title: Differential effects of manual assisted cognitive behavior therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study. Quality of life outcomes among patients with depression after 6 months of starting treatment: results from FINDER. Quality of life during treatment with haloperidol or olanzapine in the year following a first psychotic episode Comparison of EQ-5D and SF-6D utilities in mental health patients. What does the PANSS mean? Cost-effectiveness of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: a decision-making approach. Health-related quality of life assessment in euthymic and depressed patients with bipolar disorder. Psychometric performance of four self-report measures. Effectiveness of Different Modalities of Psychotherapeutic Treatment for Patients with Cluster C Personality Disorders: Results of a Large Prospective Multicentre Study Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: the POPMACT study. Selecting and Appraising Studies for a Systematic Review The Factors Influencing Depression Endpoints Research (FINDER) study: final results of Italian patients with depression Assessing the empirical validity of alternative multi-attribute utility measures in the maternity context The MATISSE study: a randomised trial of group art therapy for people with schizophrenia Effects of olanzapine alone and olanzapine/fluoxetine combination on health-related quality of life in patients with bipolar depression: secondary analyses of a double-blind, placebo-controlled, randomized clinical trial. Cost-effectiveness of a primary care model for anxiety disorders. Application of a disease-specific mapping function to estimate utility gains with effective treatment of schizophrenia Economic, clinical, and quality-of-life outcomes associated with olanzapine treatment in mania. Results from a randomized controlled trial. Estimating a Preference-Based Index from the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) Adherence therapy for people with schizophrenia. European multicentre randomised controlled trial. Cost-effectiveness and cost-utility of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine: randomised controlled trial. A randomized, controlled trial with 6-month follow-up of repetitive transcranial magnetic stimulation and electroconvulsive therapy for severe depression. Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care Symptomatic and functional outcome of bipolar disorder in Butajira, Ethiopia. The EQ-5D: A useful quality of life measure in borderline personality disorder? Effectiveness of Outpatient, Day Hospital, and Inpatient Psychotherapeutic Treatment for Patients with Cluster B Personality Disorders Patients with Cluster A Personality Disorders in Psychotherapy: An Effectiveness Study Health-related quality of life in patients with schizophrenia during treatment with long-acting, injectable risperidone. Putting the ‘Q’ in depression QALYs: a comparison of utility measurement using EQ-5D and SF-6D health related quality of life measures Olanzapine versus haloperidol in the treatment of schizophrenia and other psychotic disorders: Quality of life and clinical outcomes of a randomized clinical trial Short Form 36 and Hospital Anxiety and Depression Scale. A comparison based on patients with testicular cancer. Personality disorders in the community: a report from the Australian National Survey of Mental Health and Wellbeing Changes in quality of life in chronic psychiatric patients: A comparison between EuroQol (EQ-5D) and WHOQoL The relationship between quality of life and clinical efficacy from a randomized trial comparing olanzapine and ziprasidone. Development and validation of a patient-based health-related quality of life questionnaire in schizophrenia: the S-QoL Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression. Estimating a preference-based index from the Japanese SF-36. Cost-effectiveness of transcranial magnetic stimulation vs. electroconvulsive therapy for severe depression: a multi-centre randomised controlled trial. Prevalence and distinct correlates of anxiety, substance, and combined comorbidity in a multi-site public sector sample with bipolar disorder. A randomised controlled trial to compare the cost-effectiveness of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine. Short-term symptomatic and functional outcomes of schizophrenia in Butajira, Ethiopia Longer time to antipsychotic treatment discontinuation for any cause is associated with better functional outcomes for patients with schizophrenia, schizophreniform disorder, or schizoaffective disorder. Mood symptoms, functional impairment, and disability in people with bipolar disorder: specific effects of mania and depression. Quality of life in patients with bipolar I depression: data from 920 patients. Reliability, validity, and application of the medical outcomes study 36-item short-form health survey (SF-36) in schizophrenic patients treated with olanzapine versus haloperidol. Evaluation of the cost effectiveness of escitalopram versus venlafaxine XR in major depressive disorder Multiattribute and Single‐Attribute Utility Functions for the Health Utilities Index Mark 3 System Olanzapine versus haloperidol in the treatment of acute mania: clinical outcomes, health-related quality of life and work status
abstract: A total of 480 patients were treated in a large , multicenter r and omized trial of a brief form of cognitive therapy , manual-assisted cognitive behavior therapy ( MACT ) versus treatment as usual ( TAU ) for recurrent deliberate self-harm . Each patient was r and omized after a self-harm episode assessed at an accident and emergency center and followed up over 1 year . The main hypothesis tested was that those allocated to MACT would have a lower proportion of self-harm episodes in the succeeding year . A total of 60 % of those allocated to MACT had face-to-face treatment and 430 ( 90 % ) of all patients had self-harm data recorded after 1 year . Although the results showed no significant difference between those repeating self-harm in the MACT group ( 39 % ) compared with the TAU group ( 46 % ) ( P = 0.20 ) , the treatment was cost effective ( 10 % cheaper than TAU ) and the frequency of self-harm episodes was fewer ( 50 % ) in the MACT group . A total of nine of 10 patients had some personality disturbance ( 42 % of these with disorder ) , and for those where information on parasuicide events was collected , the proportion having a repeat episode ranged from 33 % to 63 % for different personality disorders . Those with BPD were most likely to repeat episodes quickly ( mean 89 days for 25 % to repeat ) with dissocial personality disorder ( equivalent mean 384 days ) the slowest to repeat . Total costs were significantly greater in those with personality disorder and were reduced in those allocated to MACT ; this saving was reversed in those with borderline disorder . On average , MACT appeared to increase the cost of those patients with BPD ( BPD ) and reduce the cost of those with other personality disorders . It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have BPD BACKGROUND Health-related quality of life ( HRQoL ) data in depression are limited . We studied the impact of antidepressant ( AD ) treatment on HRQoL outcomes in depressed patients and investigated factors associated with these outcomes in routine practice setting s. METHODS The Factors Influencing Depression Endpoints Research ( FINDER ) study was a 6-month , European , prospect i ve , observational study , design ed to estimate HRQoL in 3468 adult patients with a clinical ly diagnosed episode of depression at baseline and at 3 and 6-months after commencing AD treatment .  HRQoL was assessed by the Medical Outcome Short-Form ( 36 ) Health Survey ( SF-36 ) and European Quality of Life-5 Dimensions ( EQ-5D ) . Regression analysis identified baseline and treatment variables independently and significantly associated with HRQoL outcomes . RESULTS Most HRQoL improvement occurred within 3 months of starting treatment . Better HRQoL outcomes were strongly associated with fewer somatic symptoms at baseline , AD treatment taken and not switching within AD groups . Education and occupational status were also important . Depression variables ( number of previous depressions and current episode duration ) were consistently associated with worse HRQoL outcomes . Self-rated depression severity was associated with poorer outcomes on the SF-36 mental component only . LIMITATIONS As this was an observational study , the important finding that between and within AD group switching impacted HRQoL will need to be investigated in more controlled setting s. CONCLUSIONS Receiving an AD treatment was associated with large improvements in HRQoL , but switching within AD groups was consistently associated with poorer outcomes . Somatic symptoms , including painful symptoms , are often present in depressed patients and appear to negatively impact HRQoL outcomes OBJECTIVES Schizophrenia causes significant impairments of quality of life . As treatment approaches have advanced , more attention has been given to re-integrating patients into their psychosocial environments , rather than simply monitoring psychotic symptoms . The development of the second-generation antipsychotics raised hope that these medications would provide better quality of life improvement than conventional antipsychotics . This improvement is particularly relevant early in the course of schizophrenia . METHODS To address these considerations , improvements in measures of general health and social function ( determined using the SF-36 ) were assessed in 195 patients with first-episode schizophrenia for up to one year following r and omization to either olanzapine or haloperidol  in a double blind clinical trial . We hypothesized that olanzapine would demonstrate better improvement on these measures than haloperidol . In order to test this hypothesis , we used a repeated measure model with SF-36 scores as the outcome , and treatment group , time , time2 , time-by-treatment group interaction , and time2-by-treatment group interaction as fixed effects . RESULTS Both treatments demonstrated similar changes on the SF-36 . Independent of treatment , patients demonstrated significant improvements in most of the SF-36 subscales , which approached normative scores by the end of one year of treatment . Forty-six of 100 olanzapine-treated patients and 37 of 95 haloperidol-treated patients completed the one year of this study ( p<.4 ) . CONCLUSIONS These results suggest an important initial treatment goal for patients with new onset schizophrenic disorders , namely that they can expect to recover significant quality of life and social function at least initially in treatment Various  preference-based measures of health are available for use as an outcome measure in cost-utility analysis . The aim of this study is to compare two such measures EQ-5D and SF-6D in mental health patients . Baseline data from a Dutch multi-centre r and omised trial of 616 patients with mood and /or anxiety disorders were used . Mean and median  EQ-5D  and  SF-6D utilities were compared , both in the total sample and between severity subgroups based on quartiles of SCL-90 scores . Utilities were expected to decline with increased severity . Both EQ-5D and SF-6D utilities differed significantly between patients of adjacent severity groups . Mean utilities increased from 0.51 at baseline to 0.68 at 1.5 years follow-up for EQ-5D and from 0.58 to 0.70 for SF-6D . For all severity subgroups , the mean change in EQ-5D utilities as well as in SF-6D utilities was statistically significant . St and ardised response means were higher for SF-6D utilities . We concluded that both EQ-5D and SF-6D discriminated between severity subgroups and captured improvements in health over time . However , the use of EQ-5D result ed in larger health gains and consequent lower cost-utility ratios , especially for the subgroup with the highest severity of mental health problems OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate BACKGROUND Deliberate self-harm can be costly , in terms of treatment and subsequent suicide . Any intervention that reduces episodes of self-harm might therefore have a major impact on the costs incurred by service providers and the productivity losses due to illness or premature death . METHOD Four hundred and eighty patients with a history of recurrent deliberate self-harm were r and omized to manual-assisted cognitive behaviour therapy ( MACT ) or treatment as usual .  Economic data were collected from patients at baseline , 6 and 12 months , and these data were complete for 397 patients .  