Clinical and economical effects one year after establishing a decentralized psychiatric outpatient service [Abstract]

BackgroundIntensification of outpatient psychiatric care may improve the care quality in community but also increase the total care costs in the first period as well as reduce in-patient cumulative length of stay over the medium term.ObjectiveWe investigate the economic and clinical effects of establishing of a psychiatric outpatient-service in a South-Bavarian catchment area one year before and one year after establishing.MethodsAll admitted patients in a psychiatric acute ward corresponding to the catchment area of the new outpatient- service are registered one year before establishing (2007, n = 145) and one year after (2009, n = 167). Associations between clinical, demographic and economical variables were investigated by means of multivariate regression analysis. Control variables are sex, age and psychiatric diagnostic groups.ResultsCumulative length of stay (b = −1.72, p = 0.68) and number of admissions (b = −0.10; p = 0.28) decreased, but not significantly. In-patient as well as global care costs remains the same. Costs of prescribed psychopharmacological drugs (b = 54.4; p = 0.36) and outpatient psychiatric care (b = 67.8; p = 0.15) increase obviously, but not significantly.ConclusionsAdditional implementation of an outpatient-service is not related to increase of service use costs. We found out, that in the first year there is a demand increasing effect. The effects on in-patient parameters and diagnosis groups have to be observed for the following years.</jats:sec

Beyond affect: A role for genetic variation of the serotonin transporter in neural activation during a cognitive attention task

Prior work has highlighted the role of genetic variation within the repetitive sequence in the transcriptional control region of the serotonin (5-HT) transporter gene (5-HTT, SLC6A4) in modulating amygdala and prefrontal activation to negative emotional stimuli. However, these studies have not explicitly tested the assumption that the control condition (neutral baseline) does not itself produce changes in activation as a function of 5-HTT genotype. Using a fixation baseline condition, we show that variation in 5-HTT genotype is associated with differential activation to negative, positive, and neutral stimuli in limbic, striatal, and cortical regions. We replicate earlier reports of increased amygdala activation to negative, relative to neutral, stimuli, but then show that these differences are driven by decreased activation to neutral stimuli, rather than increased activation to negative stimuli, in carriers of the 5-HTT short allele. Using high-resolution structural images and automated processes to test for brain volume and gray matter density, we further report significant differences, as a function of 5-HTT genotype, in frontal cortical regions, anterior cingulate, and cerebellum. These functional and structural differences suggest a much broader role for 5-HT transport efficiency in brain processes than previously thought. 5-HTT genotype affects neural systems controlling affective, cognitive, and motor processes