Improvement In Global Assessment Of Functioning Scores Research Articles

Symptomatic and Therapeutic Significance of Generalized Anxiety Disorder Comorbidity in Patients with Obsessive-Compulsive Disorder

Background: Psychiatric disorders frequently accompany comorbid conditions, which can have negative prognostic effects. The etiological and phenomenological distinctions between these conditions may have significant implications for their therapeutic approach and clinical course. Objectives: Our study aimed to investigate the symptomatic and therapeutic significance of comorbid generalized anxiety disorder (GAD) on obsessive-compulsive disorder (OCD). Methods: This cross-sectional study included OCD patients referred to private and institutional psychiatric clinics in Rasht, Guilan, in 2021. All participants were divided into two groups: those with OCD and those with both OCD and GAD (OCD-GAD). The diagnoses were determined using structured clinical interviews that followed the DSM-5-research version (DSM-5-RV) criteria and included psychiatric histories. Patients were assessed using the Hamilton anxiety rating (HAM) scale, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and Global Assessment of Functioning (GAF). The data were analyzed using SPSS version 20. Results: Out of the 146 participants, 80 had only OCD, while 66 had both OCD and GAD. Both groups demonstrated significant improvements in GAF scores throughout the treatment period (P < 0.0001); however, there was no significant difference between the groups in terms of these improvements. The Y-BOCS score was significantly higher in the OCD group at baseline (P < 0.0001), and it decreased more during the first 3 months in the OCD-GAD group (P = 0.006). The severity of obsessive-compulsive symptoms related to symmetry (P = 0.014), hoarding (P = 0.034), taboo thoughts (P = 0.023), and aggression (P = 0.002) was significantly higher in the group with OCD. Both HAM-A and Y-BOCS scores decreased over time, but HAM-A showed a greater decline at the first follow-up, while Y-BOCS showed a greater decline at the second follow-up. Conclusions: Considering our findings, OCD-GAD diagnosis is not a unique subcategory of current psychiatric disorders, and it is not necessarily beneficial to regard it as such. However, we found that the comorbidity of GAD did not harm the prognosis of patients with OCD. Further investigations are recommended to evaluate the clinical significance of OCD-GAD comorbidity.

Effect of long-acting injectable antipsychotics on hospitalizations and global functioning in schizophrenia: a naturalistic mirror-image study.

Background:Partial adherence to antipsychotics is the most common cause of relapses and rehospitalization in patients with schizophrenia (SZ), leading to higher health care costs and psychosocial disability. The use of long-acting injectable (LAI) antipsychotics may improve therapeutic continuity and adherence to treatment.Objective:To assess the effectiveness of switching from oral antipsychotics (OAs) to long-acting antipsychotics.Methods:This 1-year mirror-image study evaluated the effect of switching from OAs to LAIs on the reduction of psychiatric hospitalizations and the improvement of global functioning in patients with schizophrenia. Differences in outcomes between second-generation (SGA) LAIs and first-generation (FGA) LAIs were also analyzed.Results:In all, 166 patients were included: 32.5% treated by FGA-LAIs and 67.5% by SGA-LAIs. There was an overall reduction of 71% in the average number of hospital admissions and an overall improvement of 29.3% in the Global Assessment of Functioning (GAF) score between the previous 12 months and the 12 months following the switching to LAIs. Patients who switched to SGA-LAIs had no significant differences in hospitalization occurrences but a significant improvement in GAF scores when compared with patients who switched to FGA-LAIs.Conclusion:Our results suggest that using LAIs could be the most adequate treatment choice for SZ patients with a high risk of relapse and low adherence rate. Patients with poorer social functioning may be ideal candidates for SGA-LAIs treatment. Our findings may be of particular interest from a clinical and health care management perspective.

A Retrospective Examination of Symptom Improvements in Primary Care Patients Receiving Behavior Therapy With and Without Concurrent Pharmacotherapy.

