Psychiatric Health Care Services Research Articles

Associations between outpatient treatment and the use of intensive psychiatric healthcare services.

The current manuscript examines concurrent and longitudinal associations between the utilization of outpatient and intensive psychiatric services among Medicaid-enrolled youth. Using an administrative dataset of Medicaid claims from 2007 to 2017, youth were included if they were between the ages of 10-18 (M = 13.4, SD = 2.6) and had a psychiatric Medicaid claim (N = 33,590). Psychiatric services were coded as outpatient, emergency department (ED), inpatient, or residential based on Medicaid codes. Logistic regression analyses indicated that the receipt of even one outpatient visit significantly reduced the odds of having an ED, inpatient, and residential visit within 60-, 90-, and 120-day windows. Survival analyses indicated most youth did not have any ED, inpatient, or residential visit following their first outpatient visit. For remaining youth, having an outpatient visit significantly increased the risk of having an ED, inpatient, and residential visit following their initial appointment, which may suggest these youth are being triaged to a more appropriate level of care. Classification accuracy analyses indicated a cutoff of 2 outpatient visits yielded maximum accuracy in determining youth with ED, inpatient, and residential visits. Findings highlight use of outpatient-level services in reducing risk of more intensive service utilization.

Association between continuity of care and treatment outcomes in psychiatric patients in Germany: a prospective cohort study

BackgroundContinuity of care is considered an important treatment aspect of psychiatric disorders, as it often involves long-lasting or recurrent episodes with psychosocial treatment aspects. We investigated in two psychiatric hospitals in Germany whether the positive effects of relational continuity of care on symptom severity, social functioning, and quality of life, which have been demonstrated in different countries, can also be achieved in German psychiatric care.MethodsProspective cohort study with a 20-months observation period comparing 158 patients with higher and 165 Patients with lower degree of continuity of care of two psychiatric hospitals. Patients were surveyed at three points in time (10 and 20 months after baseline) using validated questionnaires (CGI Clinical Global Impression rating scales, GAF Global Assessment of Functioning scale, EQ-VAS Euro Quality of Life) and patient clinical record data. Statistical analyses with analyses of variance with repeated measurements of 162 patients for the association between the patient- (EQ-VAS) or observer-rated (CGI, GAF) outcome measures and continuity of care as between-subject factor controlling for age, sex, migration background, main psychiatric diagnosis group, duration of disease, and hospital as independent variables.ResultsHigher continuity of care reduced significantly the symptom severity with a medium effect size (p 0.036, eta 0.064) and increased significantly social functioning with a medium effect size (p 0.023, eta 0.076) and quality of life but not significantly and with only a small effect size (p 0.092, eta 0.022). The analyses of variance suggest a time-independent effect of continuity of care. The duration of psychiatric disease, a migration background, and the hospital affected the outcome measures independent of continuity of care.ConclusionOur results support continuity of care as a favorable clinical aspect in psychiatric patient treatment and encourage mental health care services to consider health service delivery structures that increase continuity of care in the psychiatric patient treatment course. In psychiatric health care services research patients’ motives as well as methodological reasons for non-participation remain considerable potential sources for bias.Trial registrationThis prospective cohort study was not registered as a clinical intervention study because no intervention was part of the study, neither on the patient level nor the system level.

Effects of the COVID-19 Pandemic on Patients with Schizophrenia Spectrum Disorders

