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Alzubaidi H, Saidawi W, Alzoubi KH, Franson KL, Samorinha C, Goldstone LW. Mental Health Care Education and Training in Pharmacy Programs in Arabic-Speaking Countries. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100039. [PMID: 37534929 DOI: 10.1016/j.ajpe.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/13/2022] [Accepted: 12/02/2022] [Indexed: 08/04/2023]
Abstract
OBJECTIVE This study aimed to assess how entry-level pharmacy programs in Arab countries prepare graduates to provide mental health care, specifically examining the didactic curricula and experiential training in psychiatry in bachelor and PharmD programs. METHODS An electronic survey was sent to all entry-level pharmacy programs in the 22 Arab countries asking to report on the 2021-2022 academic year. The survey assessed teaching and learning (eg, psychiatric diseases taught and extent of the coverage; contact hours dedicated to psychiatric therapeutics, pharmacology, and medicinal chemistry), experiential training in psychiatry and its challenges, and graduates' preparedness to provide mental health. A descriptive analysis of the data was undertaken, and data were reported for bachelor and PharmD programs separately. RESULTS Overall, 35 pharmacy programs completed the survey. All PharmD programs and 80% of bachelor programs covered psychiatric therapeutics, and most contact hours were dedicated to pharmacology, followed by psychiatric therapeutics and medicinal chemistry. Over half of the faculty considered that depression and anxiety disorders were covered sufficiently, and 56.2% of programs did not offer experiential training in psychiatry. Common challenges in psychiatry experiential training included a lack of sites and qualified preceptors. Overall, 26.4% of faculty positively rated graduates' preparedness to provide mental health care. Graduates who completed experiential training in psychiatry and PharmD graduates were rated higher. CONCLUSION Pharmaceutical education in Arab countries could be improved by enhancing the teaching and assessment of mental health topics and expanding psychiatry experiential training. Such changes would improve entry-level pharmacists' competencies in mental health care provision.
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Affiliation(s)
- Hamzah Alzubaidi
- University of Sharjah, College of Pharmacy, Sharjah, United Arab Emirates; University of Sharjah, Research Institute for Health and Medical Sciences, Sharjah, United Arab Emirates; Deakin University, Faculty of Health, School of Medicine, Deakin Rural Health, Victoria, Australia.
| | - Ward Saidawi
- University of Sharjah, Research Institute for Health and Medical Sciences, Sharjah, United Arab Emirates
| | - Karem H Alzoubi
- University of Sharjah, College of Pharmacy, Sharjah, United Arab Emirates; University of Sharjah, Research Institute for Health and Medical Sciences, Sharjah, United Arab Emirates
| | - Kari L Franson
- University of Southern California, School of Pharmacy, Los Angeles, CA, USA
| | - Catarina Samorinha
- University of Sharjah, Research Institute for Health and Medical Sciences, Sharjah, United Arab Emirates
| | - Lisa W Goldstone
- University of Southern California, School of Pharmacy, Los Angeles, CA, USA
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Muhammad N, Ullah SR, Nagi TK, Yousaf RA. Factors Associated With Non-adherence to Anti-depressant Medication in Adults: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e37828. [PMID: 37091492 PMCID: PMC10114977 DOI: 10.7759/cureus.37828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 04/25/2023] Open
Abstract
The present meta-analysis has been conducted to review currently available literature to examine the factors associated with adherence to anti-depressant medications in adults. This meta-analysis and systematic review followed the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. According to this analysis, the three most important electronic resources for research were CINAHL, EMBASE, and Medline. Google Scholar was used to supplementing the articles already available for review. Keywords used to find relevant articles included "predictors," "non-adherence," "anti-depressants," and "adults." Medical subject headings (MeSH) terms and Boolean operators ("AND" and "OR") were used in the search strategy to refine the search further. Studies included in this meta-analysis had information on factors associated with non-adherence to anti-depressant medication. The study evaluated samples of adult participants over 18 years with a diagnosis of depression and who had been prescribed anti-depressants. In conclusion, this meta-analysis examined the relationship between demographic factors and non-adherence to anti-depressant medications. The findings revealed that gender, educational status, income level, marital status, and area of residence did not significantly predict non-adherence to anti-depressants. However, older age and polypharmacy were significant predictors of adherence to anti-depressants. The study also found that individuals living in urban areas were more likely to adhere to anti-depressants, but the difference was not statistically significant.
