Showing papers in "Evidence-based Mental Health in 1998"

The contribution of reliable and clinically significant change methods to evidence-based mental health

Abstract: Where outcomes are unequivocal (life or death; being able to walk v being paralysed) clinicians, researchers, and patients find it easy to speak the same language in evaluating results. However, in much of mental health work initial states and outcomes of treatments are measured on continuous scales and the distribution of the “normal” often overlaps with the range of the “abnormal.” In this situation, clinicians and researchers often talk different languages about change data, and both are probably poor at conveying their thoughts to patients. Researchers traditionally compare means between groups. Their statistical methods, using distributions of the scores before and after treatment to suggest whether change is a sampling artefact or a chance finding, have been known for many years.1 By contrast, clinicians are more often concerned with changes in particular individuals they are treating and often dichotomise outcome as “success” or “failure.” The number needed to treat (NNT) method of presenting results has gone some way to bridge this gap but often uses arbitrary criteria on which to dichotomise change into “success” and “failure.” A typical example is the criterion of a 50% drop on the Hamilton Depression Rating Scale score. A method bridging these approaches would assist the translation of research results into clinical practice. Jacobson et al proposed a method of determining reliable and clinically significant change (RCSC) that summarises changes at the level of the individual in the context of observed changes for the whole sample.2, 3–5 Their methods are applicable, in one form or another, to the measurement of change on any continuous scale for any clinical problem, although they have been reported primarily in the psychotherapy research literature. The broad concept of reliable and clinically significant change rests on 2 questions being addressed at the level of each …

Guidelines for evaluating prevalence studies

Abstract: As stated in the first issue of Evidence-Based Mental Health, we are planning to widen the scope of the journal to include studies answering additional types of clinical questions. One of our first priorities has been to develop criteria for studies providing information about the prevalence of psychiatric disorders, both in the population and in specific clinical settings. We invited the following editorial from Dr Michael Boyle to highlight the key methodological issues involved in the critical appraisal of prevalence studies. The next stage is to develop valid and reliable criteria for selecting prevalence studies for inclusion in the journal. We welcome our readers contribution to this process. You are a geriatric psychiatrist providing consultation and care to elderly residents living in several nursing homes. The previous 3 patients referred to you have met criteria for depression, and you are beginning to wonder if the prevalence of this disorder is high enough to warrant screening. Alternatively, you are a child youth worker on a clinical service for disruptive behaviour disorders. It seems that all of the children being treated by the team come from economically disadvantaged families. Rather than treating these children on a case by case basis, the team has discussed developing an experimental community initiative in a low income area of the city. You are beginning to wonder if the prevalence of disruptive behaviour disorders is high enough in poor areas to justify such a programme. Prevalence studies of psychiatric disorder take a sample of respondents to estimate the frequency and distribution of these conditions in larger groups. All of these studies involve sampling, cross sectional assessments of disorder, the collection of ancillary information, and data analysis. Interest in prevalence may extend from a particular clinical setting (a narrow focus) to an entire nation (a broad focus). In …

Evidence-based practice in mental health

Abstract: Welcome to the first issue of Evidence-Based Mental Health, a journal designed to help mental health clinicians stay up to date with the best available evidence as it is published. Evidence-Based Mental Health is one of a number of resources being developed to help clinicians who want to use the strategies of evidence-based practice (EBP).1 EBP harnesses recent advances in clinical epidemiology, biostatistics, and information science to produce a coherent and comprehensive approach to allow clinicians to base their practice on the best available evidence. EBP, far from being an esoteric activity pursued by ivory tower academics with too much time on their hands, meets a real clinical need. Evidence suggests that clinicians tend to underestimate their information requirements and, when they do recognise a need for information, they do not access the most reliable and least biased sources.2 This leads to a gap between research and clinical practice which manifests as unwarranted variations in clinical practice. There are only 2 explanations for these variations: either there is no evidence on which to base practice, or that there is evidence, but at least some of us are not using it.3 The inevitable result of these variations is that some patients are not receiving the best available care. There are several examples of the existence of such variations. One of the clearest findings in the field of mental health is the under recognition and diversity in the treatment of depression in various healthcare settings. It has proved difficult to narrow this gap between research and practice despite the production of increasingly emphatic consensus statements.4, 5 Within specialist psychiatric practice, there are the unexplained variations in the rates of use of electroconvulsive treatment both in the United States and the United Kingdom.6, 7 There are …

