John F. Crilly

The history of clozapine and its emergence in the US market: a review and analysis

Clozapine is known as the first `atypical medication and is effective in people who have treatment-resistant schizophrenia. Its 1990 emergence in the USA was marked by considerable controversy over its high cost, due in large part to having been both the first new antipsychotic medication to come to market in over a decade and the need for comprehensive safety monitor ing within a decentralized health system. This paper traces the histor y of clozapines discover y and development in Europe, its part in the 1975 Finnish agranulocytosis scare, and its subsequent volatile emergence in the USA. Analyses examine peripheral forces at the time, particularly the influence of political, corporate, medical and societal forces which shaped its market course.

Within-session changes in sensory gating assessed by p50 evoked potentials in normal subjects

1. The authors studied within-session changes in P50 suppression occurring in a group of 28 normal subjects. 2. A conditioning-testing paradigm was used with 120 pairs of 110 Db peak intensity clicks. Clicks were of 0.04 msec duration, 500 msec separation and delivered through headphones at 10 second intervals. 3. Mean P50 suppression ranged from 60.5% during the first 30 click pairs to -19.1% during the last 30 pairs, with an overall mean suppression of 25.4%. 4. The authors concluded that P50 suppression is a dynamic process in normal subjects, and that further work is necessary to elucidate the factors affecting P50 suppression.

Predictors of Arrest During Forensic Assertive Community Treatment

OBJECTIVEnAn emerging adaptation of the assertive community treatment model is forensic assertive community treatment (FACT), which aims to prevent criminal recidivism. This study examined predictors of arrest among patients in a prototype program and considered the implications of study findings for future development of the FACT model.nnnMETHODSnDemographic and clinical data from all 130 patients treated in Project Link from 1997 through 2003 were merged with a statewide criminal record database to identify variables associated with arrest.nnnRESULTSnPoisson regression revealed a history of arrests for violent offenses before treatment and evictions from residential treatment, and antisocial traits were associated with arrest during treatment. Substance abuse was not associated with arrest, but the sample lacked heterogeneity for this factor.nnnCONCLUSIONSnVariables associated with arrest were similar to those seen in the general population. In the absence of a standardized model of intervention, FACT programs should incorporate interventions that target modifiable risk factors in order to prevent criminal recidivism among high-risk patients.

Therapeutic Synergism: Optimal Pharmacotherapy and Psychiatric Rehabilitation to Enhance Functional Outcome in Schizophrenia

Abstract Despite recent advances in the pharmacologic treatment and psychiatric rehabilitation of people with chronic schizophrenia, there exist serious impediments to the maximal utilization of these techniques. Standard antipsychotic treatment is effective in controlling acute exacerbations of schizophrenia, reducing positive psychotic symptoms, and reducing the frequency of relapse. In contrast, psychiatric rehabilitation is effective in ameliorating some of the negative symptoms, behavioral dysfunction, and cognitive dysfunction in even the most severely affected patients with this disorder. Given the lack of relationship between these clusters of symptoms, it is imperative that these approaches be optimized in the delivery of care to people with schizophrenia.

Prevalence, correlates, and symptom profiles of depression among men with a history of military service

PurposeThe purpose of this study was to examine the prevalence, correlates, and symptom profiles of depressive disorders in men with a history of military service.MethodsData were obtained from the 2006 Behavioral Risk Factor Surveillance System survey. Multivariable logistic regressions were used to identify correlates of lifetime and current depression. Regularly occurring symptom profiles were identified via cluster analysis.ResultsPrevalence of lifetime and current depression was similar in men with and without a history of military service. Younger age was positively, and black minority status, being in a relationship and self-reported good health were negatively associated with a lifetime diagnosis of depression. Other minority status (non-Hispanic, non-black) was positively, and older age, some college, being in a relationship, and self-reported good health were negatively associated with current depression. A cluster of younger men who experience significant depressive symptoms but may not report depressed mood or anhedonia was identified.ConclusionsDepression is as prevalent in men with a history of military service as it is in men without a history. Research should focus on subpopulations of men with a history of military service in which depression may be more prevalent or burdensome. Younger men with significant depressive symptoms may be missed by standard depression screens and still be at elevated risk for negative outcomes associated with depression.

An Overview of Compulsory, Noncompulsory, and Coercive Interventions for Treating People with Mental Disorders in the United States

Compulsory and noncompulsory treatments in the United States have changed over the past 50 years in response to a series of events occurring politically, clinically, economically, and ethically. This paper examines the key aspects of this development and identifies both differences and similarities between these different approaches for difficult-to-engage clients. Attention is given to the integral but controversial role of coercion. As part of the ongoing continuum of development, I propose that the language and definition around coercion be refined to identify better the important proactive components that occur across the treatment spectrum.