Global Assessment Of Functioning Scale Research Articles

The functional exercise capacity is correlated with global functioning in patients with schizophrenia

The 6-minute walk test (6MWT) is commonly used to measure the functional exercise capacity in chronic patients with cardiovascular diseases. The purpose of this study was to determine whether the 6MWT is associated with the global assessment of functioning (GAF) score in patients with schizophrenia. A total of 68 male and 25 female in-patients with schizophrenia (34.6 ± 9.7 years; body mass index = 24.9 ± 4.4) performed a 6MWT and were assessed with the GAF scale and the Psychosis Evaluation tool for Common use by Caregivers (PECC). The mean distance walked on the 6MWT was 587.3 ± 98.4 m, while the mean GAF score was 52.0 ± 10.4. The Pearson's correlation coefficient between the 6MWT and the GAF score was 0.59 (P < 0.001), indicating a moderate association between both measures. The 6MWT was also significantly related to negative (r = -0.45, P < 0.001), depressive (r = -0.48, P < 0.001) and cognitive (r=, P) symptoms and with body mass index (r = -0.31, P < 0.005), smoking behaviour (r = -0.36, P < 0.001)) and dose of antipsychotic medication (r = -0.38, P < 0.001). Next to the GAF scale, clinicians in in-patient settings should consider incorporating the 6MWT into their test battery to measure the functional consequences of schizophrenia and its treatment.

Global Functioning and Suicide Among Chinese Rural Population Aged 15–34 Years: A Psychological Autopsy Case‐Control Study*

As the relationship between global functioning and young suicide remains unclear in rural China, this study was aimed to explore the relationship between them. Data of 391 rural suicides and 416 controls, all aged 15-34 years in three provinces in China were used for this study. The Global Assessment of Functioning (GAF) scale was adopted to assess global functioning of suicides and controls. The results showed that GAF score was stronger than mental illness in predicting suicide in China. Different correlates of GAF score were found between suicides and controls. Unsurprisingly, GAF score was significantly correlated with mental illness in both suicides and controls. Different characteristics were also found among three types of suicide which were classified using GAF score. Assessing global functioning is useful and GAF scale should be regularly used in suicide prevention practice.

The symptom and function dimensions of the Global Assessment of Functioning (GAF) scale

ObjectiveThe objective was to investigate the validity and clinical impact of the symptom and function dimensions of the Global Assessment of Functioning (GAF) in the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition. Is there any need for revision with respect to the DSM, Fifth Edition? MaterialThe sample comprised 2695 patients consecutively admitted to 14 different treatment units participating in the Norwegian Network of Personality-Focused Treatment Programs from 1998 to 2007. MethodsConvergent and discriminant validity of the symptom and function dimensions of GAF was analyzed by their associations with demographic variables, diagnostic status, and other self-reported variables assessing symptom distress, interpersonal problems, work and social impairment, and quality of life. ResultsThe validity of the separate GAF dimensions was confirmed by discriminant and concurrent associations to other relevant clinical measures. However, the traditional GAF measure based on the lower score of either symptom or function level was found to serve well as a global indicator of symptom distress and social dysfunction. A substantial difference between the symptom and function score of GAF was found in about 10% of the cases; and when differences were found, functional impairment was most often more severe. ConclusionThis study confirms the validity of the 2 GAF dimensions. However, substantial differences between these dimensions are rarely occurring. We therefore recommend that the GAF scale be prolonged in the DSM, Fifth Edition, roughly in the same shape as in the DSM, Fourth Edition.

