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Titolo:
A COMPARISON OF CLOZAPINE AND HALOPERIDOL IN HOSPITALIZED-PATIENTS WITH REFRACTORY SCHIZOPHRENIA
Autore:
ROSENHECK R; CRAMER J; XU WC; THOMAS J; HENDERSON W; FRISMAN L; FYE C; CHARNEY D;
Indirizzi:
VA CONNECTICUT HEALTHCARE SYST,NE PROGRAM EVALUAT CTR 182,950 CAMPBELL AVE W HAVEN CT 06516 YALE UNIV,SCH MED,DEPT PSYCHIAT NEW HAVEN CT 00000 EDWARD HINES VET ADM MED CTR,CTR COOPERAT STUDIES HLTH SERV HINES IL 60141 VET AFFAIRS COOPERAT STUDIES PROGRAM CLIN RES PHA ALBUQUERQUE NM 00000
Titolo Testata:
The New England journal of medicine
fascicolo: 12, volume: 337, anno: 1997,
pagine: 809 - 815
SICI:
0028-4793(1997)337:12<809:ACOCAH>2.0.ZU;2-4
Fonte:
ISI
Lingua:
ENG
Soggetto:
COST-EFFECTIVENESS; SCALE; CARE; AGRANULOCYTOSIS; OUTPATIENTS; QUALITY; BURDEN; ISSUES; VIEW; LIFE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
39
Recensione:
Indirizzi per estratti:
Citazione:
R. Rosenheck et al., "A COMPARISON OF CLOZAPINE AND HALOPERIDOL IN HOSPITALIZED-PATIENTS WITH REFRACTORY SCHIZOPHRENIA", The New England journal of medicine, 337(12), 1997, pp. 809-815

Abstract

Background Clozapine, a relatively expensive antipsychotic drug, is widely used to treat patients with refractory schizophrenia. It has a low incidence of extrapyramidal side effects but may cause agranulocytosis. There have been no long-term assessments of its effect on symptoms, social functioning, and the use and cost of health care. Methods Weconducted a randomized, one-year, double-blind comparative study of clozapine (in 205 patients) and haloperidol (in 218 patients) at 15 Veterans Affairs medical centers. All participants had refractory schizophrenia and had been hospitalized for the disease for 30 to 364 days inthe previous year. All patients received case-management and social-rehabilitation services, as clinically indicated. Results In the clozapine group, 117 patients (57 percent) continued their assigned treatment for the entire year, as compared with 61 (28 percent) of the patients in the haloperidol group (P < 0.001). As judged according to the Positive and Negative Syndrome Scale of Schizophrenia, patients in the clozapine group had 5.4 percent lower symptom levels than those in the haloperidol group at all follow-up evaluations (mean score, 79.1 vs. 83.6; P = 0.02). The differences on a quality-of-life scale were not significant in the intention-to-treat analysis, but they were significantamong patients who did not cross over to the other treatment (P = 0.003). Over a one-year period, patients assigned to clozapine had fewer mean days of hospitalization for psychiatric reasons than patients assigned to haloperidol (143.8 vs. 168.1 days, P = 0.03) and used more outpatient services (133.6 vs. 97.9 units of service, P = 0.03). The total per capita costs to society were high - $58,151 in the clozapine group and $60,885 in the haloperidol group (P = 0.41). The per capita costs of antipsychotic drugs were $3,199 in the clozapine group and $367in the haloperidol group (P < 0.001). Patients assigned to clozapine had less tardive dyskinesia and fewer extrapyramidal side effects. Agranulocytosis developed in three patients in the clozapine group; all recovered fully. Conclusions For patients with refractory schizophreniaand high levels of hospital use, clozapine was somewhat more effective than haloperidol and had fewer side effects and similar overall costs. (C) 1997, Massachusetts Medical Society.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 19/01/20 alle ore 07:04:28