Understanding and interpreting systematic reviews and meta-analyses. Part 2: meta-analyses

Abstract: In part 1 (August 1998 issue) we introduced the rationale for the systematic review and described the first part of how to appraise critically such articles before using them clinically. The user would want to know: did the review focus on a specific question? Was a comprehensive and clearly described search strategy used? Were the appropriate studies selected? And did the raters agree about which articles should be included? In part 2, we focus on the statistical combination of the results of a series of studies (meta-analysis). Our objective is to suggest questions that a reader should ask of an article describing a meta-analysis. We will also outline the main methods used in meta-analyses. Meta-analyses seek to provide the best estimates of treatment effect based upon all the available valid evidence. The simplest type of meta-analysis involves simply counting up the number of statistically significant studies ( vote counting ). Although vote counting is straightforward and superficially easy to interpret, it leads to various potential biases and other problems. Many treatment effects that are of potential clinical importance are only moderately sized. When they have only been investigated in small trials with insufficient statistical power, a simple vote count may fail to identify a true treatment effect that may be important clinically. Of course, such a situation is why many meta-analyses are conducted, and this is therefore a major deficiency of the vote count. Similarly, vote counts treat every study the same, when larger and more powerful studies may appropriately be attributed greater weight than small lower powered ones. A further and important problem is that vote counting does not provide a useful estimate of the magnitude of an effect across a group of studies. For these reasons, more sophisticated methods are needed to synthesise the results of several experimental studies. ### APPLYING WEIGHTS TO DIFFERENT STUDIES A …

Understanding and interpreting systematic reviews and meta-analyses. Part 1: rationale, search strategy, and describing results

Abstract: Reviews of primary studies are an important source of information for clinicians, and we include abstracts of good quality reviews in Evidence-Based Mental Health. This issue contains summaries of reviews of the effectiveness of psychotherapy (Wampold p 78), cognitive therapy in depression (Gloaguen p 76), family and couples therapy for drug abuse (Stanton p 81), chlorpromazine in schizophrenia (Thornley p 83), interventions for old age depression (McCusker p 77), support after post-partum depression (Ray p 89), relative mortality in schizophrenia (Brown p 91) and the association between apolipoprotein E and Alzheimer's disease (Farrer p 94). All of these reviews tried to access and review systematically all of the relevant articles in the field ( systematic review) and included a quantitative summary of their results ( meta-analysis). The clinical interpretation of a review article, or an abstract of a review article, requires the reader to have some conceptual understanding of how systematic reviews are conducted and the rationale behind the approach. We address these issues in this article and discuss two important stages of a review—setting a clear research question and identifying the primary studies. We will focus on systematic reviews of treatment studies although similar principles apply to reviews of different kinds of studies. In part 2 (November issue), we will describe some of the statistical issues that need to be considered when interpreting the results of a systematic review that uses statistical techniques to combine data from different studies ( meta-analysis ). One of the more important methodological “discoveries” of the past two decades was that many review articles of health interventions were methodologically inadequate.1 Although there had been significant advances in research design, such as the development of the randomised controlled trial, the review article still tended to be unsystematic and susceptible to many biases. The result was that it …

