Change in level of productivity in the treatment of schizophrenia with olanzapine or other antipsychotics

<p>Abstract</p> <p>Background</p> <p>When treating schizophrenia, improving patients' productivity level is a major goal considering schizophrenia is a leading cause of functional disability. Productivity level has been identified as the most preferred treatment outcome by patients with schizophrenia. However, little has been done to systematically investigate productivity levels in schizophrenia. We set out to better understand the change in productivity level among chronically ill patients with schizophrenia treated with olanzapine compared with other antipsychotic medications. We also assessed the links between productivity level and other clinical outcomes.</p> <p>Methods</p> <p>This post hoc analysis used data from 6 randomized, double-blind clinical trials of patients with schizophrenia or schizoaffective disorder, with each trial being of approximately 6 months duration. Change in productivity level was compared between olanzapine-treated patients (HGBG, n = 172; HGHJ, n = 277; HGJB, n = 171; HGLB, n = 281; HGGN, n = 159; HGDH, n = 131) and patients treated with other antipsychotic medications (separately vs. haloperidol [HGGN, n = 97; HGDH, n = 132], risperidone [HGBG, n = 167; HGGN, n = 158], quetiapine [HGJB, n = 175], ziprasidone [HGHJ, n = 271] and aripiprazole [HGLB, n = 285]). Productivity was defined as functional activities/work including working for pay, studying, housekeeping and volunteer work. Productivity level in the prior 3 months was assessed on a 5-point scale ranging from no useful functioning to functional activity/work 75% to 100% of the time.</p> <p>Results</p> <p>Chronically ill patients treated with olanzapine (OLZ) experienced significantly greater improvement in productivity when compared to patients treated with risperidone (RISP) (OLZ = 0.22 ± 1.19, RISP = -0.03 ± 1.17, p = 0.033) or ziprasidone (ZIP) (OLZ = 0.50 ± 1.38, ZIP = 0.25 ± 1.27, p = 0.026), but did not significantly differ from the quetiapine, aripiprazole or haloperidol treatment groups. Among first episode patients, OLZ therapy was associated with greater improvements in productivity levels compared to haloperidol (HAL), during the acute phase (OLZ = -0.31 ± 1.59, HAL = -0.69 ± 1.56, p = 0.011) and over the long-term (OLZ = 0.10 ± 1.50, HAL = -0.32 ± 1.91, p = 0.008). Significantly more chronically ill and first episode patients treated with olanzapine showed moderately high (>50%-75% of the time) and high levels of productivity (>75%-100% of the time) at endpoint, when compared to risperidone or haloperidol-treated patients (p < .05), respectively. Higher productivity level was associated with significantly higher study completion rates and better scores on the positive, negative, disorganized thoughts, hostility and depression subscales of the Positive and Negative Symptom Scale (PANSS).</p> <p>Conclusions</p> <p>Some antipsychotic medications significantly differed in beneficial impact on productivity level in the long-term treatment of patients with schizophrenia. Findings further highlight the link between clinical and functional outcomes, showing significant associations between higher productivity, lower symptom severity and better persistence on therapy.</p> <p>Trial Registration</p> <p>clinicaltrials.gov identifier <a href="http://www.clinicaltrials.gov/ct2/show/NCT00088049">NCT00088049</a>; <a href="http://www.clinicaltrials.gov/ct2/show/NCT00036088">NCT00036088</a></p

Framework for strategic wind farm site prioritisation based on modelled wolf reproduction habitat in Croatia

In order to meet carbon reduction targets, many nations are greatly expanding their wind power capacity. However, wind farm infrastructure potentially harms wildlife, and we must therefore find ways to balance clean energy demands with the need to protect wildlife. Wide-ranging carnivores live at low density and are particularly susceptible to disturbance from infrastructure development, so are a particular concern in this respect. We focused on Croatia, which holds an important population of wolves and is currently planning to construct many new wind farms. Specifically, we sought to identify an optimal subset of planned wind farms that would meet energy targets while minimising potential impact on wolves. A suitability model for wolf breeding habitat was carried out using Maxent, based on six environmental variables and 31 reproduction site locations collected between 1997 and 2015. Wind farms were prioritised using Marxan to find the optimal trade-off between energy capacity and overlap with critical wolf reproduction habitat. The habitat suitability model predictions were consistent with the current knowledge: probability of wolf breeding site presence increased with distance to settlements, distance to farmland and distance to roads and decreased with distance to forest. Spatial optimisation showed that it would be possible to meet current energy targets with only 31% of currently proposed wind farms, selected in a way that reduces the potential ecological cost (overall predicted wolf breeding site presence within wind farm sites) by 91%. This is a highly efficient outcome, demonstrating the value of this approach for prioritising infrastructure development based on its potential impact on wide-ranging wildlife species

