Primary care companion to the Journal of clinical psychiatry
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Prim Care Companion J Clin Psychiatry · Jan 2010
Hospital admission for schizophrenia and discharge against medical advice in the United States.
Hospital discharge against medical advice may leave a patient at risk for adverse health outcomes and/or readmission, yet little is known regarding its occurrence, especially among patients with mental illness. The objective of this study was to discern the prevalence of, and predictive factors for, being discharged against medical advice among hospitalized patients with a primary diagnosis of schizophrenia. ⋯ Although the percentage of patients discharged against medical advice was small, the numeric magnitude on a nationwide basis was substantial. The adjusted mean length of stay for discharge against medical advice was significantly reduced, while cost per day was significantly higher. Discharge against medical advice represents a challenge to the provision of care for patients with schizophrenia and may contribute to increased use of primary and specialty outpatient services, rehospitalization rates, morbidity, and mortality.
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Prim Care Companion J Clin Psychiatry · Jan 2009
Efficacy of duloxetine in patients with fibromyalgia: pooled analysis of 4 placebo-controlled clinical trials.
To investigate the efficacy of duloxetine in the treatment of pain and improvement in functional impairment and quality of life in patients with fibromyalgia from a pooled analysis of 4 placebo-controlled, double-blind, randomized trials. ⋯ This pooled analysis provides evidence that 12 weeks of treatment with duloxetine 60-120 mg/d effectively improves fibromyalgia symptoms and may offer benefits beyond pain relief.
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Prim Care Companion J Clin Psychiatry · Jan 2009
The effect of eszopiclone in patients with insomnia and coexisting rheumatoid arthritis: a pilot study.
To evaluate the efficacy and safety of eszopiclone 3 mg, a nonbenzodiazepine medication/hypnotic indicated for the treatment of insomnia with comorbid rheumatoid arthritis (RA). ⋯ In this pilot study of patients with insomnia comorbid with RA, eszopiclone 3 mg improved all assessed sleep and daytime function measures over the treatment period, as well as some measures of RA-associated pain, disability, and quality of life.
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Prim Care Companion J Clin Psychiatry · Jan 2009
Patient-assessed versus physician-assessed disease severity and outcome in patients with nonspecific pain associated with major depressive disorder.
This post hoc analysis compared how patients and physicians estimate disease severity and global improvement during 8 weeks of treatment for major depressive disorder (MDD) with associated nonspecific pain. In addition, predictors of pain and depression were identified. ⋯ In patients with MDD associated with at least moderate nonspecific pain, physicians consider mainly the change in depressive symptoms as measured by MADRS in their CGI-I ratings, while patients also consider pain, depression, and anxiety in their PGI-I ratings. When treating depression and assessing treatment outcome, a broad spectrum of symptoms needs to be monitored.