Primary care providers are the biggest prescribers of psychopharmacological medications. In this non-randomized retrospective examination, we asked whether primary care patients receiving behavioral health interventions with and without concurrent pharmacological treatments showed differential symptom improvement. Participants (79.4% women, 61.5% Hispanic, M age = 41.68, SD = 13.50) were 431 primary care patients referred to behavioral health with a primary concern of depression at one of three federally qualified health centers. Thirty-three percent of patients initiated or had an increase in pharmacotherapy concurrently with behavioral therapy; 26.9% had no change in medication during the episode of care, and 39.7% had no concurrent psychotropic medication prescribed during the episode of care. One-way analyses of variance revealed patients in the no medication group had higher global functioning, as measured by Global Assessment of Functioning (GAF) scores, than patients who were taking medication, or who initated or had an increase in medication. There was a significant main effect of time, where patients had significantly higher GAF scores during their last session in comparison to the first session. All three patient groups experienced comparable improvements in GAF scores, but patients in the initiated/increased medication group were significantly more likely to terminate behavioral health treatment prematurely. Results suggest primary care patients experience improvements in functioning across an episode of behavioral health care, even without concurrent psychotropic medication use.

Predictors of Nonhospitalization and Functional Response in Clozapine Treatment: A Nationwide, Population-Based Cohort Study.

Clozapine remains the only evidence-based treatment for treatment-resistant schizophrenia, and prediction of clozapine response is important in developing stratified treatment. We studied potential predictors of clozapine response, applying functional assessments as well as service use. We performed a nationwide cohort study among all individuals diagnosed with schizophrenia in Denmark after 1995 (age, ≥18 years) who initiated clozapine treatment between 2004 and 2011 with a Global Assessment of Functioning (GAF-F) score registered at clozapine initiation. During up to 2-year follow-up, clinical response was defined as (a) no further hospitalization with schizophrenia or (b) improvement in GAF-F score (moderate improvement: increase, ≥10; substantial improvement: increase, ≥20; and GAF-F, ≥50). We performed Cox regression analysis and report adjusted hazard rate ratios (HRRs; 95% confidence intervals [95% CIs]). Among 502 clozapine users with a registered GAF-F score, 232 (46.2%) remained out of hospital, 96 (19.1%) achieved moderate functional improvement, and 29 (5.8%) substantial functional improvement. Of all potential predictors, voluntary status at clozapine initiation showed borderline statistical significance with nonhospitalization (HRR, 1.61; 95% CI, 0.97-2.67). Regarding functional improvement, living with a partner was the strongest predictor with an almost threefold increased HRR (2.78; 95% CI, 1.07-7.23). Female sex was only nonsignificantly associated with functional improvement, whereas the chance of substantial improvement decreased by 15% (HRR, 0.85; 95% CI, 0.72-1.00) for each year delay in clozapine initiation among females. Living with a partner was the strongest predictor of functioning after clozapine initiation in this study. Although potentially indicating better premorbid functioning, this finding stresses the need and importance of social support during the course of the treatment independent of clinical factors.

Clinical and resource-use outcomes of risperidone long-acting injection in recent and long-term diagnosed schizophrenia patients: results from a multinational electronic registry

ABSTRACTBackground: Non-adherence to pharmacological treatment leading to frequent relapses and rehospitalizations is a major issue of concern among schizophrenia patients, especially those who are recently diagnosed. Risperidone long-acting injection (RLAI) has been shown to be efficacious, improve compliance, and increase long-term retention rate on therapy.Objective: To determine clinical outcomes and hospitalizations before and after the initiation of RLAI among schizophrenia patients with recent (≤2 years) diagnosis relative to those who had long-term (> 2 years) diagnosis.Research design and methods: The electronic Schizophrenia Treatment Adherence Registry (e-STAR) is an observational study of patients with schizophrenia who start treatment with RLAI. Data were recorded at baseline, retrospectively for the 12 months prior to baseline, and prospectively every 3 months for 24 months. Data on patients with a defined length of diagnosis were pooled from eight countries.Main outcome measures: Clinical Global Impression of Illness Severity (CGI-S), Global Assessment of Functioning (GAF) scores, and hospitalization data were key outcomes.Results: The magnitude of improvement in CGI-S scores was greater in the recent versus long-term diagnosis group [Δ −1.48 vs. Δ −0.95 (12 months); Δ −1.6 vs. Δ −1.09 (24 months)]. There were parallel improvements in GAF scores [Δ 19.4 vs. Δ 13.7 (12 months); Δ 22.3 vs. Δ 16.8 (24 months)]. The decline in the proportion of patients hospitalized from the retrospective to the prospective period was greater in the recent versus long-term diagnosis group (Δ −36.0 vs. Δ −19%, respectively) at 12 months. This was also true for the number of hospital stays (Δ −0.6 vs. Δ −0.3, respectively) and length of stay (days) (Δ −20.9 vs. Δ −6.9, respectively) at 12 months. Common adverse events in both groups included psychiatric, gastrointestinal, musculoskeletal and reproductive system and breast disorders.Conclusions: Treatment with RLAI is associated with improved outcomes in recently diagnosed and chronic patients. However, the magnitude of improvement was higher in recently diagnosed patients.