A functional comparison of patients with schizophrenia between the North and South of Europe

Introduction: The main objective of this study was to compare clinical and functional outcomes of patients with schizophrenia in Italy and Sweden with a special focus on daily functioning performance and real life milestones. Also, to study if outcome is to be regarded as a consequence of premorbid function, the level of symptom control and functional capacity or if other influences, such as cultural differences, must parallel be considered. Method: Ninety-five patients from three centres, Milan and Naples in Italy and Trollhattan in Sweden were investigated. The Positive and Negative Syndrome Scale and the UCSD Performance-Based Skills Assessment - Brief version were used together with patients' school history and their status of accommodation and occupation. Results: Patients in Trollhattan were more likely to live independently and patients in Naples to have a work or take part in education. Differences in symptoms and the performance test were present but subtle. Discussion: Differences in real life milestones were not explained by corresponding differences in symptoms, premorbid function or the performance-based test. It is therefore not appropriate only to present functional outcome as an expression of how successful treatment has been. (C) 2011 Elsevier Masson SAS. All rights reserved

Treatment response, safety, and tolerability of paliperidone extended release treatment in patients recently diagnosed with schizophrenia.

OBJECTIVE: This study was designed to explore the efficacy and tolerability of oral paliperidone extended release (ER) in a sample of patients who were switched to flexible doses within the crucial first 5 years after receiving a diagnosis of schizophrenia. METHODS: Patients were recruited from 23 countries. Adults with nonacute but symptomatic schizophrenia, previously unsuccessfully treated with other oral antipsychotics, were transitioned to paliperidone ER (3-12 mg/day) and prospectively treated for up to 6 months. The primary efficacy outcome for patients switching for the main reason of lack of efficacy with their previous antipsychotic was at least 20% improvement in Positive and Negative Syndrome Scale (PANSS) total scores. For patients switching for other main reasons, such as lack of tolerability, compliance or 'other', the primary outcome was non-inferiority in efficacy compared with the previous oral antipsychotic. RESULTS: For patients switching for the main reason of lack of efficacy, 63.1% achieved an improvement of at least 20% in PANSS total scores from baseline to endpoint. For each reason for switching other than lack of efficacy, efficacy maintenance after switching to paliperidone ER was confirmed. Statistically significant improvement in patient functioning from baseline to endpoint, as assessed by the Personal and Social Performance scale, was observed (p < 0.0001). Treatment satisfaction with prior antipsychotic treatment at baseline was rated 'good' to 'very good' by 16.8% of patients, and at endpoint by 66.0% of patients treated with paliperidone ER. Paliperidone ER was generally well tolerated, with frequently reported treatment-emergent adverse events being insomnia, anxiety and somnolence. CONCLUSIONS: Flexibly dosed paliperidone ER was associated with clinically relevant symptomatic and functional improvement in recently diagnosed patients with non-acute schizophrenia previously unsuccessfully treated with other oral antipsychotics

Intelligent Agent Transparency in Human–Agent Teaming for Multi-UxV Management

Objective: We investigated the effects of level of agent transparency on operator performance, trust, and workload in a context of human-agent teaming for multirobot management. Background: Participants played the role of a heterogeneous unmanned vehicle (UxV) operator and were instructed to complete various missions by giving orders to UxVs through a computer interface. An intelligent agent (IA) assisted the participant by recommending two plans - a top recommendation and a secondary recommendation - for every mission. Method: A within-subjects design with three levels of agent transparency was employed in the present experiment. There were eight missions in each of three experimental blocks, grouped by level of transparency. During each experimental block, the IA was incorrect three out of eight times due to external information (e.g., commander\u27s intent and intelligence). Operator performance, trust, workload, and usability data were collected. Results: Results indicate that operator performance, trust, and perceived usability increased as a function of transparency level. Subjective and objective workload data indicate that participants\u27 workload did not increase as a function of transparency. Furthermore, response time did not increase as a function of transparency. Conclusion: Unlike previous research, which showed that increased transparency resulted in increased performance and trust calibration at the cost of greater workload and longer response time, our results support the benefits of transparency for performance effectiveness without additional costs. Application: The current results will facilitate the implementation of IAs in military settings and will provide useful data to the design of heterogeneous UxV teams

Standardized remission criteria in schizophrenia.