Some useful concepts and terms used in articles about diagnosis

Abstract: On the inside back cover of this issue you will see the first installment of a glossary. In this issue it includes some of the terms used in articles about diagnostic instruments; over the course of a year or so, terms from most areas of research will be covered. By their very nature, glossary entries are brief and are most useful to people who need them the least. This notebook will expand on some of the terms and concepts that are mentioned only briefly in the glossary. To illustrate some of these terms we will use data from the article by Mintz et al which is abstracted in this issue of Evidence-Based Mental Health (p 22) . 1 One of the problems with diagnostic test terms is that there are 2 different “traditions”, each with its own terminology. For statistical and psychometric reasons, psychologists prefer to measure phenomena along a continuum (eg, amount of depression or anxiety; intelligence level; locus of control; etc.). As the scores themselves are continuous, the statistics used to assess reliability and validity are those which are appropriate for continua, such as Pearson's correlation coefficient, the intraclass correlation, and the results of t tests and analyses of variance. On the other hand, many decisions which physicians make are dichotomous in nature: prescribe or do not prescribe a medication; admit or do not admit to hospital; and so forth. Consequently, they often use scales which yield a dichotomous outcome (meeting criteria for depression or not, as opposed to the degree of depression), and the statistical tests which are appropriate for such categorical data: tests based on χ2-like tables. The terminology can also be confusing due to the evaluation of diagnostic tests in 2 different circumstances: when there already exists an established test (a “diagnostic …

Why we do not abstract analogue studies of treatment outcome and scale development

Abstract: One of the basic principles behind the publication of Evidence-Based Mental Health (EBMH) is that the research which we abstract in the journal should have immediate practical implications for mental health clinicians. The key question we ask ourselves in selecting studies to include in EBMH is will mental health clinicians be able to use the findings of this study in their practice? We do not believe that the results of analogue studies are useful in clinical practice, and in this note we outline our reasoning. By analogue studies, we are referring to studies in which the therapeutic setting is in some senses an “analogue” of routine clinical practice or the participants (usually students) are different from those to whom the treatment or scale will ultimately be applied. There are various issues that determine how useful a study can be to practitioners, some of which are shared by research in other areas of health care. Thus, for example, all studies should be designed in a way that gives readers confidence in their findings. This is why EBMH and the other evidence-based journals have explicit methodological criteria for …

Review: a brief psychological intervention (debriefing) is ineffective in preventing post-traumatic stress disorder

Abstract: Study selection Studies were selected if they were randomised controlled trials of brief psychological interventions involving a single session of debriefing delivered shortly after the trauma occurred. Studies were excluded if the participants were psychiatric patients, research participants such as psychology students, or children; the trauma involved perinatal grief or bereavement; the study was about treatment of PTSD; or the study had an n of 1 or crossover design.

Review: heterocyclic antidepressants and rational psychological therapies are effective in older patients with mild to moderate depression

Abstract: and commentary also published in ACP Journal Club

Review: clozapine reduces relapse and symptoms compared with typical neuroleptic drugs in schizophrenia

Abstract: . Essali MA, Rezk E, Wahlbeck K, et al. Clozapine v “typical” neuroleptic medication for schizophrenia . In: the Cochrane Database of Systematic Reviews [updated 4 March 1997]. In the Cochrane Library [database on disk and CD-ROM]. The Cochrane Collaboration; issue 2. Oxford: Update Software; 1997. . To compare the effectiveness of clozapine with typical neuroleptic drugs in patients with schizophrenia. Studies were identified by searching Biological Abstracts (January 1982 to May 1995), Cochrane Schizophrenia Groups' Register, EMBASE (January 1980 to May 1995), Medline (January 1966 to May 1995), PsycLIT (January 1974 to May 1995), and SCISEARCH, as well as by scanning the reference list of retrieved articles and by contacting authors of recent trials and the manufacturer of clozapine. Studies were selected if they were randomised controlled trials that compared the effectiveness of clozapine with typical neuroleptic drugs in patients with schizophrenia. Principal outcomes of interest were mortality, relapse, changes in mental state, behavioural changes, subjective wellbeing, family burden, suitability for discharge, working ability, and side effects. Data were extracted on study duration, study design, patient characteristics, study setting, specifics of …

Olanzapine produced a higher clinical response rate than risperidone in schizophrenia

Abstract: Patients 339 patients who were 18 to 65 years of age (mean age 36 y, 65% men) and met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria for schizophrenia, schizophreniform disorder, or schizoaffective disorder, and had a minimum score of >42 on the Brief Psychiatric Rating Scale. Exclusion criteria were comorbid or recent major axis I disorder, serious medical illness, pregnancy or lactation, or lack of at least minimal clinical response with>3 antipsychotic drugs in 3 chemical classes. 53% of patients completed the study.

