[A comparative clinico-economic study of 2 models of organizational forms of psychiatric care exemplified in schizophrenia]. / Sravnitel'noe kliniko-ékonomicheskoe izuchenie dvukh modelei organizatsionnykh form psikhiatricheskoi pomoshchi na primere shizofrenii.

The authors describe part of the results of a comparative clinico-economic analysis of the functioning of two models of organizational forms of psychiatric services with special reference to Moscow and Kaluga. The purpose of the given research fragment was to make a comparative analysis of expenditures on schizophrenic patients depending on the system of psychiatric services organization on the whole and between different types of services; to specify approaches to optimization of their functioning with the use of a clinico-economic approach. Based on a comparative investigation of the representative groups of schizophrenic patients (386 patients of a mental health center in Moscow and 531 patients of the Kaluga regional psychiatric hospital No. 1), it has been established that as a result of the proper organization and financing of psychiatric services in Kaluga, the "direct" expenditures on one schizophrenic patient per year could be 20% as reduced and the losses of the national income could be lowered more than 2-fold. It should necessarily be mentioned that the financing of extra hospital services in Kaluga exceeded that in Moscow more than 3-fold, reaching about 20.3% of all the expenditures on schizophrenic patients. Apparently, the organizational and financial experience gained in Kaluga with the design of the common complex and many-staged system of psychiatric services may turn fairly instrumental in elaborating approaches to optimization of the functioning of psychiatric services.

[The comparative results of a clinico-economic and socioeconomic study of 2 populations of schizophrenic patients under different organizational forms of psychiatric care]. / Sravnitel'nye rezul'taty kliniko-ékonomicheskogo i sotsial'no-ékonomicheskogo izucheniia dvukh populiatsii bol'nykh shizofreniei v usloviiakh razlichnykh organizatsionnykh form psikhiatricheskoi pomoshchi.

The paper is a fragment of a comparative clinico-economic study of two models of organizational forms of psychiatric services in Moscow and Kaluga with special reference to schizophrenic patients (386 and 531 patients, respectively). The authors describe the results of computing expenditures on patients depending on the sex, age, disease pattern and social factors including educational and skill levels, family status, and family structure. The values of "direct" and "indirect" expenditures on schizophrenic patients are fairly variable. There are definite significant relationships between the magnitude of these expenditures and clinico-psychopathological and social factors as is their certain stability in both patients' populations examined. The adequately designed psychiatric services, scientifically based financing of the appropriate treatment and social rehabilitation programs may have a noticeable effect on the magnitude and character of losses on the part of the state, connected with schizophrenic patients, decrease expenditures on them as well as markedly improve their social functioning.

[The role of clinical and economic indices in shaping the criteria for registering schizophrenic patients]. / Rol' klinicheskikh i ékonomicheskikh pokazatelei v formirovanii kriteriev ucheta bol'nykh shizofreniei.

This work is a fragment of a study into expenditures in schizophrenia. The purpose of the work was to distinguish groups of "economic risk" in the population of schizophrenic patients in order to use in future the clinico-economic criteria for the design of the principles of patients' observation and to define approaches to the optimization of the functioning of psychiatric aid services. Depending on the total expenditures per patient during one year all the patients examined were distributed in 4 groups. It is shown that attribution of the patients to one or other group of "economic risk" is related to a definite complex of clinical signs. The authors discuss the problem of the potential orienting of psychiatric services in accordance with the priorities elaborated on that basis, formation of the economic effect commensurable with the expenditures, varying whatever the changes in investments.

[An economic evaluation in the pharmacokinetic prediction of preventive carbamazepine therapy]. / Ekonomicheskaia otsenka farmakokineticheskoi prediktsii preventivnoi terapii karbamazepinom.

The paper is concerned with the data of economic evaluation of pharmacokinetic prediction of the individual efficacy of preventive carbamazepin therapy of patients suffering from affective and schizoaffective psychoses. The study was carried out with the aid of the indicators of "direct" and "indirect" expenditures characterizing the efficacy of the use of carbamazepin in the treatment period as compared to the control one, using the pharmacokinetic predictors of the efficacy and without them. The potential economic efficacy of carbamazepin therapy appreciably increases provided the differential diagnostic indications for drug administration are specified. Such a technique of economic analysis of the data of psychopharmacokinetic studies enables their quantitative estimation and determination of economically important research priorities in that area.

[Analysis of economic and socio-economic expenditures in relation to clinico-psychopathological characteristics of schizophrenia]. / Analiz ékonomicheskikh i sotsial'no-ékonomicheskikh zatrat v zavisimosti ot kliniko-psikhopatologicheskikh osobennostei shizofrenii.

The paper is a fragment of the studies into estimation of expenditures in a representative group (386 patients) with schizophrenia. The authors describe the results of an analysis of "direct" and "indirect" expenditures incurred for the treatment of schizophrenic patients depending on the sex, age, disease pattern, prevailing positive syndrome, and the level of negative symptomatology. The values of these expenditures turned out fairly variable. It could be demonstrated that there are definite, significant correlations between the magnitude of these expenditures and ++clinico-psychopathological factors. The highest expenditures were recorded in patients fit for work, they are largely determined by expenditures for inpatient treatment and disability payments. It should be emphasized that in male patients, they appear much higher, particularly in the group of patients with simple schizophrenia. It means that using economic estimates indirectly reflecting the gravity and characteristic features of schizophrenia, one can assess different manifestations of the disease in terms of universal units of cost.