Incremental cost-effectiveness was explored using the primary outcome measure , proportion of patients having a repeat episode of deliberate self-harm , and quality of life . The uncertainty surrounding costs and effects was represented using cost-effectiveness acceptability curves . RESULTS Differences in total cost per patient were statistically significant at 6 months in favour of MACT ( pounds sterling -897 , 95 % CI -1747 to -48 , P=0.04 ) , but these differences did not remain significant at 12 months ( pounds sterling -838 , 95 % CI -2142 to 466 , P=0.21 ) . Nevertheless , exploration of the uncertainty surrounding these estimates suggests there is > 90 % probability that MACT is a more cost-effective strategy for reducing the recurrence of deliberate self-harm in this population over 1 year than treatment as usual . The results for quality of life were not conclusive . CONCLUSION Cost-effectiveness acceptability curves demonstrate that , based on the evidence currently available , to reject MACT on traditional grounds of statistical significance and to continue funding current practice has < 10 % chance of being the correct decision in terms of cost-effectiveness The purpose of this study was to evaluate the psychometric properties of selected health-related quality of life ( HRQL )  self-report measures in 62 euthymic and depressed patients diagnosed with bipolar disorder . Patients completed the Quality of Life in Depression Scale ( QLDS ) , Mental Health Index-17 ( MHI-17 ) , Cognitive Function Scale , and Medical Outcomes Study Short Form-36 ( SF-36 ) at baseline and 8 weeks following treatment . Hamilton and Young Rating Scales were used to assess clinical status and vali date the HRQL measures . The MHI-17 , Cognitive Function Scale , QLDS , and SF-36 social function , vitality , role limitations -emotional , and mental health scales have good reliability and validity , and are responsive to changes in clinical status in patients with bipolar disorder . Although the small sample size limits generalizablity , euthymic and depressed out patients with bipolar disorder appear to contribute reliable self reports on selected aspects of their quality of life Background : No previous studies have compared the effectiveness of different modalities of psychotherapeutic treatment , as defined by different setting s and duration s , for patients with cluster C personality disorders . The aim of this multicentre study was to compare the effectiveness of 5 treatment modalities for patients with cluster C personality disorders in terms of psychiatric symptoms , psychosocial functioning , and quality of life . The following treatment modalities were compared : long-term outpatient ( more than 6 months ) , short-term day hospital ( up to 6 months ) , long-term day hospital , short-term inpatient , and long-term inpatient psychotherapy . Methods : The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherl and s , with a sample of 371 patients with a DSM-IV-TR axis-II cluster C diagnosis . Patients were assigned to 5 different modalities of psychotherapeutic treatment , and effectiveness was assessed at 12 months after baseline . An intention-to-treat analysis was conducted for psychiatric symptoms ( Brief Symptom Inventory ) , psychosocial functioning ( Outcome Question naire-45 ) , and quality of life ( EQ-5D ) , using multilevel statistical modelling . As the study was non-r and omised , the propensity score method was used to control for initial differences . Results : Patients in all treatment groups had improved on all outcomes 12 months after baseline . Patients receiving short-term inpatient treatment showed more improvement than patients receiving other treatment modalities . Conclusions : Psychotherapeutic treatment , especially in the short-term inpatient modality , is an effective treatment for patients with cluster C personality disorders For people at risk of depressive relapse , mindfulness-based cognitive therapy ( MBCT ) has an additive benefit to usual care ( H. F. Coelho , P. H. Canter , & E. Ernst , 2007 ) . This study asked if , among patients with recurrent depression who are treated with antidepressant medication ( ADM )  , MBCT is comparable to treatment with maintenance ADM ( m-ADM ) in ( a ) depressive relapse prevention , ( b ) key secondary outcomes , and ( c ) cost effectiveness . The study design was a parallel 2-group r and omized controlled trial comparing those on m-ADM ( N = 62 ) with those receiving MBCT plus support to taper/discontinue antidepressants ( N = 61 ) . Relapse/recurrence rates over 15-month follow-ups in MBCT were 47 % , compared with 60 % in the m-ADM group ( hazard ratio = 0.63 ; 95 % confidence interval : 0.39 to 1.04 ) . MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains . There was no difference in average annual cost between the 2 groups . Rates of ADM usage in the MBCT group was significantly reduced , and 46 patients ( 75 % ) completely discontinued their ADM . For patients treated with ADM , MBCT may provide an alternative approach for relapse prevention BACKGROUND We carried out a large r and omized trial of a brief form of cognitive therapy , manual-assisted cognitive behaviour therapy ( MACT ) versus treatment as usual ( TAU ) for deliberate self-harm . METHOD Patients presenting with recurrent deliberate self-harm in five centres were r and omized to either MACT or ( TAU ) and followed up over 1 year .  MACT patients received a booklet based on cognitive behaviour therapy ( CBT ) principles and were offered up to five plus two booster sessions of CBT from a therapist in the first 3 months of the study . Ratings of parasuicide risk , anxiety , depression , social functioning and global function , positive and negative thinking , and quality of life were measured at baseline and after 6 and 12 months . RESULTS Four hundred and eighty patients were r and omized . Sixty per cent of the  MACT group had both the booklet and CBT sessions . There were seven suicides , five in the TAU group . The main outcome measure , the proportion of those repeating deliberate self-harm in the 12 months of the study , showed no significant difference between those treated with MACT ( 39 % ) and treatment as usual ( 46 % ) ( OR 0.78 , 95 % CI 0.53 to 1.14 , P=0.20 ) . CONCLUSION Brief cognitive behaviour therapy is of limited efficacy in reducing self-harm repetition , but the findings taken in conjunctin with the economic evaluation ( Byford et al. 2003 ) indicate superiority of MACT over TAU in terms of cost and effectiveness combined Systematic Review Series Series Editors : Cynthia Mulrow , MD , MSc Deborah Cook , MD , MSc The last article in this series outlined methods with which to search the literature for studies on the clinical question that generates a systematic review [ 1 ] . Herein , we discuss the subsequent steps of selecting and appraising  studies  for a review . Both of these steps involve important judgments that can influence the results of a review . In selecting studies , review ers judge the relevance of the studies to the review question . In appraising studies , review ers judge numerous features of design and analysis . Some of these judgments are easy to make ; others are more difficult and prone to error . To be confident in their decisions , review ers should use methods that are reliable ( the results do not change if the procedure is repeated ) , impartial ( not influenced by the study results ) , and explicit ( unambiguous ) [ 2 ] . These strategies for selection and appraisal are sensible , and they distinguish most systematic review s from most narrative review s. However , evidence to support the importance of some of the methods we suggest is either scant or conflicting ; readers are referred to the original research on these approaches for more details . Selecting Studies for Systematic Review s If review ers perform a comprehensive search of the literature using the methods described previously in this series [ 1 ] , they will probably have assembled a large sample of articles . This sample will include most ( ideally , all ) studies that are relevant to the review question ( that is , the sensitivity of the search will be high ) . Inevitably , because such a wide net is cast , articles not pertinent to the clinical question will be retrieved ( that is , the specificity of the search will be modest ) . Thus , the review ers ' next task is to sort through all of the potentially relevant articles and select those that will be included in the review . To do so , review ers adopt several of the tactics listed in Table 1 and Table 2 for planning and executing the selection process ( in effect , improving the specificity of the search ) ; these tactics are described below . Table 1 . Planning Study Selection Table 2 . Strategies for Selecting and Appraising Studies Begin with a Well-Built Clinical Question Review ers should ensure that the question for review includes the four elements of a well-built clinical question [ 3 , 4 ] : the patients of interest , the main interventions under investigation , the comparison interventions , and the clinical outcomes of interest . By including these four elements , review ers can better focus the selection process . Choose Selection Criteria That Fit the Clinical Question Consider a systematic review of the effectiveness of a drug treatment ( for example , a proton-pump inhibitor ) for patients with a particular disorder ( such as esophageal reflux ) . Review ers need to decide whether to include studies of patients with any symptoms of reflux , only those with classic symptoms , or only those in whom definitive diagnostic tests have confirmed the presence of reflux . In addition , review ers might choose to include studies of patients with different comorbid conditions ; patients from different demographic or geographic or cultural background s ; or patients from different health systems , such as inpatient or community population s. Similarly , review ers should use selection criteria that reflect the main and comparison interventions of interest . In our esophageal reflux example , review ers would need to decide whether to include studies of a particular drug or studies of all agents in that drug 's class and whether to include studies of any dose and regimen or only studies with a specific regimen . For the comparison interventions , the review ers would decide whether to include studies that compare the experimental drug with alternate treatments ( such as antacids or histamine-2-receptor antagonists ) , with placebo , or with both . For the clinical outcomes , review ers have analogous tasks of defining the outcomes and translating them into criteria . In our example , the review ers would start by listing each clinical outcome ( for example , whether the outcome was endoscopic or clinical and whether it focused on cure or persistence ) and then decide whether to include studies that reported any outcome or only those with certain clinical ly important outcomes ( such as improvement in symptoms at 1 year ) . After thoroughly considering each element of the review question , review ers compile a set of explicit selection criteria . When these criteria are not explicit , the results of the review are more prone to error [ 5 , 6 ] . Reporting the selection criteria used in a review is extremely important to readers because the criteria indicate the relevance of the review to the readers ' clinical practice . Specify the Types of Study Design To Be Included After creating selection criteria that appropriately reflect the review question , review ers should consider which study design s to include . Ideally , review ers choose study design s that are most likely to produce valid results . For example , to answer questions about therapy or harm , review ers may want to include r and omized trials [ 7 ] because they provide more accurate estimates of benefit or harm than do cohort studies , casecontrol studies , and case series [ 8 ] . In reality , however , r and omized trials may not be conducted to address questions of harm [ 9 ] . Therefore , review ers need to consider which study design s are likely to be available to answer their question ; this information may necessitate modification of originally conceptualized selection criteria to incorporate observational ( nonexperimental ) studies . Specify Criteria Related to Type and Form of Publication Review ers also need to consider issues related to type and form of publication . Ideally , all of the relevant studies would be published as peer- review ed journal articles . However , some completed studies may be published only as abstract s , in non-peer- review ed form , or not at all . Review