Objective: To evaluate the mental health of patients with schizophrenia spectrum disorders with the prolongation of the pandemic. Materials and Methods: This descriptive cross-sectional study was conducted between August-October 2020. Fifty-two patients with schizophrenia spectrum disorders who were hospitalized prior to the onset of the pandemic between March 2019-March 2020 at the inpatient clinic were reassessed during the pandemic. The Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression-Severity (CGI-S) Scale, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Fear of COVID-19 Scale were used to evaluate psychopathology during the pandemic. The PANSS and the CGI severity scores at discharge from the inpatient clinic for each patient were obtained from the medical records review for comparison along with sociodemographic variables. Results: A total of 34 patients, 33 with schizophrenia (97.1%) and 1 with schizoaffective disorder (2.9%) were included. There was no significant difference between the pre- and during the pandemic assessments in the PANSS total and the CGI severity scores. The PANSS total, the CGI, HAM-D, HAM-A and the Fear of COVID-19 scale scores, medical comorbidity and utilization of psychiatric health care services were significantly higher in patients who reported subjectively increased psychiatric symptoms during the pandemic. There was no significant difference in the change of PANSS total and CGI scores between the two groups. Fear of COVID-19 Scale and HAM-A scores were correlated positively. Conclusion: During pandemic increase in psychiatric symptoms may be related not only to psychosis but also depression, anxiety. According to the results of patients who reported subjectively increased psychiatric symptoms during the pandemic, while the psychotic symptoms did not worsen during the pandemic, patients with higher anxiety or depression scores reported an increase in their symptoms and were more likely to seek help.

Evaluation of the patients’ satisfaction with psychiatric health care service depending on the depression symptoms using adapted pipeq-os tool

Evaluation of the patients’ satisfaction with psychiatric health care service depending on the depression symptoms using adapted pipeq-os tool

Health and work disability outcomes in parents of patients with schizophrenia associated with antipsychotic exposure by the offspring

This study aimed to identify if antipsychotic exposure in offspring is associated with psychiatric and non-psychiatric healthcare service use and work disability of their parents. This Swedish population-based cohort study was based on data comprising 10,883 individuals with schizophrenia, who had at least one identifiable parent in the nationwide registers, and their parents (N = 18,215). The register-based follow-up during 2006–2013 considered the level of antipsychotic exposure and persistence of use of the offspring, further categorized into first (FG) and second generation (SG) antipsychotics, and orals versus long-acting injections (LAIs). The main outcome measure was parental psychiatric healthcare service use, secondary outcomes were non-psychiatric healthcare use and long-term sickness absence. SG-LAI use was associated with a decreased risk (relative risks [RR] 0.81-0.85) of parental psychiatric healthcare use compared with not using SG-LAI, whereas oral antipsychotics were associated with an increased risk (RRs 1.10–1.29). Both FG- and SG-LAI use by the offspring were associated with a lower risk of long-term sickness absence (range of odds ratios 0.34–0.47) for the parents, compared with non-use of these drugs. The choice of antipsychotic treatment for the offspring may have an impact on work disability and healthcare service use of their parents.

Criteria for involuntary psychiatric admission – changes from 1848 until today.

Coercion and involuntary psychiatric admission have been the subject of heated debate in recent years. A new Act was proposed in the summer of 2019, the Act on limitation of coercion, which aims to collect all legislation on coercion within a single legislative Act. If the Act is adopted, the framework for the use of coercion will be the same for both somatic illness and psychiatry. Against this backdrop, we wished to investigate how involuntary admissions have been critically examined, debated and enshrined in law previously. We have examined the three main Acts (and the preparatory work on these) that have been adopted in the psychiatric healthcare service in Norway. We have paid particular attention to the criteria for involuntary admissions, which we have attempted to understand in light of their contemporary times. The legislation on coercion retained many basic features from 1848, through 1961 until 1999, even though the attitudes to coercion changed. However, the change in legislation from 2017 shows a significant change in how coercion in the mental healthcare service is viewed. If the Act on limitation of coercion is adopted, coercive mental health care will no longer be regulated by separate legislation.