Some useful concepts and terms used in articles about treatment

Abstract: One of the important principles of practising evidence-based mental health is that the results of research studies should be used to influence clinical decisions about a particular patient. The best quality evidence for making decisions about treatment comes from randomised controlled trials or from overviews of several randomised controlled trials such as a meta-analysis. The reason that a randomised controlled trial provides the best evidence is that, in most circumstances, randomisation avoids any systematic tendency to produce an unequal distribution of prognostic factors between the experimental and control treatments that could influence the outcome. It is important to remember that not all methods of allocation which are described as random are truly random, and even with true randomisation there may still be important differences at baseline between the groups due to small sample sizes. It is also important that those who are assessing outcome are blind to whether the patient received the experimental or control treatments. If there is a statistically significant difference in the rate of a favourable outcome or in change scores from baseline in the experimental group compared with the control group, then it is concluded that the treatment is “effective”. Evidence-Based Mental Health will only abstract treatment studies if the method of allocation is random, if there was adequate follow up of subjects entered into the trial, and if clinically important outcomes were reported. Unfortunately, there may not be a randomised controlled trial for each clinical question. If that is the case, then clinical decisions must be made on the basis of the best available evidence taking all relevant factors into account. Frequent replication of the intervention using different samples and outcome tools can add to the weight of the evidence in non-experimental designs. Given evidence from a randomised controlled trial, statistical significance is not the …

Fluoxetine decreased depressive symptoms in children and adolescents with non-psychotic major depressive disorder

Abstract: and commentary also published in Evidence-Based Medicine 1998 Jul-Aug.

Review: few elderly inpatients who are depressed improve

Abstract: and commentary also published in Evidence-Based Medicine 1998 Jul-Aug.

DSM-IV criteria were reliable and accurate in differentiating pervasive developmental disorder (PDD) from non-PDD and autism from Asperger's disorder

Abstract: Description of tests and diagnostic standard Patients were diagnosed as PDD, PDD subtype, or non-PDD by 1 experienced physician using a clinical assessment, available clinical records, the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS). The raw data from the ADI-R, clinical notes (excluding diagnostic opinion), ADOS, IQ, Vineland Adaptive Behavior Scales standard scores, and Austism Behavior Checklist were independently assessed by 3 experienced raters, each of whom made a separate, blind diagnosis according to DSM-IV criteria (criteria for Asperger’s disorder were modified; if a child met criteria for both autism and Asperger’s, the child was given a diagnosis of Asperger’s). A consensus best estimate diagnosis was made after discussion if there was disagreement. Main outcome measures Reliability and accuracy (calculated by comparing the agreement between the clinician’s diagnosis and the consensus best estimate, and by calculating the error rates associated with the 3 raters).

Review: assertive community treatment is an effective alternative in severe mental disorders

Abstract: Main results When ACT was compared with standard community care, patients in the ACT group were more likely to remain in contact with psychiatric services, were less likely to be admitted to hospital, spent less time in hospital, and had better outcomes in terms of accommodation status, employment (table), and patient satisfaction. No differences existed between the groups for mental state, social functioning, or costs (other than reduced cost of hospital care in the ACT group). When ACT was compared with hospital based rehabilitation, patients in the ACT group were less likely to be admitted to hospital and spent less time in hospital, and were more likely to be living alone and to be employed (table). No differences existed between the groups for other clinical and social outcomes, or remaining in contact with services. There were insufficient data to evaluate costs. When ACT was compared with case management, patients in the ACT group spent fewer days in hospital. Insufficient data were available to evaluate all other outcomes.