ers decide whether to include these incompletely reported studies when planning their literature search . By including all articles in various stages of publication and subjecting them to rigorous critical appraisal , review ers minimize the threat of publication bias ( the preferential reporting of studies with positive results ) [ 10 - 12 ] , which could generate misleading review s. Other studies may be reported more than once . To avoid over-representing duplicate studies in the review , investigators should plan to look for and exclude duplicate publications [ 13 ] . Finally , because studies may be published in different language s and because excluding studies published in different language s may bias the results of review s [ 14 , 15 ] , articles should be included , as appropriate , regardless of the language of publication ( translating as necessary ) . Limited time and re sources , however , may preclude such an approach . Construct and Pretest Selection Forms After deciding on selection criteria , review ers can prepare customized forms that contain checklists of the selection criteria ( Figure 1 ) . Using these forms can simplify the selection process , increase reliability , and provide a record of the judgments made about each study . After drafting form prototypes , review ers pretest these forms for clarity , ease of application , and reliability . To pretest the forms , two or more independent review ers typically apply them to a r and om sample of studies identified by the literature search . Review ers compare their results to identify sources of ambiguity and then revise the forms accordingly . If the revisions are substantial , this process may need to be repeated before the forms can be used . Figure 1 . Example of a form that might be developed for the selection of studies for a systematic review evaluating the efficacy of -blockers for secondary prevention of variceal bleeding .  Write a Detailed Protocol Having a selection protocol as part of a larger protocol for the entire review helps review ers in two ways . First , it provides a document that explicitly states the review question and the selection criteria , making the process accountable . Review ers can later return to the protocol for guidance in resolving disagreements about article selection . Second , the selection protocol identifies what work will be done , by whom , in what manner , when , and for what reason ; thus , it provides a mode of communication within the review team . When review ers have a very large sample of studies from which to select , they can simplify this task by review ing all of the titles , then the abstract s , and then the full articles , excluding studies that do not meet one or more selection criteria at each step . In doing so , review ers should record ( on the selection forms ) the reasons for exclusion . After review ers have selected studies for the systematic review , they will move to the next task of critical appraisal . This procedure also requires careful planning . Appraising Studies for Systematic Review s Review ers appraise the studies selected for review with three objectives in mind : 1 ) to underst and the validity of the studies , 2 ) to uncover reasons for differences among study results other than chance , and 3 ) to provide readers with sufficient information with which to judge for themselves the applicability of the systematic review to their clinical practice . To achieve these goals , review ers use the strategies outlined in Table 2 and Table 3 to carefully reexamine many important features of the primary studies . Table 3 . Planning Study Appraisal Examine Important Clinical Features Although the selection criteria for a systematic review define the population , interventions , and outcomes of interest , the appraisal process involves a detailed assessment of the patients ( for example , high , medium , or low risk ) , the study interventions ( for example , frequency , degree , and duration ) , and the outcome measurements ( for example , definitions and degree of surveillance ) Background Factors Influencing Depression Endpoints Research ( FINDER ) is a 6-month , prospect i ve , observational study carried out in 12 European countries aim ed at investigating health-related quality of life ( HRQoL ) in out patients receiving treatment for a first or new depressive episode . The Italian HRQoL data at 6 months is described in this report , and the factors associated with HRQoL changes were determined . Methods Data were collected at baseline , 3 and 6 months of treatment . HRQoL was measured using components of the  36-item Short Form Health Survey ( SF-36 ; mental component summary ( MCS ) , physical component summary ( PCS ) ) and the European Quality of Life-5 Dimensions ( EQ-5D ; visual analogue scale ( VAS ) and health status index ( HSI ) ) . The Hospital Anxiety and Depression Scale ( HADS ) was adopted to evaluate depressive symptoms , while somatic and painful physical symptoms were assessed by using the 28-item Somatic Symptom Inventory ( SSI-28 ) and a VAS . Results Of the initial 513 patients , 472 completed the 3-month observation and 466 the 6-month observation . The SF-36 and EQ-5D mean ( ± SD ) scores showed HRQoL improvements at 3 months and a further smaller improvement at 6 months , with the most positive effects for SF-36 MCS ( baseline 22.0 ± 9.2 , 3 months 34.6 ± 10.0 ; 6 months 39.3 ± 9.5 ) and EQ-5D HSI ( baseline 0.4 ± 0.3 ; 3 months 0.7 ± 0.3 ; 6 months 0.7 ± 0.2 ) . Depression and anxiety symptoms ( HADS-D mean at baseline 13.3 ± 4.2 ; HADS-A mean at baseline 12.2 ± 3.9 ) consistently decreased during the first 3 months ( 8.7 ± 4.3 ; 7.5 ± 3.6 ) and showed a further positive change at 6 months ( 6.9 ± 4.3 ; 5.8 ± 3.4 ) . Somatic and painful symptoms ( SSI and VAS ) significantly decreased , with the most positive changes in the SSI-28 somatic item ( mean at baseline 2.4 ± 0.7 ; mean change at 3 months : -0.5 ; 95 % CI -0.6 to -0.5 ; mean change at 6 months : -0.7 ; 95 % CI -0.8 to -0.7 ) ; in ' interference of overall pain with daily activities ' ( mean at baseline 45.2 ± 30.7 ; mean change at 3 months -17.4 ; 95 % CI -20.0 to -14.8 ; mean change at 6 months -24.4 ; 95 % CI -27.3 to -21.6 ) and in ' having pain while awake ' ( mean at baseline 41.1 ± 29.0 ; mean change at 3 months -13.7 ; 95 % CI -15.9 to -11.5 ; mean change at 6 months -20.2 ; 95 % CI -22.8 to -17.5 ) domains . The results from linear regression analyses showed that the antidepressant switch within classes was consistently associated with a worsening in SF-36 MCS , EQ-5D VAS and HSI compared to non-switching treatment . Furthermore , between-group antidepressants ( AD ) switch was associated with a worse SF-36 MCS and EQ-5D HSI . MCS ( P = 0.028 ) , PCS ( P = 0.036 ) and HSI ( P = 0.002 ) were inversely related to the number of each previous additional depressive episode . PCS ( P = 0.009 ) and HSI ( P = 0.005 ) were also less improved in patients suffering from a chronic medical condition . Moreover , PCS ( P = 0.044 ) and EQ-5D VAS ( P < 0.0001 ) worsening was consistently associated with the presence of a psychiatric illness in the 24 months before baseline . For every additional point on the SSI-somatic score and on the overall pain VAS score at baseline , HSI score were on average 0.062 ( P < 0.001 ) and 0.001 ( P = 0.005 ) smaller , respectively . Conclusions After starting AD treatment , HRQoL improvements at 3 and 6 months were observed . However , several factors can negatively influence HRQoL , such as the presence of somatic and painful symptoms , the presence of any chronic medical condition or previous psychiatric illness Background Multi-attribute utility measures are preference-based health-related quality of life measures that have been developed to inform economic evaluations of health care interventions . The objective of this study was to compare the empirical validity of two multi-attribute utility measures ( EQ-5D and SF-6D ) based on hypothetical preferences in a large maternity population in Engl and . Methods Women who participated in a r and omised controlled trial of additional postnatal support provided by trained community support workers represented the study population for this investigation . The women were asked to complete the EQ-5D descriptive system ( which defines health-related quality of life in terms of five dimensions : mobility , self care , usual activities , pain/discomfort and anxiety/depression ) and the SF-36 ( which defines health-related quality of life , using 36 items , across eight dimensions : physical functioning , role limitations ( physical ) , social functioning , bodily pain , general health , mental health , vitality and role limitations ( emotional ) ) at six months postpartum . Their responses were converted into utility scores using the York A1 tariff set and the SF-6D utility algorithm , respectively . One-way analysis of variance was used to test the hypothetically-constructed preference rule that each set of utility scores differs significantly by self-reported health status ( categorised as excellent , very good , good , fair or poor ) . The degree to which EQ-5D and SF-6D utility scores reflected alternative dichotomous configurations of self-reported health status and the Edinburgh Postnatal Depression Scale score was tested using the relative efficiency statistic and receiver operating characteristic ( ROC ) curves . Results The mean utility score for the EQ-5D was 0.861 ( 95 % CI : 0.844 , 0.877 ) , whilst the mean utility score for the SF-6D was 0.809 ( 95 % CI : 0.796 , 0.822 ) , representing a mean difference in utility score of 0.052 ( 95 % CI : 0.040 , 0.064 ; p < 0.001 ) . Both measures demonstrated statistically significant differences between subjects who described their health status as excellent , very good , good , fair or poor ( p < 0.001 ) , as well as monotonically decreasing utility scores ( test for linear trend : p < 0.001 ) . The SF-6D was between 29.1 % and 423.6 % more efficient than the EQ-5D at detecting differences in self-reported health status , and between 129.8 % and 161.7 % more efficient at detecting differences in the Edinburgh Postnatal Depression Scale score . In addition , the SF-6D generated higher area under the curve ( AUC ) scores generated by the ROC curves than the EQ-5D , indicating greater discriminatory power , although in all but one analysis the differences in AUC scores between the measures were not statistically significant . Conclusion This study provides evidence that the SF-6D is an empirically valid and efficient alternative multi-attribute utility measure to the EQ-5D , and is capable of discriminating between external indicators of maternal health Background Art Therapy has been promoted as a means of helping people who may find it difficult to express themselves verbally engage in psychological treatment . Group Art Therapy has been widely used as an adjunctive treatment for people with schizophrenia but there have been few attempts to examine its effects and cost effectiveness has not been examined . The MATISSE study aims to evaluate the clinical and cost effectiveness of group Art Therapy for people with schizophrenia . Method / Design The MATISSE study is a three-arm , parallel group , pragmatic , r and omised , controlled trial of referral to group Art Therapy plus st and ard care , referral to an attention control ' activity ' group plus st and ard care , or st and ard care alone .  