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Publications (10)10.54 Total impact

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    ABSTRACT: Health service providers increasingly need to consider not only the efficacy and safety of a therapy, but also its cost. Our hypothesis was that in our previously reported aripiprazole add-on or switching study, the improved outcomes would be associated with reduced costs. We here report data from this study, now to 52-week follow-up, with 27 total recruits (outpatients partially refractory or intolerant of their current antipsychotic regime). Serial clinical ratings included the Quality of Life Scale and Client Service Receipt Inventory, applied at baseline (N = 24), week 26 (N = 21) and 52 (N = 18). Cost data were unavailable for the drop outs. On last observation carried forward (LOCF) analysis, there was a significant increase in the Quality of Life Scale between baseline and one year (p = 0.007). There were also reductions over time in total direct and indirect costs. For study completers, the total costs at the one-year follow-up period were £ 482 less than those for the corresponding baseline period, with the Quality of Life Scale score at one year being 21.6 points (or 16.4 on LOCF analysis) higher. Therefore, in the completers, improved outcome was associated with reduced costs. Cost-effectiveness could be similarly investigated in a controlled trial.
    Journal of Psychopharmacology 02/2010; 25(5):675-84. · 3.37 Impact Factor
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    Angelo Ricciardi, Victoria McAllister, Paola Dazzan
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    ABSTRACT: Psychosis is a traumatic experience for both sufferers and their families. The morbidity and mortality associated with psychosis may be improved by an assertive, specialised, multidisciplinary approach to care, provided at the earliest opportunity. Early Intervention in Psychosis (EIP) uses such approach to improve the individual's short and long-term symptomatic and functional outcome, as well as quality of life. However, there is still controversy about whether this type of intervention is effective enough to justify its associated costs. We reviewed evidence from the literature on EIP for schizophrenia spectrum and non-affective psychoses, with particular attention to evidence on its effectiveness in reducing the duration of untreated symptoms, preventing relapses and reducing admission rates, reducing suicide rates, and reducing treatment costs. There is preliminary evidence that EIP may be effective in delaying transition to psychosis, reducing DUP, preventing relapses, reducing admission and suicidal rates, and reducing treatment costs. EIP remains a stimulating multidisciplinary approach to psychosis and a demanding commitment for mental health professionals and service developers.
    Epidemiologia e psichiatria sociale 09/2008; 17(3):227-35. · 3.16 Impact Factor
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    ABSTRACT: Sexual dysfunction and raised prolactin are common adverse effects of many anti-psychotics. Aripiprazole is an atypical anti-psychotic associated with a reduction in prolactin level in anti-psychotic-induced hyperprolactinemia. Our hypothesis was that switching from another anti-psychotic to aripiprazole would be associated with a reduction in sexual dysfunction. An open label switch to aripiprazole was offered to 27 subjects with inadequate therapeutic response or intolerance to another anti-psychotic, who were followed up for 26 weeks. Serial clinical ratings included the Anti-psychotic Non-Neurological Side-Effects Rating Scale (ANNSERS), and the Sexual Functioning Questionnaire. Our primary analysis point was week 12. In both sexes, there was a significant reduction in prolactin by week 12 (P = 0.003), accompanied by a significant improvement in libido (P = 0.028). In males, both erectile and ejaculatory difficulties were also significantly reduced (P = 0.04 and P = 0.017, respectively). In females, menstrual dysfunction was also significantly reduced at week 12 (P = 0.04). By week 26, the changes in all of the above remained significant, and were accompanied by a significant increase in satisfaction in overall sexual functioning (P = 0.007), despite the fact that 54.5% of subjects at were also taking their original antipsychotic. There was also a significant decrease in the total ANNSERS score (P < 0.001) and a significant improvement in all other measures of psychopathology (PANSS, CGI-S/I, GAF-S/D, and QoL). We conclude that switching to aripiprazole or the addition of aripiprazole to another antipsychotic regime is associated with a reduction in sexual dysfunction.