Donepezil improved cognitive and global function in mild to moderate Alzheimer's disease

Abstract: commentary, and author’s response also published in Evidence-Based Medicine.

Low family cohesion was associated with the incidence of major depressive disorder in adolescents

Abstract: The weighted 1 year incidence was 3.3% (95% CI 0.0% to 8.9%) for MDD, 3.4% (CI 0.0% to 9.1%) for dysthymia, and 1.0% (CI 0.0% to 2.8%) for any other disorder. Observations that remained in the same category over the next year were 20% for MDD, 3% for dysthymia, and 5% for any other disorder. Univari› ate logistic regression analyses showed that the incidence of MDD was associated with family cohesion in the previous year and with the total CES›D scores at baseline. In a multivariate analysis, only family cohesion was associated with the incidence of MDD (odds ratio 0.79, 95% CI 0.65 to 0.96); participants with greater family cohesion had a lower risk of developing MDD. For those with MDD at baseline, 10% had any other disorder and 57% had no disorder at follow up. For those with dysthymia at baseline, 19% had any other disorder, 78% had no disorder, and none had MDD at follow up. 26% of observations with any other disorder at baseline had MDD at follow up, and 11% had dysthymia. Conclusions The incidence of major depressive disorder in adolescents was associated with less emotional bonding in the family. There were no statistically significant risk factors for the incidence of dysthymia. Most adolescents with major depressive disorder or dysthymia at baseline were free of disorder 1 year later.

Risperidone and clozapine were more cost effective than haloperidol and chlorpromazine in patients with schizophrenia

Abstract: . Glennie J. Technology overview: pharmaceuticals: pharmacoeconomic evaluations of clozapine in treatment-resistant schizophrenia and risperidone in chronic schizophrenia. Ottawa (ON): Canadian Coordinating Office for Health Technology Assessment (CCOHTA); 1997 Jul. . To compare the cost effectiveness and cost utilities of clozapine and risperidone with traditional therapy in patients with treatment resistant and chronic schizophrenia, respectively. Cost effectiveness and cost utility analyses from a government payer perspective using a decision model which incorporated meta-analyses, input from an expert panel to assess outcomes for each drug and its alternatives, and patient preferences derived from interviews with 7 patients who had schizophrenia. This overview reports the results of a study commissioned by CCHOTA to meet the above objective.* Canada. A theoretical cohort of patients in hospital who had treatment resistant schizophrenia was used in the model for evaluating clozapine. A second theoretical cohort of patients who had chronic schizophrenia was used to evaluate risperidone. In the model, each drug and its alternatives were assessed for the efficacy rate (success was defined as being well enough to be discharged), relapses, and …

Child and parent training sessions led to improved child behaviour in child conduct disorder

Abstract: Intervention Participants were allocated to child training (CT) (n = 27 children), parent training (PT) (n = 26 children and 43 parents), combined child and parent training (CT + PT) (n = 22 children and 36 parents), or a wait list control (n = 22 children and 40 parents). The programmes were weekly 2 hour sessions that lasted about 6 months. The CT programme included videotaped vignettes and fantasy play that addressed interpersonal difficulties. The PT programme included videotaped programmes on parenting and interpersonal skills. Wait list control group families waited 9 months and then were allocated to 1 of the 3 programmes.

A programme of methadone maintenance plus moderate counselling services was cost effective

Abstract: and commentary also published in Evidence-Based Medicine 1998 May–Jun.

Review: antidepressant drugs are effective in dysthymia

Abstract: Main results 15 trials involving 1964 patients were included. Similar results were obtained for the efficacy of the different drug groups considered: tricyclic antidepressants (TCAs); monoamine oxidase inhibitors (MAOIs); selective serotonin reuptake inhibitors (SSRIs); and other drugs (sulpiride, amineptine, and ritanserin). A treatment response occurred more often and more patients had full remission in the TCA, SSRI, and MAOI groups when compared with the placebo groups (table). Patients in the TCA group had more adverse effects than those in the placebo group (table). This difference did not occur for SSRIs or MAOIs when compared with placebo.