Evaluation of the Patients’ Satisfaction with Psychiatric Health Care Services with an Adapted PIPEQ-OS Tool

Abstract Until now, the assessment of health care services provided by psychiatric institutions in Latvia has not been carried out and questionnaires to provide assessment from the patient’s perspective have not been adapted. For this study, a questionnaire that has been validated and successfully employed for several years in Norway was chosen to assess patients’ experience and in a psychiatric inpatient setting. The aim of the study was to determine patients’ satisfaction with the quality of mental health care services in Latvia in the subacute inpatient psychiatric ward in Rīga, adapting during this process the PIPEQ-OS (Psychiatric Inpatient Patient Experience Questionnaire) tool in Latvia. The pilot quantitative study was conducted from June 2016 till February 2017. In the study, an anonymous patient self-assessment questionnaire PIPEQ-OS containing 21 questions was used. During the adaptation process, the questionnaire was translated from English into Latvian and Russian and backwards. The quality and compliance of the translation was subsequently tested in cognitive interviews. During the study, 297 patients were discharged from the unit, and 231 of them completed the questionnaire. 12% of the completed questionnaires were not included in data processing due to being incorrectly filled in. Cognitive interviews with 20 patients were carried out; the average length of an interview was 15 minutes. Overall, the translation of the questionnaire proved to be relevant to the research theme. The subsequent factor analysis revealed three significant factors that reached the Cronbach’s alpha index of 0.7. Further studies using socio-demographic data and based on various inpatient units as well as the comparison of satisfaction indicators across different diagnostic groups are needed.

Use, costs, and predictors of psychiatric healthcare services following an autism spectrum diagnosis: Population-based cohort study.

A number of cross-sectional studies report extensive use of psychiatric services and high healthcare costs in autistic youths. However, little is known about how the use of these services evolves from the time of diagnosis, as children grow up. Our objectives were to investigate the use, costs, and predictors of psychiatric services following autism spectrum diagnosis. We built a cohort of 1227 newly diagnosed autism spectrum individuals identified in the Quebec (Canada) Régie de l'assurance maladie du Québec administrative database (January 1998 to December 2010). Mean number and cost per individual of psychiatric healthcare use (hospitalizations, medical visits, psychoactive drug use) were calculated yearly for 5 years following autism spectrum diagnosis. Mean number of psychiatric visits decreased over time by more than threefold (7.5 vs 2.1 visits) from year 1 to year 5, whereas psychoactive drug use increased from 16.0 to 25.2 claims. Psychiatric hospitalizations decreased during follow-up, but still represented the greatest costs per individual (CAD9820 for year 1; CAD4628 for year 5). Antipsychotics represented over 50% of drug costs. Mixed-effect model with repeated measures showed that previous psychoactive drug use was the strongest predictor of greater psychiatric healthcare cost during follow-up (odds ratio: 9.96; 95% confidence interval: 7.58-13.10). These trends contrast with guidelines advocating cautious prescribing of antipsychotics with periodical re-assessment of their benefit.

VITAMIN D STATUS IN PATIENTS WITH MENTAL DISORDERS: A CROSS-SECTIONAL ANALYSIS OF SINGLE COHORT FROM ROUTINE PRACTICE.

Clinical research suggests that vitamin D deficiency correlates with mental illnesses. The aim was to prove that the patients from the psychiatric health care service in Serbia had higher vitamin D deficiency than patients from general practice. The study had a cross-sectional design. The study included 47 patients aged 19 - 76 of both sexes with different mental disorders. We performed sample size calculation on available data for vitamin D deficiency in patients in health care facilities compared with the general population. The concentrations of vitamin D in serums were measured by HPLC (high performance/pressure liquid chromatography). The mean value of vitamin D (standard deviation) in the whole group of study subjects was 16.27(10.62) ng/mL; 68.1% of the patients had a deficiency of vitamin D (25(OH)D<20 ng/mL). The difference is statistically significant from expected proportion of people with vitamin D deficiency in general practice (p=0.040). Serum concentrations of 25(OH)D were significantly correlated with serum concentrations of phosphorus (ϱ=0.336, p=0.024) and sodium (ϱ=0.304, p=0.038). The patients of psychiatry health care had significantly higher frequency of vitamin D deficiency than expected. There is a significant association between serum levels of vitamin D, and phosphate and sodium.

Refugee children have fewer contacts to psychiatric healthcare services: an analysis of a subset of refugee children compared to Danish-born peers.

