Compliance, persistence, costs and quality of life in young patients treated with antipsychotic drugs: Results from the COMETA study

Background: Little data is available on the real-world socio-economic burden and outcomes in schizophrenia. This study aimed to assess persistence, compliance, costs and Health-Related Quality-of-Life (HRQoL) in young patients undergoing antipsychotic treatment according to clinical practice.Methods: A naturalistic, longitudinal, multicentre cohort study was conducted: we involved 637 patients aged 18-40 years, with schizophrenia or schizophreniform disorder diagnosed ≤10 years before, enrolled in 86 Italian Mental Health Centres and followed-up for 1 year. Comparisons were conducted between naïve (i.e., patients visiting the centre for the first time and starting a new treatment regimen) and non naïve patients.Results: At enrolment, 84% of patients were taking atypical drugs, 3.7% typical, 10% a combination of the two classes, and 2% were untreated. During follow-up, 23% of patients switched at least once to a different class of treatment, a combination or no treatment. The mean Drug-Attitude-Inventory score was 43.4, with 94.3% of the patients considered compliant by the clinicians. On average, medical costs at baseline were 390.93€/patient-month, mostly for drug treatment (29.5%), psychotherapy (29.2%), and hospitalizations (27.1%). Patients and caregivers lost 3.5 days/patient-month of productivity. During follow-up, attitude toward treatment remained fairly similar, medical costs were generally stable, while productivity, clinical statusand HRQoL significantly improved. While no significantly different overall direct costs trends were found between naïve and non naïve patients, naïve patients showed generally a significant mean higher improvement of clinical outcomes, HRQoL and indirect costs, compared to the others.Conclusions: Our results suggest how tailoring the treatment strategy according to the complex and specific patient needs make it possible to achieve benefits and to allocate more efficiently resources. This study can also provide information on the most relevant items to be considered when conducting cost-effectiveness studies comparing specific alternatives for the treatment of target patients

Incorporation of Y2O3 Particles into 410L Stainless Steel by a Powder Metallurgy Route

Addition of yttria to steels has been proposed for the fabrication of oxide-dispersion-strengthened materials for nuclear power applications. We have investigated materials prepared from 12 Cr martensitic stainless steel, AISI 410L, produced by powder metallurgy. Materials were produced with and without yttria addition, and two different sizes of yttria were used, 0.9 µm and 50 nm. Tensile and mini-creep tests were performed to determine mechanical properties. Optical microscopy, SEM, TEM, and EDX analysis were used to investigate the microstructures and deformation mechanisms and to obtain information about non-metallic inclusion particles. SiO2, MnS, and Y2Si2O7 inclusion particles were observed. An SiO2 and Y2O3 interaction was seen to have occurred during the ball milling, which impaired the final mechanical properties. Small-angle neutron scattering experiments showed that the matrix chemistry prevented effective dissolution of the yttria. © The Author(s) 201

Microstructure, tensile and creep properties of an austenitic ODS 316L steel

ODS 316L, an austenitic grade of oxide-dispersion-strengthened (ODS) steel, was fabricated by mechanical alloying, hot isostatic pressing and forging. A broad characterisation study was conducted, including High-Resolution Transmission Electron Microscopy (HRTEM) to investigate the microstructure and the interface between oxide particles and the 316L matrix. Mechanical properties at room and elevated temperature were determined by means of tensile and creep tests. Data from the room temperature and high temperature tensile tests were compared with those from conventional 316L. Creep data were used to assess the performance of the ODS 316L against standard assessment codes and in comparison with conventional 316L. Higher mechanical strength was found for the ODS 316L, in comparison to conventional 316L, at room temperature. UTS at high temperature was lower for the ODS 316L, but its yield strength was twice that of 316L. It was found that, although compliant with the Design and Construction Rules for mechanical components of nuclear installations (RCC MR) [1] code for the creep test conditions imposed, the ODS 316L studied is lower strength and has shorter rupture-life than its conventional counterpart. The HRTEM investigations indicated that small oxide particles, <15 nm in size, were coherent or semi-coherent with the steel matrix, whilst larger particles were incoheren