Review: chlorpromazine reduces relapse but increases adverse events in schizophrenia

Abstract: ; Thornley B, Adams CE, Awad G. Chlorpromazine versus placebo for those with schizophrenia. In: The Cochrane Library, issue 1. Oxford: Update Software, 1988. . Question In schizophrenia, to what extent does chlorpromazine reduce symptoms, relapse, and discontinuation of medication, and how frequent are the most common adverse events? Studies were identified by searching Biological Abstracts, Cochrane Schizophrenia Group's Register, The Cochrane Library, EMBASE, Medline, PsycLIT, and SCISEARCH; by scanning the bibliographies of identified articles; and by contacting pharmaceutical companies and authors of trials. Studies were selected if they were randomised controlled trials investigating the effectiveness of chlorpromazine compared with placebo or no treatment in patients with schizophrenia. Data were extracted on patient characteristics, drug dose, and primary outcomes of interest: death, relapse, overall improvement, discontinuation of medication, and adverse events. A meta-analysis was done. 76 reports (referring to 42 studies) met the …

Review: selective serotonin reuptake inhibitors differ from tricyclic antidepressants in adverse events

Abstract: . Trindade E, Menon D. Selective serotonin reuptake inhibitors (SSRIs) for major depression. Part I. Evaluation of the clinical literature. Ottawa (ON): Canadian Coordinating Office for Health Technology Assessment, 1997 Aug. Report 3E. . To compare the efficacy, completion rates, and adverse event rates of selective serotonin reuptake inhibitors (SSRIs) with tricyclic antidepressants (TCAs) in treating depression. Studies were identified by searching Medline, Embase, PsycINFO, International Pharmaceutical Abstracts, Pascal, Health Planning & Administration, Mental Health Abstracts, PharmacoEconomics & Outcomes News, and Current Contents databases (1980 to May 1996); scanning bibliographies of retrieved articles; hand searching journals; and consulting researchers. Studies were selected if they were double blind, randomised controlled trials, used antidepressant treatment for 4–12 weeks, and reported numerical or graphical data. Studies were excluded if they reanalysed data from previous studies. Data were extracted on efficacy, study completion, and adverse events. 162 randomised controlled trials were reviewed. SSRIs and TCAs were equally effective and the study completion rates did not differ. 7 adverse events increased and 3 decreased for SSRIs compared with TCAs (table). There were no differences in palpitations, urinary disturbance, fatigue, tremor, hypotension, {blurred vision, anorexia, and sweating}*. View this table: Selective serotonin reuptake inhibitors (SSRI) v tricyclic antidepressants (TCA)* Serotonin selective …

Long term amphetamine treatment improved behaviour in children with attention deficit hyperactivity disorder

Abstract: Patients 72 children 6–11 years of age who met >8 of the 14 DSM-III-R criteria for ADHD. Exclusion criteria were IQ < 50, chronic medical conditions, receiving ongoing medication (except for epilepsy), height 2 standard deviations below the norm, major psychosocial problems, or a history of alcohol or drug abuse in the patient or the principal caretaker. 62 patients (mean age 9 y, 82% boys, 42% with comorbid diagnosis) were randomised. 10 patients were withdrawn before randomisation.

Review: community mental health team management for adults with severe mental illnesses increases satisfaction with care

Abstract: Data sources Studies were identified using Biological Abstracts (1982 to January 1997), Cochrane Library, Cochrane Schizophrenia Group’s Register of trials, EMBASE (1980 to January 1997), Medline (1966 to January 1997), PsycLIT (1974 to January 1997), and SCISEARCH databases; bibliographies of relevant papers; hand searches of the Journal of Personality Disorders; and contact with authors and colleagues in community and forensic psychiatry.