Studies show a high level of mental health problems among refugee children. This study examined whether a subset of refugee children living in Denmark accessed psychiatric healthcare services more than those born in the country. This study compared 24,427 refugee children from Asia, The Middle East, Sub-Saharan Africa and former Yugoslavia, who obtained residency in Denmark between 1 January 1993 and 31 December 2010 with 146,562 Danish-born children, matched 1:6 on age and sex. The study looked at contacts with psychiatric hospitals as well as psychologists and psychiatrists in private practice. Between 1 January 1996 and 30 June 2012, 3.5% of the refugee children accessed psychiatric healthcare services compared to 7.7% of the Danish-born children. The rate ratio of having any first-time psychiatric contact was 0.42 (95% CI 0.40-0.45) among refugee boys and 0.35 (95% CI 0.33-0.37) among refugee girls, compared to Danish-born children. Figures were similar for those accessing private psychologists or psychiatrists, emergency room, inpatient and outpatient services. Refugee children used fewer psychiatric healthcare services than Danish-born children. This may indicate that refugee children experience barriers in accessing psychiatric healthcare systems and do not receive adequate assessment of their mental health and subsequent referral to specialist services.

CAREGIVER'S STRESS OF PSYCHIATRIC PATIENTS

INTRODUCTION: Psychiatric disorders are as old as human life. The prevalence of psychiatric disorders and their undesired personal, familial and social effects have increased simultaneously with population growth and urbanity. Limited psychiatric health care services coupled with increased psychiatric disorders led their families to play a critical role in taking care of the patients and they have to be considered as a main source of patients' caregivers. Long term care to psychiatric patients' increases caregivers' burden and decreases their mental health status. This may result in increasing psychiatric stress of caregivers and decreased patient care. MATERIAL AND METHODS: A descriptive research design was adopted to assess the caregiver's stress of psychiatric patients and coping mechanisms in this study. Fifty care givers of the psychiatric patients were selected through purposive sampling technique from inpatient and outpatient units of Universal College of Medical Sciences, Teaching Hospital. Modified and combined version of General Health Questionnaire-12 and Kingston caregiver scale, Cope scale and demographic performa were used to interview the samples. Collected data was analysed using descriptive and inferential statistics. Sociodemographic data was analyzed using frequency and percentage. Level of stress and coping was analyzed by computing frequency, percentage, mean, median, and standard deviation. The association between the caregiver's stress with sociodemographic variables was computed using chi-square test. RESULT: Result related to stress level of respondents revealed that majority of the respondents (86%) were at moderate stress, followed by 14% with severe stress. Study findings showed that caregivers were stressed with care giving, family and financial issues. In relation to coping strategies, 68% of respondent used active coping measures whereas 32% adopted passive coping methods. Majority of the respondents used social support, positive reinterpretation and religious coping strategies to overcome the stress. Caregiver's stress compared with sociodemographic variables showed a significant association between religion, ethnicity, education, marital status, onset of illness, type of illness, type of patient and relation with patient. CONCLUSION: The present study revealed that all of the respondents were under stress and most of them used active coping measures to manage their stress. The study has important implications for service delivery and clinical practice. Health care personnel should be observant of psychological problems of caregivers and if subjective complaints or functional impairment are present, evaluation and therapeutic interventions should be suggested. Information regarding support and practical assistance should also be offered to families of psychiatric patients.Journal of Universal College of Medical Sciences (2015) Vol.03 No.02 Issue 10 Page: 39-43

High work ability and performance in psychiatric health care services: Associations with organizational, individual and contextual factors