Study participants were recruited from inpatient and community-based mental health and social care services at four centres in Engl and and Northern Irel and . Participants were aged over 18 years with a clinical diagnosis of schizophrenia , confirmed by an examination of case notes using operationalised criteria . Participants were then r and omised via an independent and remote telephone r and omisation service using permuted stacked blocks , stratified by site . Art Therapy and activity groups were made available to participants once a week for up to 12 months . Outcome measures were assessed by research ers masked to allocation status at 12 and 24 months after r and omisation . Participants and care givers were aware which arm of the trial participants were allocated to . The primary outcomes for the study are global functioning ( measured using the Global Assessment of Functioning scale ) and mental health symptoms ( measured using the Positive and Negative Syndrome Scale ) assessed at 24 months . Secondary outcomes were assessed at 12 and 24 months and comprise levels of group attendance , social function , satisfaction with care , mental wellbeing , and costs . Discussion We believe that this is the first large scale pragmatic trial of Art Therapy for people with schizophrenia . Trial registration Current Controlled Trials IS RCT BACKGROUND Improving patients '  health-related quality of life ( HRQOL ) could be a treatment goal for bipolar depression . OBJECTIVES The objectives of these secondary analyses of a previous report were to determine the benefits of olanzapine alone and olanzapine-fluoxetine combination ( OFC ) for improving HRQOL in patients with bipolar depression using both a generic and a depression-specific HRQOL instrument , and to examine the association between the 2 HRQOL instruments and the construct validity of the depression-specific HRQOL instrument . METHODS This was a double-blind , placebo-controlled , 83-site , international , r and omized trial . Adults with bipolar I disorder , most recent episode depressed ( according to the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ) , were r and omly assigned to receive olanzapine ( 6 - 20 mg/d ) , OFC ( 6/25 , 12/25 , or 12/50 mg/d ) , or placebo for 8 weeks . HRQOL improvement was calculated as last-observation-carried-forward changes in dimension and component summary scores on Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) and total score on the Quality of Life in Depression Scale ( QLDS ) . RESULTS Patients were assigned to receive olanzapine ( n = 370 ) , [ corrected ] OFC ( n = 86 ) , or placebo ( n = 377 ) [ corrected ] for 8 weeks . Of 833 enrolled patients , 454 discontinued  ( olanzapine , 191/370 [ 51.6 % ] [corrected]OFC , 31/86 [ 36.0 % ] ; and placebo , 232/377 [ 61.6 % ] ) [ corrected ] Compared with placebo , olanzapine-treated patients exhibited greater improvements on SF-36 mental component summary ( MCS ) score ( P=0.002 ) and 3 of 8 SF-36 dimension scores ( mental health [ P=0.015 ] , role-emotional [ P=0.046 ] , and social functioning [ P=0.006 ) . OFC-treated patients exhibited greater improvements on MCS score ( P<0.001 ) vs both placebo and olanzapine ) , 5 SF-36 dimension scores ( general health perception ( P<0.001 ) vs placebo ; ( P<0.001 ) vs olanzapinel , mental health [ P=0.001 ] vs both placebo and olanzapine ] , role-emotional [ P<0.001 ] vs placebo ; [ P=0.007 ] vs olanzapine ] , social functioning [ P=0.001 ] vs placebo ; [ P=0.032 ] vs olanzapine ] , and vitality [ P=0.002 ] vs placebo ; [ P=0.011 ] vs olanzapine ] ) , and QLDS total score ( P<0.001 ] vs both placebo and olanzapine ) . Changes in SF-36 scores of mental health , social functioning , role-emotional , and vitality were highly correlated to changes in the QLDS total score ( all p < -0.5 ) . CONCLUSIONS Based on these analyses , patients with bipolar depression receiving olanzapine or OFC for 8 weeks had greater improvement in HRQOL than those receiving placebo . OFC treatment was associated with greater improvement in HRQOL than olanzapine alone . The correlation results support the construct validity of the QLDS BACKGROUND Individuals with anxiety disorders often do not receive an accurate diagnosis or adequate treatment in primary care . AIMS To analyse the cost-effectiveness of an optimised care model for people with anxiety disorders in primary care . METHOD In a cluster r and omised controlled trial , 46 primary care practice s with 389 individuals positively screened with anxiety were r and omised to intervention ( 23 practice s , 201 participants ) or  usual care  ( 23 practice s , 188 participants ) . Physicians in the intervention group received training on diagnosis and treatment of anxiety disorders combined with the offer of a psychiatric consultation-liaison service for 6 months .  Anxiety , depression , quality of life , service utilisation and costs were assessed at baseline , 6-month and 9-month follow-up . RESULTS No significant differences were observed between intervention and control group on the Beck Anxiety Inventory , Beck Depression Inventory and EQ-5D during follow-up . Total costs were higher in the intervention group ( euro4911 v. euro3453 , P = 0.09 ) . The probability of an incremental cost-effectiveness ratio < euro50 000 per quality -adjusted life year was below 10 % . CONCLUSIONS The optimised care model did not prove to be cost-effective Background Most tools for estimating utilities use clinical trial data from general health status models , such as the 36-Item Short-Form Health Survey ( SF-36 ) . A disease-specific model may be more appropriate . The objective of this study was to apply a disease-specific utility mapping function for schizophrenia to data from a large , 1-year , open-label study of long-acting risperidone and to compare its performance with an SF-36-based utility mapping function . Methods Patients with schizophrenia or schizoaffective disorder by DSM-IV criteria received 25 , 50 , or 75 mg long-acting risperidone every 2 weeks for 12 months . The Positive and Negative Syndrome Scale ( PANSS ) and SF-36 were used to assess efficacy and health-related quality of life . Movement disorder severity was measured using the Extrapyramidal Symptom Rating Scale ( ESRS ) ; data concerning other common adverse effects ( orthostatic hypotension , weight gain ) were collected . Transforms were applied to estimate utilities . Results A total of 474 patients completed the study . Long-acting risperidone treatment was associated with a utility gain of 0.051 using the disease-specific function . The estimated gain using an SF-36-based mapping function was smaller : 0.0285 . Estimates of gains were only weakly correlated ( r = 0.2 ) . Because of differences in scaling and variance , the requisite sample size for a r and omized trial to confirm observed effects is much smaller for the disease-specific mapping function ( 156 versus 672 total subjects ) . Conclusion Application of a disease-specific mapping function was feasible . Differences in scaling and precision suggest the clinical ly based mapping function has greater power than the SF-36-based measure to detect differences in utility INTRODUCTION The objectives of this study were to determine the economic , clinical , and quality -of-life outcomes associated with olanzapine treatment in patients diagnosed with mania . METHODS Patients with a diagnosis of bipolar I disorder with manic or mixed episodes were enrolled in a r and omized controlled trial . The study design comprised a 3-week acute phase followed by a 49-week open label extension . In the open label extension , the use of lithium and fluoxetine was permitted for patients who experienced breakthrough symptoms . Clinical , economic , and quality -of-life outcomes of treatment were assessed . RESULTS During the acute phase , olanzapine patients experienced a statistically significant greater mean improvement from baseline on the Y-MRS total score compared to the placebo patients . In the open label extension , patients experienced a statistically significant mean change of 11.8 units on the Y-MRS from the end of the acute phase . When compared to costs incurred in the previous 12 months of therapy , patients experienced savings of almost $ 900 per month during the 49 weeks of olanzapine therapy . These cost savings were largely driven by reductions in in-patient costs during the open label extension . Health-related quality of life improvements measured by the SF-36 were seen on several dimensions both in the 3-week acute phase as well as in the 49-week open label extension . CONCLUSION From a clinical , economic , and quality -of-life outcomes st and point , olanzapine had a significant impact in the treatment of mania , and could be considered a cost-effective treatment option for use in this population if these findings are extrapolated to non- clinical trial population Background . The Clinical Outcomes in Routine Evaluation– Outcome Measure ( CORE-OM ) is used to evaluate the effectiveness of psychological therapies in people with common mental disorders . The objective of this study was to estimate a preference-based index for this population using CORE-6D , a health state classification system derived from the CORE-OM consisting of a 5-item emotional component and a physical item , and to demonstrate a novel method for generating states that are not orthogonal . Methods . Rasch analysis was used to identify 11 emotional health states from CORE-6D that were frequently observed in the study population and are , thus , plausible ( in contrast , conventional statistical design might generate implausible states ) . Combined with the 3 response levels of the physical item of CORE-6D , they generate 33 plausible health states , 18 of which were selected for valuation . A valuation survey of 220 members of the public in South Yorkshire , United Kingdom , was undertaken using the time tradeoff ( TTO ) method . Regression analysis was subsequently used to predict values for all possible states described by CORE-6D . Results . A number of multivariate regression models were built to predict values for the 33 health states of CORE-6D , using the Rasch logit value of the emotional state and the response level of the physical item as independent variables . A cubic model with high predictive value ( adjusted R2 = 0.990 ) was selected to predict TTO values for all 729 CORE-6D health states . Conclusion . The CORE-6D preference-based index will enable the assessment of cost-effectiveness of interventions for people with common mental disorders using existing and prospect i ve CORE-OM data sets . The new method for generating states may be useful for other instruments with highly correlated dimensions BACKGROUND There is equivocal evidence of the effectiveness of adherence therapy in improving treatment adherence and clinical outcomes for people with schizophrenia . AIMS To evaluate the effectiveness of adherence therapy in improving quality of life for people with schizophrenia . METHOD A 52-week , single-blind , multicentre r and omised controlled trial of the effectiveness of adherence therapy .  Participants were individually r and omised to receive eight sessions of adherence therapy or health education . Assessment s were undertaken at baseline and at 52-week follow-up . RESULTS Adherence therapy was no more effective than health education in improving quality of life . CONCLUSIONS This effectiveness trial provides evidence for the lack of effect of adherence therapy in people with schizophrenia with recent clinical instability , treated in ordinary clinical setting BACKGROUND The cost-effectiveness of tricyclic antidepressants ( TCAs ) and selective serotonin reuptake inhibitors ( SSRIs ) has not been compared in a prospect i ve study in primary care . AIMS To determine the relative cost-effectiveness of TCAs , SSRIs and lofepramine in UK primary care . METHOD An open-label , three-arm r and omised trial with a preference arm . Practitioners referred 327 patients with incident depression . RESULTS No significant differences were found in effectiveness or cost-effectiveness . The numbers of depression-free weeks over 12 months ( on the Hospital Anxiety and Depression Scale ) were 25.3 ( 95 % CI 21.3 - 29.0 ) for TCAs , 28.3 ( 95 % CI 24.3 - 32.2 ) for SSRIs and 24.6 ( 95 % CI 20.6 - 28.9 ) for lofepramine .  Mean health service costs per patient were pound 762 ( 95 % CI 553 - 1059 ) for TCAs , pound 875 ( 95 % CI 675 - 1355 ) for SSRIs and pound 867 ( 95 % CI 634 - 1521 ) for lofepramine .  