Neurocognitive and symptom correlates of daily problem-solving skills in schizophrenia.

Functional outcome for individuals with schizophrenia has been associated with cognitive impairment. Deficits in attention, memory, speed of information processing and problem-solving skills affect independent functioning, vocational performance, and interpersonal functioning. This study investigated the relationship between neurocognitive functioning, clinical symptoms and daily problem-solving skills in seriously and persistently ill persons. Thirty-eight inpatients and outpatients were administered a neurocognitive battery for attention, working memory, processing speed, perceptual organization, and executive functioning; and semi-structured clinical interviews using the BPRS and SANS. Estimates of daily problem-solving skills were obtained using the relevant factor subscale from the Independent Living Scales (ILS-PB). Daily problem-solving skills were significantly correlated with negative symptoms, processing speed, verbal memory, and working memory scores. A regression model using an enter method suggests that working memory and negative symptoms are significant predictors of daily problem-solving skills and account for 73.2% of the variance. Further analyses demonstrate that daily problem-solving skills and negative symptoms were significantly different for inpatients and outpatients and significantly correlated with community status. The findings suggest the ILS-PB has utility as a proxy measure for assessing real-world functioning in schizophrenia.

Relationship between antipsychotic medication treatment and new cases of diabetes among psychiatric inpatients.

OBJECTIVE: This study examined data on patients with serious and persistent mental illness in a large state hospital system to determine whether patients who took second-generation antipsychotics were more likely to develop diabetes mellitus than patients who took first-generation antipsychotics. METHODS: A case-control study design was used. A new prescription of an antidiabetic medication was used to identify new cases of diabetes mellitus. Odds ratios were calculated for exposure to second-generation antipsychotics (clozapine, risperidone, olanzapine, quetiapine, and multiple second-generation antipsychotics) compared with exposure to first-generation antipsychotics. Cases and controls were identified by using a database that contained drug prescription information from the inpatient facilities that were operated by the New York State Office of Mental Health. Data from January 1, 2000, to December 31, 2002, were examined. Among 13,611 unique patients who received antipsychotics, 8,461 met entry criteria of being hospitalized for at least 60 days and not having an antidiabetic medication prescribed in the past. A total of 181 of these inpatients received prescriptions for an antidiabetic medication at least 30 days after their admission. Eight controls (N=1,448) for each case (N=181) were matched by calendar year, length of observation period, race, age group, and diagnosis, giving a total sample of 1,629 patients. RESULTS: Statistically significant elevations in risk were seen among patients who received more than one second-generation antipsychotic or clozapine or quetiapine, compared with patients who received first-generation antipsychotics alone. Although not statistically significant, odds ratios for olanzapine and risperidone were also elevated. Conditional logistic regression adjusting for gender and age did not change the results. CONCLUSIONS: Exposure to multiple second-generation antipsychotics or clozapine or quetiapine significantly increased the risk of treatment-emergent diabetes mellitus.

A naturalistic study of risperidone treatment outcome using prognosis-adjusted discharge rates in New York State inpatients.

BACKGROUND: Information concerning the effectiveness of newer atypical antipsychotics is derived largely from controlled clinical trials of relatively short duration. Limited information is available concerning naturalistic outcome of patients selected for clinical treatment with atypical antipsychotics. This study evaluates 1-year discharge rates among all patients treated with risperidone within the New York State inpatient psychiatric hospital system during the calendar years 1994 and 1995 ("period of interest") relative to patients treated with all other antipsychotic medications. METHOD: Data from the Integrated Research Database at Nathan Kline Institute (Orangeburg, N.Y.) were used. This database maintains complete treatment records for all inpatients within the New York State psychiatric inpatient system along with demographic, diagnostic, admission, and discharge information. Patients were identified at admission or first change in antipsychotic during the period of interest, and 1-year outcome was determined. RESULTS: 2198 risperidone-treated patients were identified versus 3259 treated with other antipsychotics. Length of hospitalization prior to treatment initiation was the primary predictor of discharge rate for both risperidone and control groups. When adjustment was made for between-group difference in prognosis (dischargeability), patients treated with risperidone within 30 days of admission were less likely to be discharged than those treated with all other agents (including clozapine), whereas risperidone was more effective in patients who had been hospitalized for 90 days or more prior to switch from another antipsychotic to risperidone. CONCLUSION: When database information is utilized to evaluate treatment effectiveness, adjustment must be made for a priori differences in prognosis or dischargeability. With appropriate methodology, database studies may indicate which patient groups are most likely to benefit from newer atypical antipsychotic agents.