IntroductionContinuing development in the German healthcare system has a strong influence on the work situation of hospital clinicians working in Psychiatric Medicine. Since the job demands for psychiatrists are growing, there is a strong need to promote, preserve and restore doctors’ work ability. The aim of this study was to assess the prevalence of psychiatrists’ work ability and to examine relations between work ability, job performance and organizational as wells as individual resources (e.g. work engagement) of doctors working in psychiatric hospitals. Methods and materialsThe current survey investigation was conducted as a cross-sectional. The Utrecht Work Engagement Scale, the Copenhagen Psychosocial Questionnaire and the Work Ability Index were used to evaluate psychiatrists’ work engagement, working conditions and work ability. ResultsPsychiatrists reported high levels of work ability and work engagement. Significant associations have been found between doctors’ sources of work engagement, work ability and organizational factors (e.g. possibilities for development, income, etc.). Moreover, significant differences in gender, age and marital status have been analyzed with regard to perceived work ability scores. ConclusionThe study results reflect the positive effect of supportive working conditions and work engagement on the preservation of psychiatrists’ work ability. Our research suggests that strengthening psychiatrists’ work ability and work engagement will contribute to a more sustainable workplace, in terms of both individual and hospital performance. Innovative strategies for physicians’ personal development and improving capacity and performance of clinicians working in Psychiatric Medicine are strongly required.

Obstacles to care in first-episode psychosis patients with a long duration of untreated psychosis.

This qualitative study is a sub-study of the early 'Treatment and Intervention in Psychosis Study' (TIPS-2), a program for early intervention strategies for people experiencing a first episode of psychosis. We aimed to improve knowledge about factors that prevent or delay patients with a long duration of psychosis from accessing psychiatric health-care services at an earlier illness stage and their personal views on the impact of ongoing informational campaigns (ICs) on help-seeking behaviour. Following an interpretative-phenomenological approach, eight consecutive TIPS-2 patients with duration of untreated psychosis lasting for more than 6 months were interviewed. The interviews were analysed using a meaning condensation procedure. Five main themes were identified: (i) participants' failure to recognize symptoms of psychosis; (ii) difficulties expressing their experiences; (iii) concerns about stigma; (iv) poor psychosis detection skills among health-care professionals; and (v) participants' lack of awareness or understanding of ICs. The five themes identified may suggest that despite exposure to the targeted ICs, participants were unable to recognize or understand the severity of their symptoms. Further, although family members or others sometimes recognized the initial symptoms of psychosis development, these symptoms were attributed to reasons other than psychosis. Participants reported that health-care personnel also had trouble identifying emerging signs of psychosis. The ICs need to be carefully crafted to relay information to people who do not consider themselves as currently experiencing signs of psychosis.

The Paradox of Being Both Needed and Rejected: The Existential Meaning of Being Closely Related to a Person with Bipolar Disorder

The aim of this study was to elucidate the existential meaning of being closely related to a person with bipolar disorder. A qualitative, descriptive, and explorative design with a phenomenological meaning-oriented analysis was used. The findings reveal a paradoxical, existential exposure of close relatives to a person with bipolar disorder, being both needed and rejected whilst being overshadowed by the specific changeable nature of bipolar disorder. Psychiatric health care services are recommended to consider changes in attitudes and structures that may facilitate close relatives’ participation in the care and treatment of persons with bipolar disorder.

Do continued antidepressants protect against dementia in patients with severe depressive disorder?

Studies on humans show that depressive disorder is associated with an increased risk of developing cognitive dysfunction, and animal studies suggest that antidepressants may have neuroprotective abilities. On the basis of these observations, it was hypothesized that treatment with antidepressants may decrease the risk of developing dementia in patients with depression. We investigated whether continued treatment with antidepressants is associated with a decreased rate of dementia in a population of patients discharged from psychiatric healthcare service with a diagnosis of depression. We used register data on all prescribed antidepressants in all patients discharged from psychiatric healthcare service with a diagnosis of depression and with subsequent diagnoses of dementia in Denmark from 1995 to 2005. A total of 37 658 patients with a diagnosis of depression at their first psychiatric contact and who were exposed to antidepressants after discharge were included in the study. A total of 2007 patients (5.3%) were subsequently diagnosed with dementia of any kind. The rate of dementia decreased during periods of two or more prescriptions of older antidepressants compared with the period of only one prescription of older antidepressants [relative risk (RR)=0.83 (95% confidence interval (CI)=0.70-0.98)]. This finding was replicated with Alzheimer's disease as the outcome [RR=0.66 (95% CI=0.47-0.94)] but not with dementia of other kinds as the outcome [RR=0.88 (95% CI=0.73-1.06)]. In contrast, during periods of continued use of selective serotonin reuptake inhibitors or newer nonselective serotonin reuptake inhibitors, the rate of dementia was not decreased, regardless of the subtype of dementia. It was concluded that continued long-term treatment with older antidepressants is associated with a reduced rate of dementia in patients treated in psychiatric healthcare settings, whereas continued treatment with other kinds of antidepressants is not. Methodological reasons for these findings cannot be excluded because of the nonrandomized nature of data.