Cost-effectiveness acceptability curves suggested SSRIs were most cost-effective ( with a probability of up to 0.6 ) . CONCLUSIONS The findings support a policy of recommending SSRIs as first-choice antidepressants in primary care OBJECTIVE Repetitive transcranial magnetic stimulation ( rTMS ) has been reported to be as effective as electroconvulsive therapy ( ECT ) for major depression . The authors conducted a multicenter r and omized , controlled trial to test the equivalence of rTMS with ECT . METHOD Forty-six patients with major depression referred for ECT  were r and omly assigned to either a 15-day course of rTMS of the left dorsolateral prefrontal cortex ( N=24 ) or a st and ard course of ECT ( N=22 ) . The primary outcome measures were the score on the 17-item Hamilton Depression Rating Scale ( HAM-D ) and the proportion of patients with remissions ( Hamilton score , < or=8 ) at the end of treatment . Secondary outcomes included mood self-ratings on the Beck Depression Inventory-II and visual analogue mood scales , Brief Psychiatric Rating Scale ( BPRS ) score , and both self-reported and observer-rated cognitive changes . The patients were followed up after 6 months . RESULTS HAM-D scores at the end of treatment were significantly lower for ECT , with 13 patients ( 59.1 % ) achieving remission in the ECT group and four ( 16.7 % ) in the rTMS group . However , at 6 months the HAM-D scores did not differ between groups . Beck scale , visual analogue mood scale , and BPRS scores were lower for ECT at the end of treatment and remained lower after 6 months . Self- and observer-rated cognitive measures were similar in the two groups . CONCLUSIONS rTMS was not as effective as ECT , and ECT was substantially more effective for the short-term treatment of depression Objective To evaluate benefits for postnatal women of two  psychologically informed interventions  by health visitors . Design Prospect i ve cluster trial r and omised by general practice , with 18 month follow-up . Setting 101 general practice s in Trent , Engl and . Participants 2749 women allocated to intervention , 1335 to control . Intervention Health visitors ( n=89 63 clusters ) were trained to identify depressive symptoms at six to eight weeks postnatally using the  Edinburgh postnatal depression scale ( EPDS ) and clinical assessment and also trained in providing psychologically informed sessions based on cognitive behavioural or person centred principles for an hour a week for eight weeks . Health visitors in the control group ( n=49 38 clusters ) provided usual care . Main outcome measures Score ≥12 on the Edinburgh postnatal depression scale at six months . Secondary outcomes were mean Edinburgh postnatal depression scale , clinical outcomes in routine evaluation- outcome measure ( CORE-OM ) , state-trait anxiety inventory ( STAI ) , SF-12 , and parenting stress index short form ( PSI-SF ) scores at six , 12 , 18 months . Results 4084 eligible women consented and 595 women had a six week EPDS score ≥12 . Of these , 418 had EPDS scores available at six weeks and six months . At six months , 34 % women ( 93/271 ) in the intervention group and 46 % ( 67/147 ) in the control group had an EPDS score ≥12 . The odds ratio for score ≥12 at six months was 0.62 ( 95 % confidence interval 0.40 to 0.97 , P=0.036 ) for women in the intervention group compared with women in the control group . After adjustment for covariates , the odds ratio was 0.60 ( 0.38 to 0.95 , P=0.028 ) . At six months , 12.4 % ( 234/1880 ) of all women in the intervention group and 16.7 % ( 166/995 ) of all women in the control group had scores ≥12 ( 0.67 , 0.51 to 0.87 , P=0.003 ) . Benefit for women in the intervention group with a six week EPDS score ≥12 and for all women was maintained at 12 months postnatally . There was no differential benefit for either psychological approach over the other . Conclusion Training health visitors to assess women , identify symptoms of postnatal depression , and deliver psychologically informed sessions was clinical ly effective at six and 12 months postnatally compared with usual care . Trial registration IS RCT N92195776 BACKGROUND Limited information is available on the outcome of bipolar disorder in developing countries . OBJECTIVE To describe the symptomatic and functional outcome of bipolar disorder . METHODS The psychoses and affective disorder modules of the CIDI were used to screen 68,378 individuals by a door-to-door survey of a defined district in Ethiopia . In addition , key informants were used to identify individuals with probable major mental illnesses . SCAN interviews were completed at the second stage to confirm the diagnosis . A total of 315 cases of bipolar disorder were identified , of which 264 ( 69 recent-onset and 195 prevalent cases ) were prospect ively followed for a mean of 2.5 ( range 1 - 4 ) years by baseline and annual clinical assessment s using symptom rating scales . Functional dimensions of the SF-36 scale were used to describe functional outcome . R and om coefficient analyses were used to evaluate potential correlates of outcome . RESULTS The magnitudes of mania and depression symptoms were elevated at baseline but improved with follow-up , although the improvement was less marked for depression . Sociodemographic or clinical variables were not associated with the improvements in symptomatic outcome . Between 35 % and 47 % of the recent-onset cases had functional role restrictions , while 42 - 52 % of long-st and ing cases had such restrictions during the follow-up years . Similarly , social and physical functioning deficits were also present in 52 - 86 % and 35 - 47 % of recent-onset and long-st and ing cases , respectively . The magnitude of depression and mania symptoms was associated with poor functional outcome , while male sex , rural residence and being married were associated with better functional outcome . CONCLUSION Although there were improvements in function with follow-up , between one-third and one-half of cases continued to have functional deficits INTRODUCTION Borderline Personality Disorder ( BPD ) is a severe psychiatric disorder and is associated with significant impairment in quality of life . The aim of the present study is to assess the internal and external responsiveness of the  EuroQoL-5D ( EQ-5D ) in BPD patients . PATIENTS AND METHODS Data from 49 patients included in a multi-center Dutch r and omized trial were used . We used both the EQ-5D utility score and the Visual Analogue Scale of the EuroQoL , and the  Borderline Personality Disorder Severity Index-IV ( BPDSI-IV ) . To determine internal responsiveness , we calculated the st and ardized response mean ( SRM ) . To determine external responsiveness , we calculated Spearman correlations for the change scores , and compared EQ-5D scores for clinical ly improved vs. non- clinical ly improved patients as measured with the BPDSI-IV . RESULTS Patient scores improved on all instruments during the three years . SRMs for BPDSI-IV were significantly higher than EQ-5D utility . Three-year Spearman correlation between change scores of BPDSI-IV and EQ-5D utility was 0.487 , between BPDSI-IV and EQ-VAS it was 0.404 , both statistically significant . EQ-5D utility scores for patients who clinical ly improved were significantly higher than for patients who did not . DISCUSSION We conclude that the EQ-5D is fairly responsive in BPD , and , therefore , especially because of its brevity and user-friendliness , can serve as a useful tool in economic evaluations in patients with BPD Background : For patients with cluster B personality disorders there is no consensus regarding the optimal treatment setting . The aim of this study was to compare the effectiveness of different psychotherapeutic setting s for patients with cluster B personality disorders , i.e. outpatient , day hospital , and inpatient treatment . Methods : The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherl and s , with a sample of 207 patients with a DSM-IV-TR axis II cluster B diagnosis . Patients were assigned to 3 different setting s of psychotherapeutic treatment and effectiveness was assessed at 18 months after baseline . An intention-to-treat analysis was conducted for psychiatric symptoms ( Brief Symptom Inventory ) , psychosocial functioning ( Outcome Question naire-45 ) , and quality of life ( EQ-5D ) , using multilevel statistical modelling . As the study was non-r and omised , the propensity score method was used to control for initial differences . Results : Patients in all 3 setting s improved significantly in terms of psychiatric symptoms , social and interpersonal functioning , and quality of life 18 months after baseline . The inpatient group showed the largest improvements . The comparison of outpatient and inpatient treatment regarding psychiatric symptoms showed a marginally significant result ( p = 0.057 ) in favour of inpatient treatment . Conclusions : Patients with cluster B personality disorders improved in all investigated treatment setting s , with a trend towards larger improvements of psychiatric symptoms in the inpatient setting compared to the outpatient setting . Specialised inpatient treatment should be considered as a valuable treatment option for cluster B personality disorders , both in research and in clinical practice Background : While psychopharmacological studies are common in patients with cluster A personality disorders , the effects of psychotherapy have received little attention . The aim of this study is to explore whether psychotherapeutic treatment yields health gains for these patients . Methods : The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherl and s , with a sample of 57 patients with a DSM-IV-TR axis II cluster A diagnosis . Patients were assigned to 3 setting s of psychotherapeutic treatment ( outpatient , day hospital , inpatient ) , and effectiveness was assessed at 18 months after baseline . An intention-to-treat analysis was conducted for psychiatric symptoms ( Brief Symptom Inventory ) , psychosocial functioning ( Outcome Question naire-45 ) and quality of life ( EQ-5D ) , using multilevel statistical modelling . As the study was non-r and omised , the propensity score method was used to control for initial differences . Results : Patients in the day hospital and inpatient group improved substantially in terms of psychiatric symptoms , social and interpersonal functioning , and quality of life . Patients in the outpatient group showed less improvement . Direct comparison of the improvement of psychiatric symptoms showed significant results in favour of day hospital ( p = 0.046 ) and inpatient ( p = 0.01 ) treatment , as compared to outpatient treatment . However , due to substantial baseline differences , this direct comparison should be judged carefully . Conclusions : Cluster A psychopathology is not a contraindication to benefit from psychotherapy . This is especially true for more intensive forms like inpatient and day hospital treatment . Future research should focus more on psychotherapeutic treatment to gain further insight into effective treatment options for this patient group BACKGROUND We investigated the impact of treatment with long-acting , injectable risperidone versus placebo on health-related quality of life ( HRQoL ) in patients with schizophrenia . Results are discussed in the context of HRQoL in the general U.S. population . METHOD Patients with DSM-IV schizophrenia entered a r and omized , double-blind , placebo-controlled trial . After screening , previous antipsychotics were discontinued , and oral risperidone was titrated up to a dose of 4 mg/day over 1 week . Patients were then r and omly assigned to receive placebo  [ N = 92 ] or long-acting risperidone ( 25 [ N = 93 ] , 50 [ N = 97 ] , or 75 mg [ N = 87 ] every 2 weeks ) for 12 weeks . HRQoL was measured using the Medical Outcomes Study Short-Form 36-item question naire ( SF-36 ) . RESULTS At week 12 , patients receiving long-acting risperidone had improved significantly ( p < .05 ) in 5 domains of the SF-36 ( bodily pain , general health , social functioning , role-emotional , and mental health ) compared with patients receiving placebo . The effect was greatest for the 25-mg group , with significant improvement versus placebo in 6 domains ( p < .05 ) . At baseline , all SF-36 domain scores except bodily pain were significantly lower ( p < .05 ) than normal values in all groups . With placebo , scores in all 8 domains remained below normal values after 12 weeks , while patients receiving long-acting risperidone showed improvement in HRQoL toward normal levels , with clinical ly meaningful improvements in all mental-health domains . In the 25-mg group , scores in 7 domains were not statistically different from normal values after 12 weeks . CONCLUSIONS Long-acting , injectable risperidone improved HRQoL toward normal levels . After 12 weeks , HRQoL of patients receiving 25 mg was not significantly different from normal Background Generic health preference measures that capture quality of life improvements in depression are important for economic analysis of new technologies . Aim To compare two widely used preference measures , the EQ-5D and SF-6D , in terms of their dimensions and health utility values . Method EQ-5D and SF-6D data collected from 114 patients with depression , who participated in a cluster , r and omised controlled trial to evaluate a collaborative care intervention in UK , primary care practice s.  