Effectiveness and safety of antipsychotics treatment in acute psychosis: an exploratory study in psychiatric inpatients

AIM: The National Institute of Mental Health recommends that research is carried out in real-world setting and that research findings are translated into routine clinical practice. The aim of the present study was to compare the effectiveness of acute antipsychotic treatment on psychotic symptoms in an inpatient sample. METHODS: One hundred and twenty patients suffering from acute psychosis and treated with haloperidol, risperidone, olanzapine or quetiapine, were evaluated using the SCID I and II, SANS, SAPS, BPRS, and CGI 1, at baseline and the DOTES, SANS, SAPS, BPRS, and CGI 2-3 at discharge, in usual clinical practice. EKG and blood tests were also performed at baseline. RESULTS: All antipsychotics proved to be effective in treating acute psychosis with no significant differences but haloperidol treatment provided a greater reduction of delusions compared with the other drugs at the lowest cost. CONCUSION: The similar effectiveness of the four antipsychotics in the acute phase may allow the use of the different antipsychotics according to the therapeutic project relevant to each patient and to symptom clusters that characterize the subtype of psychosis. Haloperidol seems to be superior to the other drugs in reducing delusions in the acute phase of psychosis

Effectiveness and safety of antipsychotics treatment in acute psychosis: An exploratory study in psychiatric inpatients

Aim. The National Institute of Mental Health recommends that research is carried out in real-world setting and that research findings are translated into routine clinical practice. The aim of the present study was to compare the effectiveness of acute antipsychotic treatment on psychotic symptoms in an inpatient sample. Methods. One hundred and twenty patients suffering from acute psychosis and treated with Haloperidol, risperidone, olanzapine or quetiapine, were evaluated using the SCID I and II, SANS, SAPS, BPRS, and CGI 1, at baseline and the DOTES, SANS, SAPS, BPRS, and CGI 2-3 at discharge, in usual clinical practice. EKG and blood tests were also performed at baseline. Results. All antipsychotics proved to be effective in treating acute psychosis with no significant differences but haloperidol treatment provided a greater reduction of delusions compared with the other drugs at the lowest cost. Conclusion. The similar effectiveness of the four antipsychotics in the acute phase may allow the use of the different antipsychotics according to the therapeutic project relevant to each patient and to symptom clusters that characterize the subtype of psychosis. Haloperidol seems to be superior to the other drugs in reducing delusions in the acute phase of psychosis

Compliance, persistence, costs and quality of life in young patients treated with antipsychotic drugs: results from the COMETA study

Background: Little data is available on the real-world socio-economic burden and outcomes in schizophrenia. This study aimed to assess persistence, compliance, costs and Health-Related Quality-of-Life (HRQoL) in young patients undergoing antipsychotic treatment according to clinical practice. Methods: A naturalistic, longitudinal, multicentre cohort study was conducted: we involved 637 patients aged 18-40 years, with schizophrenia or schizophreniform disorder diagnosed <= 10 years before, enrolled in 86 Italian Mental Health Centres and followed-up for 1 year. Comparisons were conducted between naive (i.e., patients visiting the centre for the first time and starting a new treatment regimen) and non naive patients. Results: At enrolment, 84% of patients were taking atypical drugs, 3.7% typical, 10% a combination of the two classes, and 2% were untreated. During follow-up, 23% of patients switched at least once to a different class of treatment, a combination or no treatment. The mean Drug-Attitude-Inventory score was 43.4, with 94.3% of the patients considered compliant by the clinicians. On average, medical costs at baseline were 390.93(sic)/patient-month, mostly for drug treatment (29.5%), psychotherapy Conclusions: Our results suggest how tailoring the treatment strategy according to the complex and specific patient needs make it possible to achieve benefits and to allocate more efficiently resources. This study can also provide information on the most relevant items to be considered when conducting cost-effectiveness studies comparing specific alternatives for the treatment of target patients