The role of nurse administrators and managers in quality psychiatric care

Psychiatric healthcare services in Japan demand continuous improvement to ensure quality care. Psychiatric nurse administrators and managers greatly influence the quality of services. To improve treatment, the following are considered necessary: clarification of service goal, proper assessment of treatment outcome, shortening of hospitalization, patient-centered care, establishment of trust relationships based on open communication with patients, and effective interdisciplinary teamwork. Additionally, administrators and managers must evaluate the clinical competence of individual nurses and appropriately assign them, especially when personnel shortage is an issue. Furthermore, in collaboration with other healthcare professionals, nurse managers must provide optimal care by setting goals of psychiatric services for patients in acute, sub-acute, or convalescent phases. This article presents the roles of nurse administrators and managers in improving the quality of Japanese psychiatric healthcare services.

Family member's expectation of the psychiatric healthcare professionals' approach towards them

The importance of involving family members in the care of individuals with schizophrenia or other psychotic illnesses has received increasing attention within psychiatric healthcare services. However, several studies suggest that family members often experience a lack of involvement. Furthermore, research indicates that family members' experience of the professional's approach has bearing on whether they feel involved or not. Thus, the aims of this study were to investigate the level of importance that the family members of individuals with schizophrenia or other psychotic illnesses ascribe to the professionals' approach, the level of agreement between their experiences and what they consider as important, and aspects they consider to be important with regards to contact with professionals. Seventy family members from various parts of Sweden participated. Data were collected by the Family Involvement and Alienation Questionnaire and open-ended questions. The median level and quartiles were used to describe the distribution, and percentage agreement was analysed. Open-ended questions were analysed by qualitative content analysis. The results reveal that the majority of the participants consider Openness, Confirmation, and Cooperation as important aspects of a professional's approach. Continuity emerged as an additional aspect. The results show a low level of agreement between the participants' experience and what they consider as important.

Does lithium protect against dementia?

To investigate whether treatment with lithium in patients with mania or bipolar disorder is associated with a decreased rate of subsequent dementia. Linkage of register data on prescribed lithium in all patients discharged from psychiatric health care service with a diagnosis of mania or bipolar disorder and subsequent diagnoses of dementia in Denmark during a period from 1995 to 2005. A total of 4,856 patients with a diagnosis of a manic or mixed episode or bipolar disorder at their first psychiatric contact were included in the study. Among these patients, 2,449 were exposed to lithium (50.4%), 1,781 to anticonvulsants (36.7%), 4,280 to antidepressants (88.1%), and 3,901 to antipsychotics (80.3%) during the study period. A total of 216 patients received a diagnosis of dementia during follow-up (103.6/10,000 person-years). During the period following the second prescription of lithium, the rate of dementia was decreased compared to the period following the first prescription. In contrast, the rates of dementia during multiple prescription periods with anticonvulsants, antidepressants, or antipsychotics, respectively, were not significantly decreased compared to the rate of dementia during the period with one prescription of these drugs. Continued treatment with lithium was associated with a reduced rate of dementia in patients with bipolar disorder in contrast to continued treatment with anticonvulsants, antidepressants, or antipsychotics. Methodological reasons for these findings cannot be excluded due to the nonrandomized nature of the data.