Utilities were examined across the whole sample and by level of depression severity using the PHQ-9 . Results Depression was associated with disutility at baseline . At 3 month follow-up mean utility increased 0.147 for EQ-5D and 0.082 for SF-6D . Health gains were observed in patients in remission from depression and those with the mildest level of depression severity . Conclusions Both generic preference measures were sensitive to health gains in depression within a relatively short follow-up period ; larger health gain was observed for the EQ-5D Background : Little information is available on the impact of the atypical antipsychotic olanzapine on quality of life ( QOL ) . A 6-week , double-blind r and omized multicenter trial , with a long-term extension , was conducted to evaluate the clinical efficacy and QOL of olanzapine and haloperidol in treating schizophrenia and other psychotic disorders . Methods : A total of 828 out patients provided QOL data . Study patients were aged greater than 18 years with a DSM-III-R diagnosis of schizophrenia , schizophreniform disorder , or schizoaffective disorder and baseline BPRS ( items scored on 0–6 scale ) total scores , ≥18 were r and omized to 6 weeks of treatment with olanzapine 5 to 20 mg/day or haloperidol 5 to 20 mg/day . Patients entered a 46-week double-blind extension if they demonstrated minimal clinical response and were tolerant to study medication . The Quality of Life Scale ( QLS ) and SF-36 Health Survey were used to evaluate QOL . Results : During the 6-week acute phase , olanzapine treatment significantly improved BPRS total ( p = 0.004 ) , PANSS total scores ( p = 0.043 ) , QLS total ( p = 0.005 ) , intrapsychic foundations ( p < 0.001 ) and interpersonal relations scores ( p = 0.036 ) , and SF-36 mental component summary scores ( p < 0.001 ) compared with haloperidol . During the extension phase , olanzapine treatment significantly improved PANSS negative scores ( p = 0.035 ) and improved QLS total ( p = 0.001 ) , intrapsychic foundations ( p < 0.001 ) , and instrumental role category scores ( p = 0.015 ) versus haloperidol treatment . Significantly more  haloperidol patients discontinued treatment due to adverse events during the acute and extension phases ( p = 0.041 and p = 0.014 , respectively ) . Changes in QLS total and MCS scores were associated with changes in clinical symptoms , depression scores and extrapyramidal symptoms . Conclusions : Olanzapine was more effective than haloperidol in reducing severity of psychopathology and in improving QOL in patients with schizophrenia and other psychotic disorders . The QOL benefits of olanzapine , although modest , may be important for long-term treatment BACKGROUND The aim of this study was to compare the scorings of  anxiety and depression  assessed by the  Hospital Anxiety and Depression Scale ( HADS-A [ Anxiety ] and HADS-D [ Depression ] )  with the scorings on the eight subscales of Short Form 36 ( SF-36 ) and the Physical ( PCS ) and Mental Component Summary ( MCS ) assessed by the same patients . METHOD In a cross-sectional study 736 long-term survivors after treatment for testicular cancer ( TC ) completed HADS and SF-36 . Pearson 's correlation coefficients were calculated on item and scale level to assess the associations between the HADS and the SF-36 scales and , in particular , between HADS and PCS and MCS , respectively . Independent predictors for PCS and MCS were identified by linear regression analysis . RESULTS HADS-A and HADS-D were significantly associated with the SF-36 summary scales . HADS-A explained 5 % of the variance of PCS and 49 % of the variance of MCS . The comparable figures for HADS-D were 10 % and 45 % , respectively . In the multivariate analysis the HADS-D scoring independently predicted the level of PCS together with the patients ' educational level , long-lasting working disability and age ( variance : 30 % ) . Both HADS-D and HADS-A remained independent parameters for MCS ( variance : 58 % ) together with the patient 's civil status . HADS-D item D4 ( " slowed down " ) was similarly associated with both PCS and MCS . CONCLUSION In univariate analyses HADS-D and HADS-A were statistically associated with PCS and MCS . The highest r values were observed for the associations between HADS and MCS , in particular between HADS-A and MCS . In the multivariate analyses HADS-D , but not HADS-A , contributed to PCS , whereas both HADS-A and HADS-D were associated with MCS . This pattern of different predictions of the summary scales of SF-36 supports a clinical practice that anxiety and depression should be assessed separately . Additional use of a self-rating instrument for depression and anxiety , such as HADS , is recommended when SF-36 is used for quality of life ( QL ) assessment Background : The first set of aims of the present study was to determine the prevalence of personality disorders  ( PDs ) in a nation , and gender differences in the types and numbers of PDs endorsed . The second set of aims was to establish the relationship of PD to other , non-PD disorders , physical conditions , and disability . Method : Data were obtained from the Australian National Survey of Mental Health and Wellbeing , conducted between May and August 1997 . A stratified r and om sample of households was generated , from which all those aged 18 or over were considered potential interviewees . There were 10,641 respondents to the survey , and this represented a response rate of 78 % . Each interviewee was asked 59 questions indexing specific ICD-10 PD criteria . Results : Of the total survey sample , 704 persons had at least one PD . Using weighted replicate weights , it was estimated that approximately 6.5 % of the adult population of Australia have one or more PDs ( lifetime prevalence ) . Persons with PD were more likely to be younger , male , and not married , and to have an anxiety disorder , an affective disorder , a substance use disorder , or a physical condition . They were also more likely to have greater disability than those without PD . Conclusion : The study is the first nation-wide survey of mental disorders conducted within Australia . It provides an estimate of the prevalence of the various types of PD . The survey has considerable limitations , however , and these are discussed It has often been postulated that simple , short question naires are unable to reflect complex changes in well-being of individuals with chronic psychiatric disorders . To investigate these assumptions we included two recently developed instruments to measure quality of life  ( the WHOQoL-Bref and the EuroQoL EQ-5D ) in a r and omised control trial ( RCT ) in which two treatment conditions were compared . Aims of the study were to assess the sensitivity and validity of these  quality of life (QoL)-instruments  , to establish their relationship and to examine the predictors of changes in QoL. Subjective changes in QoL were measured on three assessment s waves in a period of 18 months and compared to objective changes in psychopathology and social functioning in a sample of 76 chronic schizophrenic patients who participated in the RCT . Results indicated that both WHOQoL-Bref and EuroQoL EQ-5D are capable of detecting changes in QoL over time in physical and psychological well-being . The instruments partly measure the same aspects of QoL , indicated by 50 % common variance on total scores . Reduction of positive psychotic symptoms appeared to be the most important factor in improving QoL. The weighted TTO-score of EuroQoL-5D , which is often used as an index in economic evaluations of health care , did however not correspond with these changes , which indicates that it is less sensitive to changes in social and psychological well-being . It ’s use as the core measure in ( economic ) health evaluation in the field of psychiatry therefore seems less appropriate OBJECTIVE To examine treatment-specific changes in health-related quality of life ( QOL ) among patients with schizophrenia and to assess the association between clinical and QOL improvement . METHOD This post hoc analysis used the findings of a 28-week , r and omized , multicenter trial of patients with schizophrenia ( DSM-IV ) treated with olanzapine ( 10 - 20 mg/day ) or ziprasidone ( 80 - 160 mg/day ) . Data were collected from August 2001 to December 2002 .  Efficacy was measured using the Positive and Negative Syndrome Scale ( PANSS ) . Quality of life was assessed with the generic health self-administered Medical Outcomes Study Short-Form 36-Item Health Survey ( SF-36 ) and the disease-specific expert-administered Heinrichs-Carpenter Quality of Life Scale ( QLS ) . Mixed-effects-repeated- measures and last-observation-carried-forward approaches were used to assess the effects of treatment on QOL and the association of clinical outcomes to QOL outcomes . RESULTS Olanzapine- and ziprasidone-treated patients demonstrated similar improvement from baseline to endpoint on the SF-36 and QLS . All correlations between changes in PANSS scores and the SF-36 were significant ( p < .001 ) , ranging from -0.159 to -0.400 . All correlations between changes in PANSS scores and the QLS were significant ( p < .0001 ) , ranging from -0.286 to -0.603 . The correlations between the 2 QOL measures were generally significant but small to moderate in magnitude . CONCLUSIONS The results of this study indicate that , in patients with schizophrenia , olanzapine and ziprasidone treatment are associated with significant QOL and clinical improvements . Further , the significant correlation between change scores on the PANSS and QOL measures suggests that treatment-related clinical improvements are associated with improved health-related and disease-specific QOL . CLINICAL TRIALS REGISTRATION Clinical Study Results .org identifier 2347 We developed a self-administered instrument to assess  health-related quality of life ( HRQL ) among people with schizophrenia . The S-QoL , based on Calman 's approach to the subject 's point of view , is a multidimensional instrument that is sensitive to change . The scale is a 41-item question naire with eight subscales ( psychological well-being , self-esteem , family relationships , relationships with friends , resilience , physical well-being , autonomy and sentimental life ) and a total score . In-depth interviews with patients determined the pertinent issues for item development . The validation study , performed with 207 patients , showed high internal consistency reliability , reproducibility and responsiveness . Construct validity was confirmed using established clinical and HRQL measures . S-QoL covers domains that differ from areas tapped in other measures , with greater responsiveness . The S-QoL is an efficient instrument for the measurement of the impact of schizophrenia  on individuals ' lives CONTEXT Collaborative care interventions for depression in primary care setting s are clinical ly beneficial and cost-effective . Most prior studies were conducted in urban setting s. OBJECTIVE To examine the cost-effectiveness of a rural telemedicine-based collaborative care depression intervention . DESIGN R and omized controlled trial of intervention vs usual care . SETTING Seven small ( serving 1000 to 5000 veterans ) Veterans Health Administration community-based outpatient clinics serving rural catchment areas in 3 mid-South states . Each site had interactive televideo dedicated to mental health but no psychiatrist or psychologist on site . Patients Among 18 306 primary care patients who were screened , 1260 ( 6.9 % ) screened positive for depression ; 395 met eligibility criteria and were enrolled from April 2003 to September 2004 . Of those enrolled , 360 ( 91.1 % ) completed a 6-month follow-up and 335 ( 84.8 % ) completed a 12-month follow-up . Intervention A stepped-care model for depression treatment was used by an off-site depression care team to make treatment recommendations via electronic medical record . The team included a nurse depression care manager , clinical pharmacist , and psychiatrist . The depression care manager communicated with patients via telephone and was supported by computerized decision support software . MAIN OUTCOME MEASURES The base case cost analysis included outpatient , pharmacy , and intervention expenditures . The effectiveness outcomes were depression-free days and quality -adjusted life years ( QALYs ) calculated using the 12-Item Short Form Health Survey st and ard gamble conversion formula . RESULTS The incremental depression-free days outcome was not significant ( P = .10 ) ; therefore , further cost-effectiveness analyses were not done . The incremental QALY outcome was significant ( P = .04 ) and the mean base case incremental cost-effectiveness ratio was $ 85 634/QALY . Results adding inpatient costs were $ 111 999/QALY to $ 132 175/QALY . CONCLUSIONS In rural setting s , a telemedicine-based collaborative care intervention for depression is effective and expensive . The mean base case result was $ 85 634/QALY , which is greater than cost per QALY ratios reported for other , mostly urban , depression collaborative care interventions OBJECTIVE The main objective of the study was to estimate a preference-based Short Form (SF)-6D index from the SF-36 for Japan