Increase in brain-derived neurotrophic factor in first episode psychotic patients after treatment with atypical antipsychotics

Some preclinical and postmortem studies suggest that the effects of atypical antipsychotics could be mediated by brain-derived neurotrophic factor (BDNF). Olanzapine is an atypical antipsychotic with shown efficacy in psychosis treatment. The aim of this study was to compare plasma BDNF levels at baseline and after 1 year of olanzapine treatment in 18 drug-naive patients who experienced a first psychotic episode with those of 18 healthy control participants matched by age, sex, and socioeconomic level. Plasma BDNF levels were measured in patients at the index episode and at 1, 6, and 12 months of follow-up using an enzyme-linked immunosorbent assay. Symptoms and functioning of patients and controls were assessed with the Positive and Negative Symptom Scale and Global Assessment of Function Scale. BDNF levels of patients at onset were significantly lower than controls but increased toward control values during olanzapine treatment. There was a significant positive correlation between BDNF levels and functioning (Global Assessment of Function Scale). BDNF levels were also negatively correlated with positive symptoms, but not with negative symptoms or general psychopathology. Results suggest that olanzapine can offset the low BDNF levels at the onset of first psychotic episodes, and improving psychotic symptoms. The increase in BDNF levels may be its mechanism of action in improving positive symptoms.

Obsessive-Compulsive Symptom Dimensions in Japanese Tourette Syndrome Subjects

To investigate the current and lifetime frequency and severity of obsessive-compulsive (OC) symptom dimensions in Tourette syndrome (TS) patients, and how these dimensions affect clinical characteristics. Forty TS outpatients (29 males, 11 females) were interviewed with the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS), the Yale Global Tic Severity Scale (YGTSS), the Shapiro Tourette Syndrome Severity Scale, and the Global Assessment of Functioning (GAF). OC symptoms were present in 80% of the total sample. The miscellaneous and the symmetry dimensions were the most frequent at the "current" and "lifetime" surveys, respectively. The aggression dimension had the smallest difference between "worst ever" and current ratings among the all OC symptom dimensions. TS patients with the aggression dimension (n=7) had significantly lower scores in the GAF scale and higher frequencies of coprolalia. There were significant correlations between the YGTSS severity scores and specific DY-BOCS dimensions. OC symptoms are frequent in TS subjects and there were differences in the frequency, severity, and course of the OC symptom dimensions. These results emphasize the need for future longitudinal studies using a dimensional approach for the evaluation of OC symptoms in tic disorders.

P03-26 Survey of safety and efficacy of long-acting injectable risperidone in daily practice: An open-label, non-interventional prospective study

Objective:This post-authorization safety survey evaluated the long-term safety, tolerability, and efficacy of risperidone long-acting injectable (RLAI) in routine clinical practice.Methods:In this 6-month, multicenter, European, naturalistic survey, patients were included if, during routine clinical practice, long-term antipsychotic therapy with RLAI was deemed necessary by the treating physician. Efficacy measures (at baseline and after 1, 3, 6 months) included Clinical Global Impression-Severity (CGI-S) and Global Assessment of Functioning (GAF). Safety was evaluated by recording treatment-emergent adverse events (TEAEs) at every visit.Results:RLAI was initiated in 5,134 predominantly male (58.6%) patients (aged 14-94 years) with a diagnosis of paranoid schizophrenia (69.8%). RLAI initial doses were 25 mg every-two-weeks in 37.0%, or 50 mg in 44.4% of patients. at endpoint, RLAI dosages were 50 mg in 49.3% of patients, 25 mg in 27.0%, and 37.5 mg in 22.1%. Six-month treatment with RLAI was completed by 4,314 patients (84.0%). RLAI was discontinued due to loss to follow-up (n=346;6.7%), insufficient response (n=116;2.3%), and AEs (n=106;2.1%). CGI-S significantly improved from baseline to endpoint (p&lt; 0.001). Patient functioning in the GAF scale also significantly improved from baseline to endpoint (45.4±16.0 versus 62.4±17.7, respectively, p&lt; 0.001). TEAEs were recorded by 20% of patients. AEs occurring in ≥5% of patients were akathisia, extrapyramidal disorders, depression, psychotic disorder, anxiety, and weight gain. Serious AEs were reported by 384 (8%) patients.Conclusions:This large prospective survey confirms the good safety, tolerability, and efficacy of RLAI as reported in previous controlled clinical trials when used in routine clinical practice.