Review: discontinuation rates are the same for serotonin specific reuptake inhibitors and newer tricyclic and heterocyclic antidepressants

Abstract: (1997) Br J Psychiatry. 170, 120. Hotopf M, Hardy R, Lewis G. . Discontinuation rates of SSRls and tricyclic antidepressants: a meta-analysis and investigation of heterogeneity. . Feb . : . –7. . [OpenUrl][1][Abstract/FREE Full Text][2] To determine if the advantage in discontinuation rates of serotonin specific reuptake inhibitors (SSRIs) shown in previous reviews was present when compared with newer tricyclic or heterocyclic antidepressants for the treatment of depression. As part of an ongoing Cochrane Collaboration review, randomised controlled trials were identified by searching Medline for previous reviews that compared SSRIs (fluoxetine, sertraline, paroxetine, and fluvoxamine) with tricyclics and heterocyclics. Additional studies were identified by hand searching 2 journals. If data for discontinuation rates were not complete, the first author was contacted. Trials were selected if they compared tricyclics or heterocyclics with SSRIs for the treatment of depression. Studies of these compounds for other indications were excluded. Data were … [1]: {openurl}?query=rft.jtitle%253DThe%2BBritish%2BJournal%2Bof%2BPsychiatry%26rft.stitle%253DBr.%2BJ.%2BPsychiatry%26rft.issn%253D0007-1250%26rft.aulast%253DHotopf%26rft.auinit1%253DM.%26rft.volume%253D170%26rft.issue%253D2%26rft.spage%253D120%26rft.epage%253D127%26rft.atitle%253DDiscontinuation%2Brates%2Bof%2BSSRIs%2Band%2Btricyclic%2Bantidepressants%253A%2Ba%2Bmeta-%2Banalysis%2Band%2Binvestigation%2Bof%2Bheterogeneity%26rft_id%253Dinfo%253Adoi%252F10.1192%252Fbjp.170.2.120%26rft_id%253Dinfo%253Apmid%252F9093499%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bjprcpsych&resid=170/2/120&atom=%2Febmental%2F1%2F1%2F21.atom

Review: patients who have schizophrenia have increased mortality from all causes, natural causes, and unnatural causes

Abstract: (1997) Br J Psychiatry 171, 502; Brown S. . Excess mortality of schizophrenia. A meta-analysis. . Dec; . : . –8 . [OpenUrl][1][Abstract/FREE Full Text][2] Question What is the mortality rate in patients who have schizophrenia? Studies were identified by searching Medline and BIDS Gateway (1986–96) and scanning the bibliographies of relevant studies. Studies were selected if they were cohort studies published in English or French, were peer reviewed, had >100 patients, had ≥2 years of follow up, had ≥85% of patients complete the study follow up, and the number of observed and expected deaths could be calculated. The number of observed and expected deaths were extracted. Meta-analytical techniques were used. 18 studies (61 161 patients) met the inclusion criteria. 10 260 deaths occurred and 6788 deaths were expected. Aggregate standardised mortality ratios (SMRs) were calculated by dividing the sum of the observed deaths by the sum of the expected deaths (derived from matched cohorts of the general population) and multiplying the result by 100. All cause, unnatural cause, and natural … [1]: {openurl}?query=rft.jtitle%253DThe%2BBritish%2BJournal%2Bof%2BPsychiatry%26rft.stitle%253DBr.%2BJ.%2BPsychiatry%26rft.issn%253D0007-1250%26rft.aulast%253DBrown%26rft.auinit1%253DS.%26rft.volume%253D171%26rft.issue%253D6%26rft.spage%253D502%26rft.epage%253D508%26rft.atitle%253DExcess%2Bmortality%2Bof%2Bschizophrenia.%2BA%2Bmeta-analysis%26rft_id%253Dinfo%253Adoi%252F10.1192%252Fbjp.171.6.502%26rft_id%253Dinfo%253Apmid%252F9519087%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bjprcpsych&resid=171/6/502&atom=%2Febmental%2F1%2F3%2F91.atom