    Journal of Psychopharmacology 05/2008; 22(3):244-53. · 3.37 Impact Factor
  • Schizophrenia Research - SCHIZOPHR RES. 01/2008; 102(1):162-162.
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    ABSTRACT: Background:  The aim of this study was to investigate associations between demographic and clinical variables and duration of untreated psychosis (DUP) in a sample of cases of psychosis across an adult early intervention in psychosis service and a child and adolescent community team.Method:  Cross-sectional baseline data for cases of psychosis across the two teams on the caseload at a given time point were collected, including age of onset, gender, ethnicity, referral route, and DUP.Results:  The median DUP across the entire sample was 91 days, while those patients with initial treatment for psychosis from the child and adolescent team had a median DUP of 69 days. Using multiple linear regression, there were two variables that showed a significant association with DUP: referral route (p < .001), and age of onset, with earlier age of onset associated with shorter DUP (p = .015).Conclusion:  These findings are discussed in relation to possible explanatory factors, with particular focus on service-level variables and pathways to care. It is suggested that the involvement of child and adolescent teams is vital to the work of early intervention in psychosis services.
    Child and Adolescent Mental Health 08/2007; 13(3):130 - 133. · 0.64 Impact Factor
  • Schizophrenia Research - SCHIZOPHR RES. 01/2006; 86.
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    ABSTRACT: Object: Aripiprazole is an antipsychotic with partial agonism activity at D 2 and 5-HT 1A receptors, not currently licensed for the treatment of psychotic depression (Burris et al. 2002 and Jordan et al. 2002). This case series reports outcomes of using aripiprazole in the treatment of patients with psychotic depression. Methods: Four individuals with psychotic depression treated with a combination of an antidepressant and an antipsychotic with inadequate therapeutic response or intolerance were switched to aripiprazole. Clinical ratings included Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression Scale for Severity/ Improvement (CGI-S/I), Global Assessment of Functioning Scale -Symptoms/ Disability (GAF-S/D), Antipsychotic Non-Neurological Side-Effects Rating Scale (ANNSERS, Yusufi et al. 2005), Quality of Life (QoL, Heinrichs et al. 1984) and Preference of Medication Scale (POM, a 1-5 scale, 1 = greatest preference). Results: Case 1: Switching was conducted without cross-tapering, and was uneventful. At one-year follow-up (on aripiprazole 10 mg and citalopram 40 mg), there was improvement on GAF-S (70 to 80), ANNSERS (16 to 5) and POM (1). Case 2: Cross-taper with amisulpride resulted in an improvement by 12 weeks in GAF-S (60 to 70), and ANNSERS (41 to 18). From week 26, depressive symptoms recurred. His medication (aripiprazole from 30 mg to 20 mg, citalopram 30 mg to 40 mg) was adjusted, which resulted in some improvement. However at one year, the patient was still reporting depressive symptoms along with paranoid ideation. At this point he was treated by introducing 200 mg of amisulpride. Case 3: Cross-taper with risperidone (4 mg) over 12 weeks was well tolerated and resulted by 1 year in a PANSS change from 71 to 40, CGI-S change from 3 to 1, and a POM score of 1. Case 4: Aripiprazole (10 mg to 15 mg over 2 weeks), cross-tapering with risperidone (2 mg), resulted in an improvement in his total side effects (ANNSERS from 13 to 9) as well as sexual side effects only by week 26. Conclusions: This case series suggests that further study of aripiprazole in the treatment of psychotic depression is indicated. Declaration of interest: This study was funded by Bristol-Myers Squibb Pharmaceuticals Limited (see Acknowledgements). Dr Katherine J Aitchison is on the UK Core Steering Group for Abilify (Aripiprazole), and has received consultancy fees from Bristol-Myers Squibb Pharmaceuticals Limited.
    332 Clinical Neuropsychiatry. 01/2006; 3(5).
  • Schizophrenia Research - SCHIZOPHR RES. 01/2006; 86.
  • Schizophrenia Research - SCHIZOPHR RES. 01/2006; 86.
  • Schizophrenia Research - SCHIZOPHR RES. 01/2006; 86.