[Results of the socioeconomic study of the population of patients with schizophrenia]. / Nekotorye rezul'taty sotsial'no-ékonomicheskogo izucheniia populiatsii bol'nykh shizofreniei.

The authors provide the results of an analysis of direct and indirect expenses for schizophrenic patients (n-386) depending on certain social factors. The analysis has shown a wide variability of expenses for patients depending on the level of education and skills, the character of work organization, familial status, and living conditions. The social parameters exerting the most essential influence on the magnitude and character of expenses for schizophrenic patients, incurred by the state have also been defined. Adequate financing of the appropriate social and rehabilitation programs may produce an appreciable effect on the patients social status, lead to a decrease of expenses for them, which later will warrant the primary expenses for the programs.

[Clinical and economic approach to evaluation of the effectiveness of moditen-depot and haloperidol decanoate in the maintenance therapy of attack-like schizophrenia]. / Klinicheskii ékonomicheskii podkhod k otsenke sravnitel'noi éffektivnosti moditena-depo i galoperidola dekanoata v podderzhi- vaiushchei terapii u bol'nykh pristupoobraznoi shizofreniei.

The efficacy of the use of moditen-depo and haloperidol decanoate as preventive anti-recurrence+ therapy was studied and compared in 2 groups of patients suffering from attack-like schizophrenia with frequent exacerbations. The cost-use analysis made it possible to establish their higher efficacy as compared to the routine maintenance therapy. Proceeding from the clinical, economic and socioeconomic indicators the use of haloperidol decanoate turned out more effective than the use of moditen-depo.

[Comparative evaluation of clinical and economic effectiveness of preventive therapy of affective and schizoaffective psychoses]. / Sravnitel'naia otsenka klinicheskoi i ékonomicheskoi éffektiv- nosti profilakticheskoi terapii affektivnykh i shizoaffektivnykh psikhozov.

The authors provide the results of a comparative study into the action of different drug approaches to the prevention of relapses of affective and schizoaffective psychoses with the aid of multifactorial consideration of different clinical, economic and socioeconomic indicators characterizing the "benefits and losses" because of the use of carbamazepine and lithium carbonate. The comparative analysis has shown a high normothymic activity of carbamazepine and lithium carbonate in the patients examined, with the preventive action of carbamazepine being more remarkable as regards the economic and clinical indicators.

[Clinico-economic study of schizophrenia: methodology and comparative analysis of expenditures in the hospital and ambulatory care networks]. / Kliniko-ékonomicheskoe izuchenie shizofrenii: metodologiia issledovaniia i sravnitel'nyi analiz stoimostnykh zatrat v statsionarnoi i ambulatornoi seti.

The paper is concerned with part of the results of an analysis of expenditures for the treatment of schizophrenic patients. The task of the present fragment was to delineate ways of optimizing the functioning of the psychiatric assistance services. Research methods including clinico-economic, statistic, mathematic and epidemiological approaches are described in detail. Based on an examination of the representative group of schizophrenic patients (n-386) of one of the psychoneurological dispensaries of Moscow, it has been established that the main "direct" (793.8 rubels per patient/year on the average) and "indirect" (3520.94 rubels per patient/year on the average) expenditures are connected with expensive inpatient treatment and disability allowance payments. It is suggested that redistribution of investments with a purpose of eliminating economic unbalance between different psychiatric services (hospital and ambulatory) will contribute to optimizing their functioning and enable the efficacy of their work to be enhanced.

[Clinico-economical aspects of long-term therapy with moditen-depot]. / Kliniko-ékonomicheskie aspekty dlitel'noi terapii moditenom-depo.

As many as 16 patients with multi-attack schizophrenia were examined for the dynamics of the efficacy of long-term therapy with moditen-depot , expressed in the clinico-economic parameters. It turned out that the degree of positive treatment effect was different, being dependent on the main disease tendencies during the treatment. In half patients who received the drug during retention of progredient tendencies, "depletion" of the positive treatment effect was observed which affected the dynamics of the clinico-economic parameters. Apparently, in the latter cases the replacement of the long-acting drug is desirable.

[Clinico-social prognosis of long-term remissions in paroxysmal schizophrenia]. / Kliniko-sotsial'nyi prognoz dlitel'nykh remissii pristupoobraznoi shizofrenii.

The author has carried out blanket examination of outpatients with attack-type schizophrenia characterized by prolonged remissions. Peculiarities of social adaptation are considered with regard to the clinical picture and dynamics of remission states. Characteristics of prolonged, interrupted and stable remissions are compared. A number of factors associated with a possible development of long-term recurrences have been ascertained.

[Clinico-dynamic aspects of long-term remissions in schizophrenia]. / Kliniko-dinamicheskie aspekty dlitel'nykh remissii pri shizofrenii.

The authors studied 56 patients with paroxysmal schizophrenia who had remissions lasting over 10 years. Three variants of such long remissions were identified: with a negative time-course characterized by a gradual decrease in their quality and the presence of signs of slow progression of the disease; with a positive time-course characterized by an elevation in their levels, a gradual reduction of positive symptomatology and stabilization of the patient's status; stationary remissions with an unaltered clinical picture throughout their course. The time-course of prolonged remissions correlated with the regularities of the course of the endogenic process on the whole. Sociotherapeutic recommendations are presented for each of the identified variants.