OBJECTIVE: Recent work has focussed on schizophrenia as a 'deficit' state but little attention has been paid to defining illness plasticity in terms of symptomatic remission. METHOD: A qualitative review of a recently proposed concept of remission [N.C. Andreasen, W.T. Carpenter Jr, J.M. Kane, R.A. Lasser, S.R. Marder, D.R. Weinberger (2005) Am J Psychiatry 162: 441] is presented. RESULTS: The proposed definition of remission is conceptually viable, and can be easily implemented in clinical trials and clinical practice. Its increasing acceptance may reset expectations of treatment to a higher level, improve documentation of clinical status and facilitate dialogue on treatment expectations. The availability of validated outcome measures based on remission will enhance the conduct and reporting of clinical investigations, and could facilitate the design and interpretation of new studies on cognition and functional outcomes. While useful as a concept, it is important to consider that remission is distinct from recovery. CONCLUSION: The introduction of standardized remission criteria may offer significant opportunities for clinical practice, health services research and clinical trials

Performance-Based Measurement of Functional Disability in Schizophrenia: A Cross-National Study in the United States and Sweden

BACKGROUND: Recent advances in the assessment of disability in schizophrenia have separated the measurement of functional capacity (the ability to perform everyday functioning skills in structured assessments) from real-world functional outcomes. This study examined the similarity of performance-based assessments of everyday functioning, real-world disability, and achievement of milestones in people with schizophrenia in the United States and in Sweden. METHODS: Samples of schizophrenia patients living in rural areas in Sweden (n=146) and in New York (n=244)) performed the brief version of the UCSD Performance-based Skills Assessment (UPSA-B) and a neuropsychological assessment and were rated for functioning by their case managers. Information from records and case managers was used to determine the frequency of living independently, working, and having ever experienced a stable romantic relationship. RESULTS: Performance on the UPSA-B was essentially identical in the two samples (New York, M=13.84; Sweden, M=13.30). So were scores on the case manager ratings of everyday activities (New York: M=49.0; Sweden: M=48.8). The correlations between UPSA-B scores, NP test performance, and SLOF ratings did not differ across the two samples. The proportion of cases who had never had a close relationship and rates of vocational disability were also nearly identical. In contrast, 80% of the Swedish patients and 46% of the New York patients were living independently. CONCLUSIONS: Scores on performance-based measures of everyday living skills were very similar in people with schizophrenia across cultures. In contrast, real-world residential outcomes were very different. These data suggest that cultural and social support systems can lead to divergent real-world outcomes in individuals who have evidence of the same levels of ability and potential

A Meta-Analysis of Factors Influencing the Development of Trust in Automation

Objective: We used meta-analysis to assess research concerning human trust in automation to understand the foundation upon which future autonomous systems can be built. Background: Trust is increasingly important in the growing need for synergistic human-machine teaming. Thus, we expand on our previous meta-analytic foundation in the field of human-robot interaction to include all of automation interaction. Method: We used meta-analysis to assess trust in automation. Thirty studies provided 164 pairwise effect sizes, and 16 studies provided 63 correlational effect sizes. Results: The overall effect size of all factors on trust development was g = +0.48, and the correlational effect was r = +0.34, each of which represented medium effects. Moderator effects were observed for the human-related (g = +0.49; r = +0.16) and automation-related (g = +0.53; r = +0.41) factors. Moderator effects specific to environmental factors proved insufficient in number to calculate at this time. Conclusion: Findings provide a quantitative representation of factors influencing the development of trust in automation as well as identify additional areas of needed empirical research. Application: This work has important implications to the enhancement of current and future human-automation interaction, especially in high-risk or extreme performance environments