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Affiliation(s)
- Nazar Muhammad
- Psychiatry, Cornerstone Family Healthcare, New York, USA
| | - Salecah R Ullah
- Internal Medicine, Khawaja Muhammad Safdar Medical College, Sialkot, PAK
| | - Talwinder K Nagi
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
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Kirkøen B, Berstad P, Hoff G, Bernklev T, Randel KR, Holme Ø, de Lange T, Robb KA, Botteri E. Type and Severity of Mental Illness and Participation in Colorectal Cancer Screening. Am J Prev Med 2023; 64:76-85. [PMID: 36216655 DOI: 10.1016/j.amepre.2022.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The effectiveness of colorectal cancer screening programs depends on the participation rate. This study examined the association between type and severity of mental illness and colorectal cancer screening participation. METHODS Between 2012 and 2017, a total of 46,919 individuals were invited to sigmoidoscopy screening in Norway, and 70,019 were invited to fecal immunochemical testing. In 2022, logistic regression was used to evaluate the association between the use of antipsychotics, anxiolytics, hypnotics, and antidepressants in the year preceding the screening invitation and screening participation, adjusted for demographic and socioeconomic factors. Defined daily doses of individual drugs were used to assess dose‒response relationships. RESULTS Overall, 19.2% (24.8% of women, 13.4% of men) of all invitees used at least 1 psychotropic medication. Nonparticipation in the 2 arms combined was associated with the use of anxiolytics (60.7% in users vs 43.2% in nonusers; OR=1.53; 95% CI=1.45, 1.62) and antipsychotics (64.3% vs 43.8%; OR=1.41; 95% CI=1.30, 1.53) and increased with higher doses for both drugs. Hypnotics and antidepressants were only weakly associated with nonparticipation in higher doses. Participation rates were 57.3%, 52.3%, 42.9%, and 35.4% in those prescribed 0, 1, 2, and 3-4 classes of psychotropic medications, respectively. The associations between the use of psychotropic medications and nonparticipation were similar for the 2 screening tests. CONCLUSIONS These findings show significant disparities in colorectal cancer screening participation for individuals with mental illness, independent of the screening method. Moreover, screening participation varied depending on the type and severity of mental illness. Targeted interventions are warranted to ensure that people with mental illness are supported to access the benefits of colorectal cancer screening.
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Affiliation(s)
- Benedicte Kirkøen
- From the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Regional Center for Child and Adolescent Mental Health (RBUP), Oslo, Norway.
| | - Paula Berstad
- From the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Geir Hoff
- From the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Department of Research and Development, Telemark Hospital Trust, Skien, Norway; Institute of Clinical Medicine, University of Oslo Oslo, Norway
| | - Tomm Bernklev
- Institute of Clinical Medicine, University of Oslo Oslo, Norway; Department of Research and Development, Vestfold Hospital Trust, Tønsberg, Norway
| | - Kristin R Randel
- From the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Øyvind Holme
- Department of medicine, Sørlandet Hospital, Kristiansand, Norway; Institute of Health & Society, University of Oslo, Oslo, Norway
| | - Thomas de Lange
- Department of Medicine, Sahlgrenska University Hospital-Mölndal, Region Västra Götaland, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medical Research, Bærum Hospital, Gjettum, Norway
| | - Kathryn A Robb
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Edoardo Botteri
- From the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; and the Department of Research, Cancer Registry of Norway, Oslo, Norway
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González de León B, Abt-Sacks A, Acosta Artiles FJ, del Pino-Sedeño T, Ramos-García V, Rodríguez Álvarez C, Bejarano-Quisoboni D, Trujillo-Martín MM. Barriers and Facilitating Factors of Adherence to Antidepressant Treatments: An Exploratory Qualitative Study with Patients and Psychiatrists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16788. [PMID: 36554679 PMCID: PMC9779577 DOI: 10.3390/ijerph192416788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
This study examines the experiences and expectations of patients with depressive disorders regarding the disease and different antidepressants, as well as examining the barriers and facilitating factors that could affect their adherence to medications. An exploratory qualitative study was carried out. The study involved two focus groups made up of patients and caregivers and six semi-structured interviews with psychiatrists. In both cases, the participants were selected by intentional theoretical sampling, seeking maximum significance variation of social types. Prejudice about the side effects of medication was relevant. The importance of patients being well informed about the disease/treatments was noteworthy. The stigmatization of antidepressants by patients was identified as a barrier to medication adherence. The involvement of family members and the motivation of patients to be actively involved in the process to recover from the disease were identified as facilitating factors. The work carried out suggests the need for patients to have rigorous information about the disease/treatment to reduce the possible prejudices generated by beliefs. Maintaining greater contact and monitoring of patients/caregivers to help therapeutic adherence in patients with depressive disorders was also identified as being of great importance.