Deep Brain Stimulation of the Ventral Capsule/Ventral Striatum for Treatment-Resistant Depression

We investigated the use of deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) for treatment refractory depression. Fifteen patients with chronic, severe, highly refractory depression received open-label DBS at three collaborating clinical sites. Electrodes were implanted bilaterally in the VC/VS region. Stimulation was titrated to therapeutic benefit and the absence of adverse effects. All patients received continuous stimulation and were followed for a minimum of 6 months to longer than 4 years. Outcome measures included the Hamilton Depression Rating Scale-24 item (HDRS), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Global Assessment of Function Scale (GAF). Significant improvements in depressive symptoms were observed during DBS treatment. Mean HDRS scores declined from 33.1 at baseline to 17.5 at 6 months and 14.3 at last follow-up. Similar improvements were seen with the MADRS (34.8, 17.9, and 15.7, respectively) and the GAF (43.4, 55.5, and 61.8, respectively). Responder rates with the HDRS were 40% at 6 months and 53.3% at last follow-up (MADRS: 46.7% and 53.3%, respectively). Remission rates were 20% at 6 months and 40% at last follow-up with the HDRS (MADRS: 26.6% and 33.3%, respectively). The DBS was well-tolerated in this group. Deep brain stimulation of the VC/VS offers promise for the treatment of refractory major depression.

Sustained improvement of obsessive–compulsive disorder by deep brain stimulation in a woman with residual schizophrenia

Co-occurrence of obsessive–compulsive disorder (OCD) and schizophrenia is not rare (Eisen et al., 1997). Given that the obsessional content is not related to psychotic subject matter, both disorders can be regarded as delimitable diagnostic entities (Bottas et al., 2005). Recently, a number of case reports and small case series have demonstrated that deep brain stimulation (DBS) targeting the fronto-striato-thalamic circuit can have beneficial effects on OCD (Abelson et al., 2005; Greenberg et al., 2006; Sturm et al., 2003). DBS treatment of patients with current or past psychotic disorders has not yet been reported. Here, we present a comprehensive clinical evaluation of a woman with intractable OCD and residual symptoms of schizophrenia that were treated with unilateral DBS of the right nucleus accumbens (NAc), including neuropsychological long-term follow-up, neurophysiological measurements and functional brain imaging. This 51-yr-old right-handed woman suffered from a severely disabling, chronic and intractable form of OCD with excessive hand washing, cleaning, rearrangement of objects and compulsory praying [Yale–Brown Obsessive Compulsive Scale (YBOCS) score 32/40, 1 month prior to treatment]. Psychosocial functioning as measured by the GAF (Global Assessment of Functioning) scale was severely impaired (31/100). The symptoms started during childhood and accumulated during her early twenties. Obsession consisted of preoccupation with thoughts about guilt and purgation. Later in the course of the disease, psychotic symptoms (delusions, hallucinations, disorganized behaviour) meeting DSM-IV criteria for schizophrenia occurred transiently. The remaining presence of a few odd beliefs, minor paranoid ideation and disorganized behaviour in an attenuated form that were unrelated to the obsessions and compulsions led to the diagnosis of residual schizophrenia according to DSM-IV using SCID (Structured Clinical …

Validation of the Personal and Social Performance (PSP) Scale in a German sample of acutely ill patients with schizophrenia

In trying to more broadly define outcome in the efficient long-term treatment of patients with schizophrenia it is necessary to consider not only a reduction in psychopathological symptoms but also a successful psychosocial reintegration. Thus, a more exact assessment of psychosocial functioning is needed. Since the GAF (Global Assessment of Functioning) scale and the SOFAS (Social and Occupational Functioning Assessment Scale) are less operationalized and confuse psychosocial facts with psychopathological symptoms, the Personal and Social Performance (PSP) scale was developed [Morosini, P.L., Magliano, L., Brambilla, L., Ugolini, S., Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica, 1001, 323–329.] containing the four main areas “socially useful activities, personal and social relationships, self-care, as well as disturbing and aggressive behaviour”. Validation of the PSP scale was conducted in a sample of 62 patients with acute schizophrenia. Rating instruments were PSP, GAF, SOFAS, PANSS, CGI, and Mini-ICF-P (Mini-ICF-Rating for Mental Disorders). The results showed good reliability with alpha=.64–.84, high test–retest reliability as well as good inter-rater reliability for the PSP scale. Furthermore, PSP proved good validity with high correlations to GAF (r=.91), SOFAS (r=.91), and Mini-ICF-P (r=−.69). The hypothesis that more critically ill patients would show lower scores on PSP than lesser ill patients was only confirmed for PANSS negative symptoms. Thus, the findings prove the PSP scale to be a reliable and valid instrument for assessing social functioning of patients with schizophrenia during the course of treatment as well as in the acute state.

