Predicting costs of mental health care: a critical literature review

Cost evaluation research in the mental health field is being increasingly recognized as a way to achieve a more effective deployment of scarce resources. However, there is a paucity of studies that seek to identify predictors of psychiatric service utilization and costs. This paper aims to critically review the published research in the field of psychiatric service utilization and costs, and discusses current methodological developments in this field

Review: multiple daily doses of antidepressants are not more effective than single daily doses

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Admissions for personality disorders in Italy from 1988 to 1998

BACKGROUND: Personality disorders affect a substantial proportion of the population. It is unclear, however, whether the burden of personality disorders on modern mental health services has been increasing. To fill this gap, we analyzed trends in admissions for personality disorders in Italy from 1988 to 1998. METHODS: We used the yearly data from the Italian Central Institute of Statistics to analyse trends in the total number of admissions for personality disorders and in the total number of first admissions for personality disorders. RESULTS: The absolute number of admissions for personality disorders almost trebled from 1988 to 1998, as well as the proportion of all psychiatric admissions that were for personality disorders. Whilst there has been a marked increase in the absolute number of first admissions, the proportion of all first psychiatric admissions that were for personality disorders showed a steady but modest increase, from 5.7% to 7.6%. CONCLUSION: In Italy, the burden of personality disorders on modern mental health services has been increasing. In terms of public health, these findings highlight the urgent need of developing policies to tackle the increasing demand of care of this difficult-to-treat patient population

How I treat patients with polycythemia vera

AbstractThe clinical course of polycythemia vera (PV) is marked by a high incidence of thrombotic complications; fibrotic and leukemic disease transformations are additional causes of morbidity and mortality. Major predictors of vascular events are increasing age and previous thrombosis; leukocytosis and high JAK2 V617F allele burden are currently being investigated for additional prognostic value in this regard. Myelosuppressive drugs can reduce the rate of thrombosis, but there is concern that their use raises the risk of transformation into acute leukemia. To tackle this dilemma, a risk-oriented management strategy is recommended. Low-risk patients should be treated with phlebotomy and low-dose aspirin. Cytotoxic therapy is indicated in high-risk patients, and the drug of choice is hydroxyurea because of its efficacy in preventing thrombosis and low leukemogenicity. Interferon-alpha should be reserved for selected categories of patients due to high cost and toxicity. The demonstration of JAK2 V617F mutation in the vast majority of PV patients opens the avenue for the development of promising new molecularly targeted drugs

Achievements, concerns and (unanswered) questions

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Why it is important to include unpublished data in systematic reviews.

It is known that studies with statistically significant results have a higher probability to be published (publication bias). Therefore, studies with no statistically significant differences (or not favoring the investigational drug) may not be found in commonly accessed databases and remain unpublished. Moreover, unpublished data may also refer to information that are not included in study reports published in scientific journals but that may be important to estimate study outcomes. Retrieving unpublished evidence represents a compelling challenge for researchers, and in the present paper we explore how to do it

Nucleation and cluster formation in low-density nucleonic matter: A mechanism for ternary fission

Ternary fission yields in the reaction 241Pu(nth,f) are calculated using a new model which assumes a nucleation-time moderated chemical equilibrium in the low density matter which constitutes the neck region of the scissioning system. The temperature, density, proton fraction and fission time required to fit the experimental data are derived and discussed. A reasonably good fit to the experimental data is obtained. This model provides a natural explanation for the observed yields of heavier isotopes relative to those of the lighter isotopes, the observation of low proton yields relative to 2H and 3H yields and the non-observation of 3He, all features which are shared by similar thermal neutron induced and spontaneous fissioning systems.Comment: 6 pages, 3 figure

Mapping the selection, availability, price and affordability of essential medicines for mental health conditions at a global level

Aims: To provide a cross-country analysis of selection, availability, prices and affordability of essential medicines for mental health conditions, aiming to identify areas for improvement. Methods: We used the World Health Organization (WHO) online repository of national essential medicines lists (EMLs) to extract information on the inclusion of essential psychotropic medicines within each country's EML. Data on psychotropic medicine availability, price and affordability were obtained from the Health Action International global database. Additional information on country availability, prices and affordability of essential medicines for mental disorders was identified by searching, up to January 2021, PubMed/Medline, CINAHIL, Scopus and the WHO Regional Databases. We summarised and compared the indicators across lowest-price generic and originator brand medicines in the public and private sectors, and by country income groups. Results: A total of 112 national EMLs were analysed, and data on psychotropic medicine availability, price and affordability were obtained from 87 surveys. While some WHO essential psychotropic medicines, such as chlorpromazine, haloperidol, amitriptyline, carbamazepine and diazepam, were selected by most national lists, irrespective of the country income level, other essential medicines, such as risperidone or clozapine, were included by most national lists in high-income countries, but only by a minority of lists in low-income countries. Up to 40% of low-income countries did not include medicines that have been in the WHO list for decades, such as long-acting fluphenazine, lithium carbonate and clomipramine. The availability of generic and originator psychotropic medicines in the public sector was below 50% for all medicines, with low-income countries showing rates lower than the overall average. Analysis of price data revealed that procurement prices were lower than patient prices in the public sector, and medicines in the private sector were associated with the highest prices. In low-income countries, the average patient price for amitriptyline and fluoxetine was three times the international unit reference price, while the average patient price for diazepam was ten times the international unit reference price. Affordability was higher in the public than the private sector, and in high-income than low-income countries. Conclusion: Access to medicines for mental health conditions is an ongoing challenge for health systems worldwide, and no countries can claim to be fully aligned with the general principle of providing full access to essential psychotropic medicines. Low availability and high costs are major barriers to the use of and adherence to essential psychotropic medicines, particularly in low-and middle-income countries