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Biomedical subjects

R Guscott

Publications and source records attributed to R Guscott.

7 recordsLinked to original sources
PubMed2000

Development and testing of a utility measure for major, unipolar depression (McSad).

OBJECTIVE: To develop and test a direct utility measure (McSad) for major, unipolar depression. METHODS: A depression specific, multi-attribute health state classification system was created; clinical validity was evaluated by experts using specially designed structured exercises; a cross-sectional survey was conducted to obtain directly measured utilities for depression health states. SETTING: Tertiary care, university medical centre. PARTICIPANTS: Three psychiatrists, 3 psychiatric nurses and 3 social workers assessed depression health state clinical validity. Survey participants were referred by psychiatrists and consisted of 105 outpatients, currently in remission with at least one episode of major, unipolar depression in the past two years. SURVEY RESULTS: Respondent self-health state utility (mean and 95% confidence interval (CI)) was 0.79 (0.74-0.83). Utilities for hypothetical, untreated depression health states were: mild depression, 0.59 (0.55-0.62); moderate depression, 0.32 (0.29-0.34); severe depression, 0.04 (0.01-0.07). Fifty-six percent of respondents rated severe depression worse than being dead. Utilities for the hypothetical health states were not correlated with self-health utility. The intra-class correlation coefficient (ICC) was satisfactory for 13 of the 14 health states assessed. CONCLUSIONS: McSad was feasible and acceptable in patients with a history of major unipolar depression. The utilities for mild, moderate and severe untreated depression show the low health-related quality of life associated with depression. Initial assessments of test-retest reliability and validity yielded satisfactory results but further studies are needed to extend our knowledge of the measurement properties of McSad.

Adult↗
PubMed2000

Cost-utility analysis in depression: the McSad utility measure for depression health states.

Cost-utility analysis, used increasingly over the past decade to analyze costs and effects in treating physical diseases, has received little attention in psychiatry. This article briefly introduces the concepts and methods of utility measurement and illustrates it using depression as an example. The authors describe the McSad health state classification system for depression, a direct utility measure for depression, and report results of an application of McSad among 105 patients who had a recent history of depression. Utility measures express patient preferences for specific health states on a scale ranging from 0, representing death, to 1, representing perfect health. These scores provide the weights used to calculate the number of quality-adjusted life-years gained by an intervention or service. McSad allows a patient's depression health state to be classified according to level of functioning in six dimensions of depression and to be compared with other hypothetical depression health states in order to produce utility scores indicating the patient's relative preferences.

Adult↗
PubMed1994

Lithium prophylaxis in recurrent affective illness. Efficacy, effectiveness and efficiency.

The efficacy of lithium prophylaxis for recurrent mood disorders is well established. Despite concern that the later efficacy studies have shown poorer results, these studies (after 1980) are equally confirmatory of lithium's efficacy. However, questions have been raised with regards to the effectiveness of lithium prophylaxis under 'ordinary' clinical conditions. Part of the confusion stems from the failure to distinguish clearly efficacy (the potential of a treatment) from effectiveness (the results obtained under clinical conditions). Studies of effectiveness or naturalistic studies show poorer results than efficacy studies in all areas of medicine. The major reason for this discrepancy with lithium prophylaxis is poor compliance. Estimations of the efficiency (cost benefits) of lithium prophylaxis are flawed by the failure to consider such issues. It is proposed that specialised lithium or mood disorders clinics have the potential to narrow the gap between efficacy and effectiveness--efficiency.

Bipolar Disorder↗
PubMed1991

Serotonergic interhemispheric asymmetry: neurochemical and pharmaco-EEG evidence.

1. Postmortem neurochemical investigations revealed interhemispheric asymmetry in the mediofrontal region of human brain. Significantly higher right hemisphere serotonin metabolite (5HIAA) content as well as increased maximal imipramine binding (IB) were found in the right hemisphere than in the left side. 2. IB did not show a gender difference in the mediofrontal area. However, women had higher IB in the right orbital frontal cortex than did men. 3. In vivo pharmaco-EEG results tend to support the postmortem neurochemical data. Intravenous chlorimipramine resulted in an asymmetric topographic distribution of the P300 auditory evoked potential, peak amplitudes were shifted to the right hemisphere.

Adult↗
PubMed1991

The clinical meaning of refractory depression: a review for the clinician.

OBJECTIVE: The authors' goal is to address the complex issue of treatment-refractory depression from a clinical perspective. DATA COLLECTION: They review the literature on the major clinical and methodological issues involved in the treatment and study of treatment-refractory depression as well as primary and tertiary care surveys of patients whose depression has not responded to treatment. FINDINGS: There are methodological problems in defining treatment-refractory depression and in the tertiary care surveys of treatment-refractory depression. The authors define treatment-refractory depression as primarily involving diagnostic-treatment variables rather than patient variables. They articulate these variable as a series of questions the clinician may consider when confronted with patients who are considered refractory: 1) Is the diagnosis correct? 2) Has the patient received adequate treatment? 3) Was a rational stepped-care approach used? 4) How was outcome measured? 5) Is there a coexisting medical or psychiatric disorder that interferes with response to treatment? and 6) Are there factors in the clinical setting that are interfering with treatment? CONCLUSIONS: The problem of treatment-refractory depression has to do primarily with the diagnostic-treatment process than with patient variables. This has a number of implications in the areas of training, education, research, and public health. The evidence indicates that improvements in the recognition and treatment of depression are needed.

Antidepressive Agents↗