The use of nocturnal Heart Rate monitoring as an indicator of psychiatric therapy efficacy

PURPOSE: The purpose of the present study was to measure the effect of a 12-week treatment with a physical activity-based therapy for Anxiety Disorders (AD) in children and adolescent, i.e. Autoregulation by Adventure Activity Therapy (AAA-T) on symptoms of anxiety and nocturnal heart rate (HR). METHODS: Subjects included in this study were aged from 8yrs to 17yrs (26M, 14F, mean age 13.02 ± SD 2.73), free from tachycardia (>100 bpm) and reporting a total time in bed between 6 and 10 hours. All subjects had a primary diagnosis of AD using DSM-IV criterias and were referred to AAA-T by a pedopsychiatrist. Pre and post tests included a psychiatric interview using the Global Assessment of Function (GAF) scale, a sleep questionnaire and HR monitoring. AAA-T, in group format, was given through 12 weekly sessions of two hours each. Nocturnal HR was recorded from lights out to lights on, using an ambulatory monitor (Polar, S810i) for three consecutive nights before and after AAA-T. RESULTS: GAF scale improved with treatment. Mean nocturnal HR decreased significantly from pre to post treatment levels (78bpm ± SD 9.04 vs. 72bpm ± SD 6.11, p=0.002). Results from the sleep questionnaire showed that most patients (87%) reported fatigue and exhaustion in the morning before therapy and were less likely to report it after treatment (31%). Energy level following the morning awakening increased in all patients following treatment. CONCLUSIONS: AAA-T, which included physiological Autoregulation as well as parental modeling and coaching, significantly reduced symptoms of anxiety, increased sleep quality and decreased nocturnal HR. These results show a promising efficacy profile of AAA-T with regards to the physiological dimension of AD in children and adolescents. Deep breathing associated with the Autoregulation process may explain parts of the significant nocturnal HR decrease. More research is needed to better understand the cardiovascular dimension in AD.

Incarceration Rates of Persons With First-Admission Psychosis

Incarceration Rates of Persons With First-Admission Psychosis

Gender differences in 542 Chinese inpatients with schizophrenia

Objective To investigate gender differences in the onset and other clinical features of Han Chinese inpatients with schizophrenia. Methods Five-hundred-and-forty-two Han Chinese inpatients with DSM-IV schizophrenia were assessed with the Positive and Negative Symptoms Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Function scale (GAF) and locally-developed standardized data collection forms. Comparisons were made between male and female patients. Results This is the largest study of gender differences in schizophrenia to be conducted in a Chinese population. In our sample, we found that schizophrenia onset occurred at a significantly earlier age in male patients compared to female patients and that late-onset schizophrenia (as defined by onset ≥ 45 years) was significantly more common in female patients. The paranoid subtype of schizophrenia was less common in male patients, males received higher daily doses of antipsychotics and demonstrated a different pattern of antipsychotic usage, being less likely to be treated with SGAs. Further, cigarette smoking was more common in male patients and male patients were more likely to be single or never married. By contrast, female patients showed a different pattern of ongoing symptoms and severity, being more likely to have persistent positive symptoms, more severe positive and affective symptoms, and a greater number of suicide attempts whereas male patients were more likely to show severe deterioration over time. Conclusions There are notable gender differences in the age at onset, treatment and a range of other clinical features in Han Chinese patients with schizophrenia. Such differences were largely consistent with those reported in Western studies. These gender differences need to be considered in the assessment and management of Chinese patients with schizophrenia.

