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Biomedical subjects

K G Terkelsen

Publications and source records attributed to K G Terkelsen.

12 recordsLinked to original sources
PubMed1995

Risperidone augmentation of clozapine.

While effective as a single agent in a significant proportion of treatment refractory patients, clozapine is often used in combination with other medications, including classical neuroleptics (1), mood stabilizers and antidepressants (2), benzodiazepines (3) and lithium (4). In Denmark, where clozapine has been in near continuous use since 1975, up to 60% of clozapine patients receive additional medication (4). Classical neuroleptics, often at antipsychotic levels, are the medications most frequently added, and are used in 30-35% of patients receiving clozapine (4,5). Clozapine, due to its low D2-blocking effect, may be therapeutically insufficient to contain symptoms and additional agents may be required (4). In controlled clinical trials risperidone has been shown to be superior to haloperidol (6), but has not yet been rigorously compared to clozapine. In light of its established efficacy and pharmacological profile (7) risperidone may be reasonably construed to be a medication with efficacy somewhere between clozapine and classical neuroleptics. As such, it may be especially well suited for use with clozapine as a part of an augmentation strategy. There are no reports in the literature describing the concurrent use of risperidone and clozapine. We present two cases demonstrating augmentation of clozapine's effects through combined use with clozapine.

Adult↗
PubMed1995

Measuring the costs of schizophrenia. Implications for the post-institutional era in the US.

Schizophrenia is a stress-related biomedical condition of the brain, characterised by unusual internal experiences, severe and often persistent functional disability and socially inappropriate behaviour. It is estimated that schizophrenia affects approximately 1% of all adults worldwide. Young adults are especially vulnerable. It is an illness with profound economic impact on patients, their families and society at large. Before the 1950s, most patients with schizophrenia were admitted to hospital for long inpatient stays. Keeping the patient in an institutional setting was all that psychiatry could offer, because there was little active treatment available. After World War II, and especially following the introduction of chlorpromazine in 1954, treatment was offered increasingly in outpatient settings. At present, more than 90% of individuals with schizophrenia will receive most healthcare services in outpatient facilities, supplemented by brief hospital treatment. The trend toward community-based care continues into the 1990s, supported in part by recent pharmacotherapeutic developments that are making a new generation of drug treatment options available. Clozapine, the most widely used of these new drugs, has been the subject of several studies that compared its costs with those of conventional drug treatments. These early studies suggest that further reductions in the cost of hospital treatment are possible in the near future. At the same time, despite the increasing availability of effective treatment in outpatient settings, the shift of resources from institutional to community care will not occur as quickly as some might wish. Delays in the transformation of care systems are caused by political interest groups and the sheer inertia of the infrastructure left over from the era of institutional care. These factors must be taken into account in estimating the cost of schizophrenia care during the next decade. The aim of this review is to provide a clinical picture of schizophrenia, emphasising features that contribute most to the cost of illness. We define and quantify the direct and indirect costs of the illness, discuss the cost implications of new pharmacotherapeutic and psychosocial treatments, and critique strategies for measuring the economic efficacy of these new treatments. The difficulties in measuring the costs of schizophrenia that are related to the transition from institutional to community-based systems of care in the US are also reviewed.

Adult↗
PubMed1994

Development of clinical methods for utilization review in psychiatric day treatment.

When a time-limited day treatment program was reconfigured to serve individuals with long-standing psychotic disorders, the number of treatment episodes exceeding six months rose to 70%. To justify this concentration of resources, the program needed methods to identify individuals for whom sustained treatment was appropriate. This report describes development of utilization review methods adapted to publicly funded day treatment of individuals with serious mental illness and training of clinicians in new documentation skills. Data from three years of operation suggest that symptom severity is not a reliable indicator of medical necessity in day treatment. As expected with a clinically based system, a composite measure of benefit and medical necessity indicators weighted toward functioning in living, learning, working, and socializing environments predicted physician reviewer denial of continued day treatment, but length of stay did not.

Day Care, Medical↗
PubMed1993

The role of personality in the treatment of schizophrenic and schizoaffective disorder inpatients: a pilot study.

As a prelude to a prospective study of personality functioning in chronically psychotic patients, the medical records of 736 hospitalized schizophrenic and schizoaffective disorder patients were retrospectively reviewed. The authors found much higher rates of Axis II personality disorder (PD) diagnoses among patients on extended-care inpatient units, which was consistent with their belief that clinicians on these units were using Axis II labels to document concurrent as well as premorbid personality factors. In addition, patients with PD diagnoses had significantly different courses of inpatient treatment, as documented by length-of-stay data. Level of function at discharge did not differ between those with and without PD diagnoses. The authors posit various hypotheses about these findings and discuss difficult conceptual and methodological issues regarding the influence of personality factors in schizophrenia.

Comorbidity↗
PubMed1990

Estimating clozapine's cost to the nation.

Clozapine, an effective but expensive drug treatment for patients with severe, chronic schizophrenia who are unresponsive to conventional antipsychotics, is associated with a high risk of agranulocytosis, which is sometimes fatal. Weekly blood tests to detect evidence of this side effect are required. To estimate the number of potential candidates for this treatment and the national cost of administering the drug to this population, the authors used data from three recent patient surveys conducted in New York State. Depending on the criteria used to exclude unsuitable candidates, between 133,000 and 189,000 individuals will be eligible for treatment with clozapine nationally at a cost of $1.2 to $1.7 billion annually.

Adult↗
PubMed1983

Schizophrenia and the family: II. Adverse effects of family therapy.

Theoretical formulations of the past thirty years have championed the hypothesis that family interaction contributes heavily to the etiology of schizophrenia, a position that has dominated contemporary family therapy even in the absence of solid empirical confirmation. The possibility that sociogenic modeling of schizophrenia is not only incorrect but even harmful to families, and to the relationship between families and clinicians, has never been taken seriously, despite its implications for the practice of family therapy. The author describes untoward effects of the sociogenic hypothesis in his own ten-year experience with families of chronic schizophrenics and examines pertinent reports in the family therapy literature, offering the reinterpretation that many communicational aberrations are adaptations to two therapist attributes: (a) failure to absolve the family of initial causal responsibility, and (b) failure to inform the family about the nature of the illness.

Family↗