Barbara M. Rohland

Treatment outcomes of depression: the pharmacogenomic research network antidepressant medication pharmacogenomic study.

Background The effectiveness of selective serotonin reuptake inhibitors (SSRIs) in patients with major depressive disorder (MDD) is controversial. Aims The clinical outcomes of subjects with nonpsychotic MDD were reported and compared with the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study outcomes to provide guidance on the effectiveness of SSRIs. Methods Subjects were treated with citalopram/escitalopram for up to 8 weeks. Depression was measured using the Quick Inventory of Depressive Symptomatology—Clinician Rated (QIDS-C16) and the 17-item Hamilton Depression Rating Scale. Results The group of subjects with at least 1 follow-up visit had a remission (QIDS-C16 ⩽ 5) rate of 45.8% as well as a response (50% reduction in QIDS-C16) rate of 64.8%, and 79.9% achieved an improvement of 5 points or higher in QIDS-C16 score. The Pharmacogenomic Research Network Antidepressant Medication Pharmacogenomic Study subjects were more likely to achieve a response than STAR*D study subjects. After adjustment for demographic factors, the response rates were not significantly different. When reporting the adverse effect burden, 60.5% of the subjects reported no impairment, 31.7% reported a minimal-to-mild impairment, and 7.8% reported a moderate-to-severe burden at the 4-week visit. Conclusions Patients contemplating initiating an SSRI to treat their MDD can anticipate a high probability of symptom improvement (79.9%) with a low probability that their symptoms will become worse. Patients with lower baseline severity have a higher probability of achieving remission. The Pharmacogenomic Research Network Antidepressant Medication Pharmacogenomic Study replicates many findings of the first phase of the STAR*D study after controlling for the differences between the studies.

Physical limitations and self-rated overall health in family medicine patients

Objective: To assess how physical limitations relate to self-rated health among family medicine patients after adjustment for severity of illness. Design: A telephone survey of family medicine patients, linked with medical record information. Setting: A large family medicine department in Rochester, Minnesota, USA. Subjects: Self-ratings of health were linked to medical records for 804 adult patients. Results: Adjusting for severity and other confounders using multiple logistic regression analysis revealed that having physical limitations was inversely and independently related to good self-rated health (adjusted odds ratio = 0.20, P<0.001). Odds ratios also were lower for high severity of illness (adjusted odds = 0.43). Morbidly obese patients and patients older than 65 years of age also had reduced odds of good self-rated health. Conclusions: In our sample of family medicine patients, part of the disparity in health status experienced by people with physical limitations is attributable to greater severity of illness, age and obesity.

Electroconvulsive and Neuromodulation Therapies: International perspectives

Electroconvulsive and neuromodulation therapies / , Electroconvulsive and neuromodulation therapies / , کتابخانه دیجیتال جندی شاپور اهواز

Oversight of managed care for behavioral health services.

Contract specifications for behavioral health services can be used to ensure that services are accessible, efficient, and effective. Staff-per-population ratios and service utilization rates derived from the health services research literature, are proposed as a practical set of performance indicators. Structural, process, and outcome indicators are included. Examples include therapist full-time equivalents per 1000 cases (structural), number of crisis calls per 1000 enrollees (process), and number of emergency department visits per 1000 (outcome). The need for occasional clinical audits and further research in other areas is discussed.