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Affiliation(s)
- Beatriz González de León
- Multiprofessional Teaching Unit of Family and Community Care La Laguna-Tenerife Norte, Management of Primary Care of Tenerife, 38320 Santa Cruz de Tenerife, Spain
| | - Analía Abt-Sacks
- Canary Islands Health Research Institute Foundation, 38320 Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Santa Cruz de Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
| | - Francisco Javier Acosta Artiles
- Department of Mental Health, General Management of Healthcare Programs, Canary Islands Health Service, 35071 Las Palmas de Gran Canaria, Spain
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Department of Psychiatry, Insular University Hospital of Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Tasmania del Pino-Sedeño
- Canary Islands Health Research Institute Foundation, 38320 Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Santa Cruz de Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
| | - Vanesa Ramos-García
- Canary Islands Health Research Institute Foundation, 38320 Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Santa Cruz de Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
| | | | - Daniel Bejarano-Quisoboni
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Center for Public Health Research (CSISP-FISABIO), 46020 Valencia, Spain
- Institute of Biomedical Technologies, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain
| | - María M. Trujillo-Martín
- Canary Islands Health Research Institute Foundation, 38320 Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Santa Cruz de Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Institute of Biomedical Technologies, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain
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Cheng P, Wang L, Xu L, Zhou Y, Zhao G, Zhang L, Li W. Factors related to the length of stay for major depressive disorder patients in China: A real-world retrospective study. Front Public Health 2022; 10:892133. [PMID: 35968457 PMCID: PMC9372622 DOI: 10.3389/fpubh.2022.892133] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background As numerous patients with depression have to be hospitalized because of various reasons, the demand far exceeds the limited bed count in the psychiatry department. Controlling the length of stay (LOS) of the patient is gradually being considered an effective method to alleviate this problem. Given the lack of statistical evidence of the LOS of patients with major depressive disorder (MDD) in China and the strain on the limited psychiatric resources, the purpose of our study was to investigate the LOS of patients with MDD among in-patient samples and to analyze related factors of the LOS in China by building a regression model. Method The data were exported from the electronic medical record system. A total of three categories of independent variables were enrolled in our study, namely, demographic, clinical, and biochemical. Univariate analysis and binominal regression analysis were applied comprehensively to find the factors related to the LOS among MDD samples. The discrimination accuracy of the model was evaluated by the receiver operating characteristic (ROC) analysis. ROC analysis indicated that the discrimination accuracy of our model was acceptable (AUC = 0.790, 95% CI = 0.714–0.865, P < 0.001). Result A total of 254 patients were finally brought into analysis after filtering. Regression analysis indicated that abnormal LDL was the only risk factor of long LOS (OR = 3.352, 95% CI = 1.087–10.337, P = 0.035) among all the kinds of variables. Notably, in the statistically irrelevant factors of the LOS, the category of anti-depressant drugs [serotonin–norepinephrine reuptake inhibitor (SNRI) or selective serotonin reuptake inhibitor (SSRI)] prescribed to patients with MDD was not associated statistically with the LOS, which was against our initial hypothesis that the LOS of patients with MDD treated with SNRI would vary from that of the patients treated with SSRI. Conclusion Up to our knowledge, our research is the first study to show the potential factors related to the LOS from various domains, especially biochemical indexes, and the effect of drugs, among clinical patients with MDD in China. Our results could provide a theoretical reference for efficient psychiatry hospitalization management and prioritization of allocating medical resources. Future studies are required for updating independent variables which are potentially related to the LOS and verifying existing results in a larger sample.
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Affiliation(s)
- Peng Cheng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lirong Wang
- Xiangya School of Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Lizhi Xu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Guangju Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Li Zhang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Weihui Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Weihui Li
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Marasine NR, Sankhi S, Lamichhane R. Impact of Pharmacist Intervention on Medication Adherence and Patient-Reported Outcomes among Depressed Patients in a Private Psychiatric Hospital of Nepal: a randomised controlled trial. Hosp Pharm 2022; 57:26-31. [PMID: 35521002 PMCID: PMC9065529 DOI: 10.1177/0018578720970465] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Aim: We aimed to evaluate the impact of pharmaceutical service intervention on medication adherence and patient-reported outcomes among patients diagnosed with depression in a private psychiatric hospital in Nepal. Methods: A single-center, open trial with a parallel design was conducted among 18 to 65 years aged patients, diagnosed with depression and under antidepressant medication(s) for ≥2 months. Patients were randomised into either the intervention or control group. The control group (n = 98) received the usual care, while the intervention group (n = 98) received a pharmaceutical service intervention. The two groups were compared using the Mann-Whitney U test, independent t-test, or chi-square test at 2 and 4 months for changes in medication adherence and patient-reported [severity of depression and health-related quality of life (HRQoL)] outcomes. Results: One hundred ninety adult patients were enrolled in the study. At baseline, there were no significant differences in any of the outcome measures between the intervention and control groups. At 2 and 4 months, the intervention group had a significant improvement only in medication adherence (P < .001) compared with the control group [MGL score: 1 (2) vs 2 (2) and 1 (1) vs 2 (1), P < .001, respectively]. Conclusion: Our study suggests that a brief pharmaceutical service intervention in the hospital setting can have a significant impact on patients' adherence to antidepressants but does not improve their severity of depression and HRQoL.