and compare it with the UK results . STUDY DESIGN AND SETTING The SF-6D was translated into Japanese . Two hundred and forty-nine health states defined by this version of the SF-6D were then valued by a representative sample of 600 members of the Japanese general population using st and ard gamble ( SG ) . These health-state values were modeled using classical parametric r and om-effect methods with individual-level data and ordinary least squares ( OLS ) on mean health-state values , together with a new nonparametric approach using Bayesian methods of estimation . RESULTS All parametric models estimated on Japanese data were found to perform less well than their UK counterparts in terms of poorer goodness of fit , more inconsistencies , larger prediction errors and bias , and evidence of systematic bias in the predictions . Nonparametric models produce a substantial improvement in out-of- sample predictions . The physical , role , and social dimensions have relatively larger decrements than pain and mental health compared with those in the United Kingdom . CONCLUSION The differences between Japanese and UK valuations of the SF-6D make it important to use the Japanese valuation data set estimated using the nonparametric Bayesian technique presented in this article BACKGROUND Electroconvulsive therapy ( ECT ) has a long history of use in treating depression . Repetitive transcranial magnetic stimulation ( rTMS ) has been introduced more recently to the treatment spectrum . Its cost-effectiveness has not been explored . METHOD Forty-six right-h and ed people with severe depressive episodes referred for ECT were r and omised to receive either ECT twice weekly or rTMS on consecutive weekdays . Health and other service use were recorded for retrospective periods of 3 months prior to initiation of treatment and during the 6 months following the end of allocated treatment . Costs were calculated for the treatment period and the subsequent 6 months , and comparisons made between groups after adjustment for any baseline differences . Cost-effectiveness analysis was conducted with incremental change on the 17-item Hamilton Rating Scale for Depression ( HRSD ) as the primary outcome measure , and quality -adjusted life years ( based on SF6D-generated utility scores with societal weights ) as secondary outcome , cost-effectiveness acceptability curves plotted . RESULTS Based on the HRSD scores and other outcome measures , rTMS was not as effective as ECT . The cost of a single session of rTMS was lower than the cost of a session of ECT , but overall there were no treatment cost differences . In the treatment and 6-month follow-up periods combined , health and other service costs were not significantly different between the two groups . Informal care costs were higher for the rTMS group . Total treatment , service and informal care costs were also higher for the rTMS group . The cost-effectiveness acceptability curves indicated a very small probability that decision-makers would view rTMS as more cost-effective than ECT . LIMITATIONS Small sample size , some sample attrition and a relatively short follow-up period of 6 months for a chronic illness . Productivity losses could not be calculated . CONCLUSIONS ECT is more cost-effective than rTMS in the treatment of severe depression BACKGROUND Recent data indicate high prevalence of both anxiety and substance comorbidity in bipolar disorder . However , few studies have utilized public sector sample s , and only one has attempted to separate contributions of each type of comorbidity . METHODS 328 inpatient veterans with bipolar disorder across 11 sites were assessed using selected Structured Clinical Interview for DSM-IV modules and self-reports . RESULTS Comorbidity was common ( current : 57.3 % ; lifetime : 78.4 % ) , with multiple current comorbidities in 29.8 % . Substance comorbidity rate was comparable to rates typically reported in non-veteran inpatient sample s ( 33.8 % current , 72.3 % lifetime ) . Selected anxiety comorbidity rates exceeded those in other inpatient sample s and appeared more chronic than episodic/recurrent ( 38.3 % current , 43.3 % lifetime ) . 49 % of PTSD was due to non-combat stressors . Major correlates of current substance comorbidity alone were younger age , worse marital status , and higher current employability . Correlates of current anxiety comorbidity alone were early age of onset , greater number of prior-year depressive episodes , higher rates of disability pension receipt , and lower self-reported mental and physical function . Combined comorbidity resembled anxiety comorbidity . LIMITATIONS This is a cross-sectional analysis of acutely hospitalized veterans . CONCLUSIONS Distinct patterns of substance and anxiety comorbidity are striking , and may be subserved by distinct neurobiologic mechanisms . The prevalence , chronicity and functional impact of anxiety disorders indicate the need for improved recognition and treatment of this other dual diagnosis group is warranted . Clinical and research interventions should recognize these divergent comorbidity patterns and provide individualized treatment built " from the patient out . OBJECTIVE To determine the relative cost-effectiveness of three classes of antidepressants : tricyclic antidepressants ( TCAs ) , selective serotonin reuptake inhibitors ( SSRIs ) , and the modified TCA lofepramine , as first choice treatments for depression in primary care . DESIGN Open , pragmatic , controlled trial with three r and omised arms and one preference arm . Patients were followed up for 12 months . SETTING UK primary care : 73 practice s in urban and rural areas in Engl and . PARTICIPANTS Patients with a new episode of depressive illness according to GP diagnosis . INTERVENTIONS Patients were r and omised to receive a TCA ( amitriptyline , dothiepin or imipramine ) , an SSRI ( fluoxetine , sertraline or paroxetine ) or lofepramine . Patients or GPs were able to choose an alternative treatment if preferred . MAIN OUTCOME MEASURES At baseline the Clinical Interview Schedule , Revised ( CIS-R PROQSY computerised version ) was administered to establish symptom profiles . Outcome measures over the 12-month follow-up included the Hospital Anxiety and Depression Scale self-rating of depression ( HAD-D ) , CIS-R , EuroQol ( EQ-5D ) for quality of life , Short Form ( SF-36 ) for generic health status , and patient and practice records of use of health and social services . The primary effectiveness outcome was the number of depression-free weeks ( HAD-D less than 8 , with interpolation of intervening values ) and the primary cost outcome total direct NHS costs . Quality -adjusted life-years ( QALYs ) were used as the outcome measure in a secondary analysis . Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were computed . Estimates were bootstrapped with 5000 replications . RESULTS In total , 327 patients were r and omised . Follow-up rates were 68 % at 3 months and 52 % at 1 year . Linear regression analysis revealed no significant differences between groups in number of depression-free weeks when adjusted for baseline HAD-D. A higher proportion of patients r and omised to TCAs entered the preference arm than those allocated to the other choices . Switching to another class of antidepressant in the first few weeks of treatment occurred significantly more often in the lofepramine arm and less in the preference arm . There were no significant differences between arms in mean cost per depression-free week . For values placed on an additional QALY of over 5000 pounds , treatment with SSRIs was likely to be the most cost-effective strategy .  TCAs were the least likely to be cost-effective as first choice of antidepressant for most values of a depression-free week or QALY respectively , but these differences were relatively modest . CONCLUSIONS When comparing the different treatment options , no significant differences were found in outcomes or costs within the sample , but when outcomes and costs were analysed together , the result ing cost-effectiveness acceptability curves suggested that SSRIs were likely to be the most cost-effective option , although the probability of this did not rise above 0.6 . Choosing lofepramine is likely to lead to a greater proportion of patients switching treatment in the first few weeks . Further research is still needed on the management of depressive illness in primary care . This should address areas such as the optimum severity threshold at which medication should be used ; the feasibility and effectiveness of adopting structured depression management programmes in the UK context ; the importance of factors such as physical co-morbidity and recent life events in GPs ' prescribing decisions ; alternative ways of collecting data ; and the factors that give rise to many patients being reluctant to accept medication and discontinue treatment early BACKGROUND Prospect i ve outcome studies based on a community sample of mostly neuroleptic naive cases of schizophrenia are uncommon . OBJECTIVES To describe short-term symptomatic and functional outcomes of schizophrenia , and potential predictors of outcome . METHODS After a baseline assessment , 63 incident and 208 prevalent cases of schizophrenia were followed by a yearly clinical assessment for an average of 2.5 ( range 1 - 4 ) years . Scores of negative symptoms and positive symptoms were used as indicators of symptomatic outcomes . SF-36 scores of physical and social functioning , and role limitation due to mental health problems were used as indicators of functional outcomes . Several variables were evaluated as potential predictors of outcome in r and om coefficient models . RESULTS Functioning and other measures of health related quality of life were significantly diminished in cases as compared to the general population of the area at baseline and follow up . Of the socio-demographic and clinical factors evaluated , only lower negative and positive symptom scores were significantly associated with improvements in functioning . The level of functioning observed in cases from Butajira was lower than that reported for cases from developed countries . CONCLUSIONS Our findings are not in accord with other outcome studies that have reported better functional outcome for cases of schizophrenia from developing countries OBJECTIVE Time to all-cause treatment discontinuation is considered a composite proxy measure of treatment efficacy , safety , and tolerability . Longer time to discontinuation of antipsychotic medication for any cause has been shown to be associated with greater symptom improvements in the treatment of schizophrenia . This study examines whether longer time to all-cause medication discontinuation is also linked to better functional outcomes . METHOD Using pooled data from 4 r and omized , double-blind antipsychotic trials of 24- to 28-weeks ' duration , this study examined the association between time to all-cause treatment discontinuation and functional outcomes , as assessed by a disease-specific , clinician-rated measure ( Quality of Life Scale [ QLS ] ) and a generic , patient-reported measure ( Medical Outcomes Study Short Form 36 [ SF-36 ] ) . Patients in these trials had a DSM-IV diagnosis of schizophrenia , schizophreniform disorder , or schizoaffective disorder . This post hoc analysis used Pearson partial correlations to assess relationships between time to treatment discontinuation and changes in functional scores , adjusting for baseline scores . Repeated measures analyses were also conducted to compare post-baseline functional outcome change over time between completers and noncompleters . RESULTS Longer time to all-cause treatment discontinuation was found to be significantly associated with greater improvements in all assessed functional domains ( p < .05 ) . Patients who completed their respective trials ( 46.8 % , 761/1627 ) experienced significantly greater improvement in functional outcome measures ( in 4 QLS domains and SF-36 mental health component summary score ; all , p < .001 ) compared to patients who discontinued for any cause . In addition , greater symptom improvement was significantly associated with greater functional improvements in assessed domains . CONCLUSIONS Findings from this post hoc analysis illustrate the importance of longer treatment duration with antipsychotics for improving functional outcomes in the treatment of patients with schizophrenia OBJECTIVE To examine the relationship between changes in mood symptoms and changes in functioning or disability in people treated for bipolar disorder . METHOD This study was a secondary analysis of data from 441 patients enrolled in a r and omized trial of a care management and psychoeducational intervention for bipolar disorder ( diagnosed according to DSM-IV ) . Study participants were enrolled between August 1999 and October 2000 , and follow-up data were collected until October 2001 . Five in-person assessment s spaced 3 months apart included structured assessment of current mood symptoms  ( using the Structured Clinical Interview for DSM-IV ) , the  Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) functional status question naire , and questions regarding days of disability during the past 3 months .  