S23-03 - Lithium treatment and the risk of dementia

IntroductionTo investigate whether treatment with lithium in patients with mania or bipolar disorder is associated with a decreased rate of dementia.MethodsLinkage of register data on prescribed lithium in all patients discharged from psychiatric health care service with a diagnosis of mania or bipolar disorder and subsequent diagnoses of dementia in Denmark during a period from 1995 to 2005.ResultsContinued treatment with lithium was associated with a reduced rate of dementia in patients with bipolar disorder, in contrast to continued treatment with anticonvulsants, antidepressants or antipsychotics. Methodological reasons for these findings cannot be excluded due to the non-randomized nature of data. A total of 4.856 patients with a diagnosis of a manic or mixed episode or bipolar disorder at their first psychiatric contact were included in the study. Among these patients, 2,449 (50.4%) were exposed to lithium, 1,781 were exposed to anticonvulsants (36.7%), 4,280 to antidepressants (88.1%) and 3,901 to antipsychotics (80.3%) during the study period. A total of 216 patients got a diagnosis of dementia during follow-up (103.6 / 10.000 person years). During the period following the second prescription of lithium the rate of dementia was decreased compared to the period following the first prescription. In contrast, the rates of dementia during multiple prescription periods with anticonvulsants, antidepressants or antipsychotics, respectively, were not significantly decreased compared to the rate of dementia during the period with one prescription.ConclusionContinued treatment with lithium was associated with a reduced rate of dementia.

PMH37 UNITED KINGDOM COST-CONSEQUENCE ANALYSIS OF ARIPIPRAZOLE IN SCHIZOPHRENIA: DIABETES AND CORONARY HEART DISEASE RISK PROJECTIONS (STAR STUDY)

PMH37 UNITED KINGDOM COST-CONSEQUENCE ANALYSIS OF ARIPIPRAZOLE IN SCHIZOPHRENIA: DIABETES AND CORONARY HEART DISEASE RISK PROJECTIONS (STAR STUDY) Barnett AH, Millar H, Loze JY, L’Italien GJ, van Baardewijk M, Knapp M University of Birmingham and Heart of England NHS Foundation Trust, Birmingham,West Midlands, UK, Tayside Primary Care Division, Dundee, UK, Otsuka Pharmaceutical France, Paris, France, Bristol-Myers Squibb,Wallingford, CT, USA, Bristol-Myers Squibb, Braine l’Alleud, Belgium, London School of Economics, London, UK OBJECTIVE: Schizophrenia is associated with increased morbidity and mortality compared to the general population, largely resulting from increased incidence of cardiovascular disease and diabetes. Some atypical antipsychotics are associated with adverse metabolic symptoms, such as weight gain, dyslipidaemia and glucose dysregulation, which may further increase the risk of coronary heart disease (CHD) and diabetes. This study aimed to assess the impact of these symptoms on cost of treating patients’ physical health. METHODS: Data from the Schizophrenia Trial for Aripiprazole (STAR) study showed that metabolic side effects of aripiprazole treatment are less than those experienced by patients receiving standard-of-care (SOC) treatment (physicians’ selection of olanzapine/quetiapine/risperidone). In a post-hoc analysis, projected risks for diabetes/coronary heart disease (CHD) were calculated using the Stern and Framingham models. These risks were used to estimate the difference in direct and indirect cost consequences of diabetes and CHD in schizophrenia patients treated with aripiprazole or SOC over a 10-year period, assuming risk of diabetes onset/CHD events remained linear. Diabetes costs were estimated from UKPDS and UK T2ARDIS studies, respectively, and CHD costs were estimated using prevalence data from the Health Survey of England and published literature. All costs were inflated to 2007 costs using the UK government’s Pay and Prices Index inflation rates. RESULTS: The number of avoided diabetes cases (23.4 cases/1000 treated patients) in patients treated with aripiprazole compared with SOC was associated with estimated total (direct and indirect) cost savings of 37,261,293 over ten years for the UK population. Similarly, the number of avoided CHD events (3.9 events/ 1000 treated patients) was associated with estimated total cost savings of 7,506,770 over ten years. CONCLUSION: Compared with SOC, the favourable metabolic profile of aripiprazole treatment may provide reductions in health and economic burden to schizophrenia patients and psychiatric health care services in the UK.