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Affiliation(s)
- Nirmal Raj Marasine
- Pharmaceutical Sciences Program, School of Health and Allied Sciences, Pokhara University, Pokhara-30, Kaski, Nepal,Western Health Science Academy, Pokhara, Kaski, Nepal,Nirmal Raj Marasine, Clinical Pharmacy, School of Health and Allied Sciences, Pokhara University, Pokhara-30, Kaski 33700, Nepal.
| | - Sabina Sankhi
- Pharmaceutical Sciences Program, School of Health and Allied Sciences, Pokhara University, Pokhara-30, Kaski, Nepal
| | - Rajendra Lamichhane
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
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Leiz M, Pfeuffer N, Rehner L, Stentzel U, van den Berg N. Telemedicine as a Tool to Improve Medicine Adherence in Patients with Affective Disorders - A Systematic Literature Review. Patient Prefer Adherence 2022; 16:3441-3463. [PMID: 36605330 PMCID: PMC9809413 DOI: 10.2147/ppa.s388106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/17/2022] [Indexed: 12/31/2022] Open
Abstract
Affective disorders are a common psychological impairment. A major problem with respect to treatment is medication non-adherence. eHealth interventions are already widely used in the treatment of patients living with affective disorders. The aim of this systematic literature review is to obtain the current scientific evidence to eHealth as a tool to improve medication adherence in patients with affective disorders. A systematic search was performed across PubMed, Cochrane Library, Web of Science and PsycInfo. Studies in English and German published between 2007 and 2020 were included. The review followed the PRISMA guidelines and were performed with the CADIMA online tool. A total of 17 articles were included in this review. Eleven studies were randomized controlled trials, two were controlled clinical trials, and four had a pre-/post-design. Three different types of interventions could be identified: internet-based self-management programs (n=4), multi-faceted interventions addressing different dimensions of medication adherence (n=4), and single-faceted interventions (n=9) comprising four mobile interventions and five telehealth interventions. Eleven interventions addressed patients with (comorbid) depressions and six addressed patients with bipolar disorders. Six interventions showed a statistically significant positive effect on medication adherence. None of the studies showed a statistically significant negative effect. All interventions which had a statistically significant positive effect on medication adherence involved personal contacts between therapists and patients. All included eHealth interventions are at least as effective as control conditions and seems to be effective for patients with depression as well as with bipolar disorders. Personal contacts seem to improve the effectiveness of eHealth interventions. eHealth interventions are an effective way to improve medication adherence in patients with affective disorders. In rural or underserved regions, eHealth can supplement usual care interventions on medication adherence by expanding access. More analyses are needed in order to understand determinants for the effectiveness of eHealth interventions on medication adherence enhancement.
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Affiliation(s)
- Maren Leiz
- Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - Nils Pfeuffer
- Institute for Community Medicine, University Medicine, Greifswald, Germany
- Correspondence: Nils Pfeuffer, Institute for Community Medicine, Ellernholzstr. 1–2, Greifswald, 17487, Germany, Tel +49 3834 / 86 76 18, Email
| | - Laura Rehner
- Institute for Nursing Science and Interprofessional Learning, University Medicine, Greifswald, Germany
| | - Ulrike Stentzel
- Institute for Community Medicine, University Medicine, Greifswald, Germany
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Roth CB, Papassotiropoulos A, Brühl AB, Lang UE, Huber CG. Psychiatry in the Digital Age: A Blessing or a Curse? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8302. [PMID: 34444055 PMCID: PMC8391902 DOI: 10.3390/ijerph18168302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022]
Abstract
Social distancing and the shortage of healthcare professionals during the COVID-19 pandemic, the impact of population aging on the healthcare system, as well as the rapid pace of digital innovation are catalyzing the development and implementation of new technologies and digital services in psychiatry. Is this transformation a blessing or a curse for psychiatry? To answer this question, we conducted a literature review covering a broad range of new technologies and eHealth services, including telepsychiatry; computer-, internet-, and app-based cognitive behavioral therapy; virtual reality; digital applied games; a digital medicine system; omics; neuroimaging; machine learning; precision psychiatry; clinical decision support; electronic health records; physician charting; digital language translators; and online mental health resources for patients. We found that eHealth services provide effective, scalable, and cost-efficient options for the treatment of people with limited or no access to mental health care. This review highlights innovative technologies spearheading the way to more effective and safer treatments. We identified artificially intelligent tools that relieve physicians from routine tasks, allowing them to focus on collaborative doctor-patient relationships. The transformation of traditional clinics into digital ones is outlined, and the challenges associated with the successful deployment of digitalization in psychiatry are highlighted.
