my data we use in the preference centre. We also hypothesized that patients with both prior and subsequent relapse will be the costliest and that prior relapse will be a significant predictor of subsequent relapse along with other distinct patient characteristics such as substance use and poor medication adherence. Am J Psychiatry. Relapse in schizophrenia can be associated with progressive functional deterioration, declining treatment response, worsening clinical outcome, escalating caregiver burden, and an increased economic burden for families and society (Wiersma et al., 1998; Almond et al., 2004; Awad and Voruganti, 2008; Hong et al., 2009). 17. Correspondence to Information about the cost of relapse in schizophrenia and the predictors of relapse is of interest to clinicians, payers, and other health care decision makers. This study has a number of strengths, including the breadth of its clinical and economic measures and the diversity of the patient population across geographies and health care systems, suggesting high generalizability of the findings. 10.4088/JCP.v67n0317. 2004, 192 (2): 119-128. Participants were excluded if they were unable to provide informed consent or had participated in a clinical drug trial within 30 days prior to enrollment. For the first time, the technique of classification and regression tree (CART) analysis has been employed for this purpose. Background Expressed emotion (EE) is a measure of the family environment that has been demonstrated to be a reliable psychosocial predictor of relapse in schizophrenia. 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