Repeated- measures analyses examined the associations between each outcome measure and severity of mood symptoms . Additional analyses separated variability in mood symptoms into between-person variation ( average symptom severity , or trait effects ) and within-person variation ( change from average symptom severity , or state effects ) . RESULTS Severity of depression symptoms showed a strong and consistent association with all 4 measures of impairment and disability ( SF-36 Role-Emotional score , SF-36 Social Function score , days unable to perform household responsibilities , days disabled from other activities ; p < .001 for all comparisons ) . These associations all remained highly significant ( p < .001 ) after adjustment for co-occurring symptoms of mania . Severity of mania/ hypomania symptoms also showed significant association with all disability measures ( p < .001 for all comparisons ) , but these associations were weaker after adjustment for co-occurring symptoms of depression ( p < .001 for SF-36 Role-Emotional score , p = .004 for SF-36 Social Function score , p = .069 for days unable to perform household activities , p = .049 for days disabled from other activities ) . In analyses focused on within-person variation , change in depression was again strongly related to all measures of impairment and disability ( p < .001 for all comparisons ) . After adjustment for co-occurring depression , change in mania/hypomania was not consistently associated with measures of impairment or disability ( p = .02 for SF-36 Role-Emotional score ; p > .40 for all other comparisons ) . CONCLUSIONS Among people treated for bipolar disorder , modest changes in severity of depression are associated with statistically and clinical ly significant changes in functional impairment and disability . In contrast , changes in severity of mania or hypomania are not consistently associated with differences in functioning . Conventional measures of functioning , however , may not be sensitive to the effects of mania symptoms OBJECTIVE To determine the impact of acute depression on quality of life ( QOL ) in patients with bipolar I disorder and to compare these results with published data on QOL in patients with unipolar depression . METHODS Quality of life was assessed using the SF-36 in bipolar patients ( n = 958 ) who had recently experienced an episode of acute bipolar depression and participated in a large r and omized , double-blind , safety and efficacy trial . Seven studies that included SF-36 data from patients with unipolar depression were identified in the published literature and descriptive comparisons of SF-36 scores were made between the unipolar depression trials and this bipolar depression trial . RESULTS There were 920 patients who completed the SF-36 .  Mean transformed scores , which could range from 0 to 100 , were very low in bipolar depressed patients for the role-physical ( 36.7 ) , vitality ( 22.4 ) , social functioning ( 29.9 ) , role-emotion ( 11.4 ) , and mental health ( 31.0 ) subscales . Mean SF-36 scores for all subscales were significantly and inversely correlated ( p < 0.0001 ) with the HAM-D indicating that patients with milder depressive symptoms had better QOL . Further , the mean SF-36 scores for the bipolar sample were consistently lower compared with published data on QOL in unipolar depression on four of the eight subscales : general health ; social functioning ; role-physical , and role-emotional . CONCLUSIONS While both unipolar and bipolar depression have serious detrimental effects on patient QOL , our results suggest that some aspects of QOL may be worse in bipolar depression UNLABELLED Schizophrenia leads to impairments in mental , social , and physical functioning , which should be included in evaluations of treatment . OBJECTIVES This study was design ed to determine the reliability and validity of the Medical Outcomes Study Short Form Health Survey ( SF-36 ) for schizophrenic patients , to characterize perceived functioning and well being and to compare short-term change in SF-36 scores for patients treated with olanzapine or haloperidol .  RESEARCH DESIGN Data were obtained from a r and omized , double-blind trial comparing these agents for safety , efficacy , and cost effectiveness . A 6-week acute treatment portion preceded a 46-week " responder extension " phase . SUBJECTS A sub sample ( n = 1,155 ) completing a pre-treatment SF-36 provided data for this study . MEASURES Psychometric analyses were conducted , and perceived level of functioning was compared with that for the US adult population . Change from baseline to 6 weeks was examined by treatment group . RESULTS Clear evidence was obtained for the instrument 's reliability and validity for these patients . There were marked deficits in General health , Vitality , Mental health , Social functioning , and in Role limitations result ing from both physical and emotional problems . Olanzapine-treated patients improved in 5 of 8 domains to a significantly greater degree than did haloperidol patients . CONCLUSIONS The SF-36 can be a reliable and valid measure of perceived functioning and well being for schizophrenic patients . The perceptions of functioning can be valuable indices of disease burden and can help to demonstrate the effectiveness of newer antipsychotic medications such as olanzapine Abstract Aim : To assess the relative cost effectiveness of escitalopram compared with venlafaxine XR in patients with major depressive disorder ( MDD ) . Methods : An economic evaluation was conducted alongside a double-blind , multinational , r and omised clinical trial and examined the costs and quality of life of 251 patients taking escitalopram versus venlafaxine . Out patients fulfilling criteria for MDD were r and omised to receive oral escitalopram 10–20 mg/day or venlafaxine 75–150 mg/day for 8 weeks . Patient-reported outcomes ( EuroQOL question naire , Quality of Life Depression Scale ) , use of medical services and absence from work ( relating to the previous 3 months ) were recorded at baseline , with repeated measurements at week 8 . Unit costs in year values were applied to the re source utilisation data . A cost-effectiveness analysis was performed using the EuroQOL score as the effectiveness measure . The perspective was that of the healthcare payer , with a societal perspective considered in a sensitivity analysis . Results : Statistically significant improvements in patient-reported outcomes ( vs baseline ) were observed in both groups after 8 weeks ’ treatment . Patients treated with escitalopram tended to report fewer problems on the EuroQOL dimensions than venlafaxine recipients . Mean per-patient costs in euros ( € , year 2003 values ) for the escitalopram group , compared with the venlafaxine group , were 32 % lower ( € 110 vs € 161 ) from a healthcare perspective , although this was not a statistically significant difference . Differences were related to lower drug acquisition costs and fewer hospitalisations  for escitalopram than venlafaxine recipients . A multivariate model adjusting for baseline characteristics showed that escitalopram  reduced direct costs compared with venlafaxine ( p = 0.007 ) . Bootstrapped distributions of the incremental cost-effectiveness ratios also showed similar effectiveness but lower costs for escitalopram compared with venlafaxine . Inclusion of indirect costs led to similar results . Conclusion : This prospect i ve economic analysis suggests that escitalopram has similar effectiveness to venlafaxine in the treatment of MDD , but may be associated with lower healthcare costs . These findings are consistent with previously published economic evaluations Background . The Health Utilities Index Mark 3 ( HUI3 ) is a generic multiattribute preference‐based measure of health status and health‐related quality of life that is widely used as an outcome measure in clinical studies , in population health surveys , in the estimation of quality ‐adjusted life years , and in economic evaluations . HUI3 consists of eight attributes ( or dimensions ) of health status : vision , hearing , speech , ambulation , dexterity , emotion , cognition , and pain with 5 or 6 levels per attribute , varying from highly impaired to normal . Objectives . The objectives are to present a multiattribute utility function and eight single‐attribute utility functions for the HUI3 system based on community preferences . Study Design . Two preference surveys were conducted . One , the modeling survey , collected preference scores for the estimation of the utility functions . The other , the direct survey , provided independent scores to assess the predictive validity of the utility functions . Measures . Preference measures included value scores obtained on the Feeling Thermometer and st and ard gamble utility scores obtained using the Chance Board . Respondents . A r and om sample of the general population ( ≥16 years of age ) in Hamilton , Ontario , Canada . Results . Estimates were obtained for eight single‐attribute utility functions and an overall multiattribute utility function . The intraclass correlation coefficient between directly measured utility scores and scores generated by the multiattribute function for 73 health states was 0.88 . Conclusions . The HUI3 scoring function has strong theoretical and empirical foundations . It performs well in predicting directly measured scores . The HUI3 system provides a practical way to obtain utility scores based on community preferences We aim ed to compare clinical outcomes , health-related quality of life ( HRQOL ) and work status associated with olanzapine and haloperidol treatment in patients with bipolar disorder . This double-blind , r and omized controlled trial , comparing flexible dosing of olanzapine ( 5–20 mg/day , n = 234 ) to haloperidol ( 3–15 mg/day , n = 219 ) , consisted of a 6-week acute phase , followed by a 6-week continuation phase . Symptomatic remission rates were similar for olanzapine- and haloperidol-treated patients at weeks 6 and 12 . At week 6 , significant changes in five dimensions of the Medical Outcomes Study 36-Item Short Form Health Survey ( SF-36 ) [ general health ( P = 0.010 ) , physical functioning ( P < 0.001 ) , role limitations due to physical problems ( P < 0.001 ) , social functioning ( P < 0.05 ) and vitality ( P < 0.01 ) ] and the SF-36 physical components summary score were found in favour of olanzapine compared to haloperidol . At week 12 , olanzapine treatment maintained the significantly favourable HRQOL changes . At the end of week 12 , patients on olanzapine showed significantly greater improvement than haloperidol  in work activities impairment and household activities impairment scores on the Streamlined Longitudinal Interview Clinical Evaluation from the Longitudinal Interval Follow-up Evaluation ( SLICE/LIFE ) activities impairment scores . Subgroup analyses revealed that olanzapine treatment significantly increased a proportion of employed patients and their weekly paid working hours . In conclusion , compared to haloperidol , olanzapine treatment was comparably effective in the remission of bipolar mania and significantly improved HRQOL and work status in patients with bipolar I disorder
target: The EQ-5D and SF-36 achieved mixed results in the quantitative testing against psychometric criteria .
  The qualitative analysis suggests this is because they provide a very limited coverage of themes identified by people with mental health problems .
background: BACKGROUND Generic preference-based measures of health like the EQ-5D and SF-6D ( ® ) are increasingly being used in economic evaluation and outcome assessment .
  However , there are concerns as to whether or not these generic measures are appropriate for use in people with mental health problems .
  OBJECTIVES The EQ-5D and SF-36 ( ® ) ( including its derivatives the SF-12 ( ® ) and SF-6D ) were assessed using the psychometric criteria of validity and responsiveness using quantitative and qualitative methods .
  Another aim was to estimate mapping functions between the EQ-5D and SF-6D and condition-specific measures , where appropriate .