Concurrent Validity of the Global Assessment of Functioning Scale for Clients with Schizophrenia

Although the Global Assessment of Functioning (GAF) scale is a widely utilized instrument, little data on construct validity is available about its use with clients having schizophrenia. This study compared point-specific GAF scores with concurrent ratings of symptomatology and social and occupational impairments using the Functional Assessment Rating Scale (Ward & Dow, 1994). A linear multiple regression analysis of empirical data from investigations of clients' global functioning showed that increased work and school-related problems, danger to others, and psychotic symptoms predicted lower GAF scores. In general, GAF scores seem to reflect the construct of global psychological, social, and occupational functioning that the scale was designed to measure.

DETERMINANTS OF INPATIENT PSYCHIATRIC LENGTH OF STAY IN AN URBAN COUNTY HOSPITAL

This study investigated predictors of length of stay (LOS) for two inpatient psychiatric units (a crisis stabilization unit and a longer-stay milieu unit) in a large, urban, university-affiliated, county hospital. It was hypothesized that three variables would be independently associated with shorter LOS: (1) higher Global Assessment of Functioning (GAF) scale scores, (2) not requiring the use of seclusion or restraints, and (3) the presence of a comorbid substance use disorder. Data were collected on consecutive discharges (n=234) from the two inpatient units. Bivariate tests were conducted, and multiple linear regression models assessed the independent effects of potential determinants of LOS. The presence of a comorbid personality disorder or substance use disorder was predictive of shorter LOS on the crisis stabilization unit (n=88). Several variables were found to be predictive of shorter LOS on the longer-stay milieu unit (n=146), including: involuntary legal status on discharge, not requiring seclusion or restraints, higher admission GAF scale score, female gender, and the presence of a comorbid substance use disorder. Findings indicate that a substantial portion of the variance in LOS in this setting can be predicted from basic sociodemographic and clinical factors available in hospital medical charts.

Improvement of Psychiatric Symptoms after Electroconvulsive Therapy in Young Adults with Intractable First-Episode Schizophrenia and Schizophreniform Disorder

Schizophrenia is a serious psychiatric disorder that develops mainly in young adults. Electroconvulsive therapy (ECT) is known to be effective and safe in patients with schizophrenia with acute psychotic exacerbation. Because of the shortage of systematic studies, we conducted a prospective naturalistic study to examine the short-term effects of acute ECT and its safety in young adults with medically intractable first-episode schizophrenia. Subjects were seven consecutive patients, 15-35 years of age, with first-episode schizophrenia or schizophreniform disorder (Diagnostic and Statistical Manual of Mental Disorders, 4th edition; DSM-IV), who had failed to respond to neuroleptics. The seven patients were treated with a first course of ECT, and their clinical symptoms were evaluated on the basis of the Brief Psychiatric Rating Scale (BPRS) (18 items, rated 0-6) and Global Assessment of Functioning (GAF) Scale. The GAF Scale is presented in DSM-IV as a means of assessing global functioning of a psychiatric patient. Scores range from 1-100; the higher GAF score indicates the higher global functioning. Adverse effects resulting from acute ECT were also evaluated. The total BPRS score 1 week after the final session improved significantly compared to the total pre-ECT BPRS score. The GAF score also improved significantly compared to the pre-ECT GAF score. There were no adverse effects during the acute ECT course, except for mild delirium. We conclude that ECT may be an effective and safe treatment option for young adults with intractable first-episode schizophrenia.

From Fuzzy Logic Toward Plurimonism: The Science of Active and Empathic Observation