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

This study compared patients with schizophrenia whose antipsychotic medications were switched to manage treatment-resistant positive psychotic symptoms with those for whom another antipsychotic was added. Psychiatrists' characteristics and perceptions of effectiveness of the medication change on clinical outcomes were also reported. Psychiatrists participating in a nationally representative mailed survey (N=209) reported on the clinical features, management, and response to the change in antipsychotic medication (added versus switched) of one adult patient with treatment-refractory schizophrenia under their care for at least one year. Thirty-three percent of patients were treated with an added antipsychotic medication. Compared with patients whose antipsychotic medications were switched, those with an added antipsychotic medication were more likely to be female, to have received care from the same psychiatrist for more than two years, and to have been recently prescribed an antidepressant. Compared with psychiatrists who switched antipsychotic prescriptions, those who added an antipsychotic reported that the change was less likely to reduce positive symptoms, improve functioning, and prevent hospitalization. Psychiatrists who added rather than switched antipsychotics reported more frequent attendance at educational programs sponsored by a pharmaceutical company. Consistent with other lines of research and practice guideline recommendations, psychiatrists perceive antipsychotic polypharmacy to be a generally ineffective strategy for treatment-resistant positive psychotic symptoms. In light of these findings, efforts to identify and implement more effective evidence-based pharmacologic approaches should be undertaken.

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

Equine-assisted psychotherapy: a mental health promotion/intervention modality for children who have experienced intra-family violence

Equine-assisted psychotherapy (EAP) is a specialized form of psychotherapy using the horse as a therapeutic tool. This modality is designed to address self-esteem and personal confidence, communication and interpersonal effectiveness, trust, boundaries and limit-setting, and group cohesion. Substantial numbers of children witness family violence. There is evidence that violence between parents has adverse effects on the children in the family. These children are at greater risk of behavioural problems and mental health disorders, including anxiety, anger, depression and suicidal ideations, withdrawal, low self-esteem, and attention deficit hyperactivity disorder. The purpose of the present pilot study was to test the efficacy of EAP in a cross-sectional group of children referred to a psychotherapist for various childhood behavioural and mental health issues over an 18-month period (June 2003-January 2005). Sixty-three children received a mean number of 19 EAP sessions. Scores on the Children's Global Assessment of Functioning (GAF) Scale were determined pre- and post-treatment. The mean (+/- standard deviation, SD) pretreatment score was 54.1 (SD 3.2) and post treatment mean score was 61.7 +/- 5.0 (t = 9.06, d.f. = 96, P < 0.001). All children showed improvement in GAF scores, and there was a statistically significant correlation between the percentage improvement in the GAF scores and the number of sessions given (r = 0.73, P = 0.001). Univariate analysis showed that the greatest improvement in the GAF scores occurred in the youngest of the subjects. Children in the group who had a history of physical abuse and neglect had a statistically significant greater percentage improvement in GAF scores after treatment than those who did not have a history of abuse and neglect. This study has demonstrated a quick response to EAP, especially in younger children, but it remains to be determined what kind of long-term effects this type of intervention may provide.

EEG abnormalities before clozapine therapy predict a good clinical response to clozapine.

The purpose of this study was to test the hypothesis that minor EEG abnormalities predict a favorable response to clozapine. Eighty-six psychotic clozapine-treated psychiatric inpatients with EEG records before starting clozapine were included in the study. When all diagnostic groups were combined, there were no significant differences in clinical outcome between patients with abnormal EEGs and patients with normal EEGs. However, female patients with abnormal EEGs had a significantly greater improvement in Global Assessment of Functioning (GAF) scores compared to female patients with normal EEGs. In addition, patients with major depressive episodes (bipolar, schizoaffective, unipolar) and abnormal EEGs had a significantly greater improvement in GAF scores compared to the same subgroup of patients with normal EEGs. The results suggest that EEG abnormalities before clozapine treatment many predict a favorable clinical response in specific groups of patients.