Plurimonism is a new philosophy and method of science. It holds that the revolution in computer science and artificial intelligence has reached the point that all the sciences in general can now account for the complex relations of an irreducible plurality of unique observers engaged in describing the same event. Plurimonism seeks to describe the conscious and unconscious relations of the scientific observer during the act of observation of a given event while preserving the historical uniqueness and indivisible identity of each such observer. Using the framework of plurimonism, we mathematically formulate the problem of empathy. This self-reflective mathematical model entails four components of the empathic process involving two observers. They are: 1) the self; 2) the self's-other; 3) the other; and 4) the other's-self. It measures the degree of accuracy of the therapist-observer's empathy, as well as conscious and unconscious processes involved in the patient-observer's idealization and the therapist-observer's confidence in clinical psychotherapy. Ratings are obtained from both patient and therapist from four different points of view. The plural views of the patient's global assessment of functioning (GAF) are from: 1) the therapist's view (TGAF); 2) the patient's view (PGAF); 3) the therapist empathic view (TEGAF), which represents the therapist's estimate of PGAF; and 4) the patient's empathic estimate of the TGAF. The GAF scale is the standard dimensional 100-point-scale measure used in psychiatry for recording a patient's functioning. The patient's estimate of the therapist's degree of accuracy as well as the therapist's confidence in his or her empathic accuracy is also represented. Three formulae are presented that describe the degree of the therapist's empathic accuracy, the patient's over-idealization/under-idealization, and the therapist's over-confidence/under-confidence. The concept of empathy is here restricted to mean the degree to which one observer can take the point of view of another observer when both are observing the same thing.

Deep Brain Stimulation for OCD and Major Depression

Back to table of contents Previous article Next article Letter to the EditorFull AccessDeep Brain Stimulation for OCD and Major DepressionBRUNO AOUIZERATE, M.D., Ph.D., CORINNE MARTIN-GUEHL, M.D., Ph.D., EMMANUEL CUNY, M.D., DOMINIQUE GUEHL, M.D., Ph.D., HELENE AMIEVA, Ph.D., ABDELHAMID BENAZZOUZ, Ph.D., COLETTE FABRIGOULE, Ph.D., BERNARD BIOULAC, M.D., Ph.D., JEAN TIGNOL, M.D., and PIERRE BURBAUD, M.D., Ph.D., BRUNO AOUIZERATESearch for more papers by this author, M.D., Ph.D., CORINNE MARTIN-GUEHLSearch for more papers by this author, M.D., Ph.D., EMMANUEL CUNYSearch for more papers by this author, M.D., DOMINIQUE GUEHLSearch for more papers by this author, M.D., Ph.D., HELENE AMIEVASearch for more papers by this author, Ph.D., ABDELHAMID BENAZZOUZSearch for more papers by this author, Ph.D., COLETTE FABRIGOULESearch for more papers by this author, Ph.D., BERNARD BIOULACSearch for more papers by this author, M.D., Ph.D., JEAN TIGNOLSearch for more papers by this author, M.D., and PIERRE BURBAUDSearch for more papers by this author, M.D., Ph.D., Bordeaux, FrancePublished Online:1 Nov 2005https://doi.org/10.1176/appi.ajp.162.11.2192AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Deep brain stimulation has been proposed to alleviate treatment-resistant obsessive-compulsive disorder (OCD) (1). We examined the long-term efficacy of deep brain stimulation of the ventral caudate nucleus in a case of primary, severe, and intractable OCD with concomitant major depression.We previously reported the case of Mr. A, a 56-year-old man suffering from a severely disabling and refractory form of OCD that began over 4 decades before (2). He mainly experienced somatic obsessions concerning potential disturbances in bodily functioning, especially regarding his arms, fingers, legs, and gastrointestinal tract, and his mental capacities, with compulsive verification of functioning, comprising repetitive voluntary movements, controlled intake of foods according to their purgative properties, and repeated mental acts of questioning. Aggressive obsessions with fear of embarrassing thoughts about his children occurred, although considerably less frequently. OCD coexisted only with a lifetime history of recurrent major depression. Mr. A’s written informed consent had been obtained before his participation in the study. Psychiatric assessments included the Yale-Brown Obsessive Compulsive Scale, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, and the Global Assessment of Functioning (GAF) scale. Neuropsychological assessments consisted of a wide range of tests primarily exploring memory and executive functions (2). These evaluations were performed independently and blindly, regarding stimulation settings. No pharmacological and/or psychological treatment was administered postoperatively.We previously reported that deep brain stimulation of the ventral caudate nucleus progressively improved Mr. A’s depressive and anxiety symptoms until remission was achieved at 6 months (Hamilton depression scale score ≤7 and Hamilton anxiety scale score ≤10) (2). There was also a marked but delayed reduction in OCD symptom severity on the Yale-Brown Obsessive Compulsive Scale from a baseline score of 25 to 10 and 14 at 12 and 15 months after deep brain stimulation, respectively. His level of functioning on the GAF scale gradually increased from 35 to 60 over the first 15 months of the postoperative period (2). Failure of the pulse generator battery, which was discovered after a clinical impairment, did not affect depressive and anxiety symptom intensity but worsened his obsessive-compulsive manifestations, especially his somatic preoccupations and the related checking compulsions (Yale-Brown Obsessive Compulsive Scale score=21), with a slight deterioration of global functioning (GAF scale score=55) at 18 months. A return to remission levels of OCD (Yale-Brown Obsessive Compulsive Scale score <16) was observed 3 months after replacement of the generator and remained stable until the end of the 27-month follow-up (final Yale-Brown Obsessive Compulsive Scale score=12). This was paralleled by an improvement in psychosocial functioning (final GAF scale score=65). Of interest, no neuropsychological alteration or any adverse clinical effect was reported.Thus, this finding strengthens our previous report, suggesting that deep brain stimulation of the ventral caudate nucleus could be a promising strategy for the treatment of refractory cases of both OCD and major depression.

Il trattamento dei disturbi psicotici con olanzapina, risperidone e neurolettici tipici: una valutazione comparativa di costo/efficacia in una realtà psichiatrica locale

BACKGROUND: Several clinical trials demonstrated that atypical antipsychotics are more effective but also more expensive (as drug cost) compared with the typical neuroleptics by treating psychotic disorders. The present study aimed to evaluate this result using an observational approach which better reflects the real clinical practice. OBJECTIVE: To evaluate clinical effectiveness (including work and social functioning) and overall direct costs in a group of patients affected by psychotic disorders (schizophrenia and bipolar) and treated with typical and atypical (olanzapine and risperidone) antipsychotics. METHODS: With a multicentre observational design - two years long - 89 patients (in charge by Psychiatric Centers of Regione Campania - Italy) were assessed using CGI (Clinical Global Impression) and GAF (Global Assessment of Functioning) scales. Moreover economic data were collected with reference to pharmacological and non-pharmacological (hospitalization, medical/nurse visits, etc.) resources consumption. The pharmacoeconomic analysis were conducted choosing the perspective of the local Psychiatric Services for costs attribution. RESULTS: Considering the treatment outcomes, the use of the atypical drugs provided better performances with reference to the patients quality of life. The results in terms of work and social functioning indicated an advantage in the olanzapine group of patients. Overall direct costs of treatment (drugs and healthcare resources) didn’t generate significant differences among the groups of therapy despite the pharmacological cost evidentiated an economic advantage (p

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A Case Study: Treatment of Refractory Schizoaffective Disorder with Aripiprazole

Objective: To report the use of aripiprazole in the treatment of refractory schizoaffective disorder. Case Summary: A 42-year-old African American male with a 10-year history of schizoaffective disorder decompensated while being treated with haloperidol decanoate 200 mg intramuscularly per month and valproic acid 500 mg twice daily. Upon admission, his Global Assessment of Function scale (GAF) score was 10 and his Mini-Mental State Examination (MMSE) score was 2. He was treated with an initial injection of haloperidol decanoate 100 mg and, thereafter, with haloperidol 5 mg orally twice a day. He remained refractory to haloperidol and, on day 14, chlorpromazine 150 mg/day was added. The patient continued to show no response. On day 20, oral aripiprazole 15 mg was substituted for haloperidol and chlorpromazine. Forty-eight hours later, the GAF score was 30 and the MMSE score was 18. Ninety-six hours after receiving aripiprazole, the GAF and MMSE scores were 40 and 26, respectively. Discussion: Aripiprazole has been approved for the treatment of schizophrenia and bipolar disorder; however, it has not been approved for treatment of schizoaffective disorder. Aripiprazole is a novel drug representing a new class of agents used for the treatment of psychosis. Aripiprazole is a partial agonist at the dopamine D2 and serotonin 5-HT1A receptors, but an antagonist at the serotonin 5-HT2A receptors. Conclusions: Aripiprazole may be useful in treatment of refractory schizoaffective disorder.