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Affiliation(s)
- Carl B. Roth
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Andreas Papassotiropoulos
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Birmannsgasse 8, CH-4055 Basel, Switzerland
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, CH-4055 Basel, Switzerland
- Biozentrum, Life Sciences Training Facility, University of Basel, Klingelbergstrasse 50/70, CH-4056 Basel, Switzerland
| | - Annette B. Brühl
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Undine E. Lang
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Christian G. Huber
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
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Eshtehardi SS, Taylor AA, Chen TA, de Dios MA, Correa-Fernández V, Kendzor DE, Businelle MS, Reitzel LR. Sociodemographic Determinants of Nonadherence to Depression and Anxiety Medication among Individuals Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157958. [PMID: 34360251 PMCID: PMC8345659 DOI: 10.3390/ijerph18157958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/11/2021] [Accepted: 07/27/2021] [Indexed: 12/03/2022]
Abstract
Psychiatric medication nonadherence continues to be a leading cause of poor health outcomes for individuals experiencing homelessness. Identifying the sociodemographic factors that contribute to medication nonadherence may help guide strategies to care for and support this group. This study examined 200 adults with depression diagnoses and active anti-depressant prescriptions (Mage = 43.98 ± 12.08, 59.4% Caucasian, 58.5% male, 70% uninsured, 89.5% unemployed) and 181 adults with anxiety diagnoses and active anti-anxiety prescriptions (Mage = 43.45 ± 11.02, 54.4% Caucasian, 57.5% male, 66.3% uninsured, 88.9% unemployed) recruited from six homeless-serving agencies in Oklahoma City. Self-reported sociodemographic variables included: age, sex, race/ethnicity, education, monthly income, employment status, and health insurance status. Adjusted logistic regression analyses revealed that employed (OR = 4.022, CI0.95: 1.244–13.004) and insured (OR = 2.923, CI0.95: 1.225–6.973) participants had greater odds of depression medication nonadherence. For anxiety, being employed (OR = 3.573, CI0.95: 1.160–11.010) was associated with greater odds of anxiety medication nonadherence, whereas having depression and anxiety diagnostic comorbidity (OR = 0.333, CI0.95: 0.137–0.810) was associated with lower odds of anxiety medication nonadherence. Interventions aimed at facilitating accessible prescription acquisition or otherwise reducing barriers to prescription medications for employed adults, including those with health insurance, may benefit adherence, but more research is needed. Future studies would benefit from using a qualitative approach to better delineate nuanced barriers to psychiatric medication adherence.
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Affiliation(s)
- Sahar S. Eshtehardi
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
| | - Ashley A. Taylor
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
| | - Tzuan A. Chen
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Marcel A. de Dios
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma, OK 73104, USA; (D.E.K.); (M.S.B.)
| | - Michael S. Businelle
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma, OK 73104, USA; (D.E.K.); (M.S.B.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
- Correspondence: ; Tel.: +1-713-743-6679
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10
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Verma S, Agrawal R. Psychotropic Medication Adherence in Children and Adolescents. South Med J 2021; 114:388-394. [PMID: 34215889 DOI: 10.14423/smj.0000000000001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Researchers believe that almost 20% of children and adolescents struggle with chronic and persistent mental health concerns. Mental health is the leading cause of disability in the United States. Youth can struggle with several impairing mental health disorders, such as attention-deficit/hyperactivity disorder, mood disorders, psychotic disorders, and autism spectrum disorder. Inadequately treated chronic mental illnesses can adversely affect the growing brain profoundly, including academic decline, early school dropout, cognitive deficits, interpersonal relationship concerns, aggression, suicide attempts or completion, substance use disorders, frequent hospital admissions, and inability to maintain employment. Even if diagnosed early in their course of illness, many of these individuals struggle to continue medications as prescribed. The factors predicting adherence to medications are underresearched in children and adolescents. Psychotropic medication compliance is a complicated issue that is tied to various aspects of caring for a minor individual. Hence, it is relevant to discuss factors that are predicted to contribute to noncompliance in this age group. The purpose of this review is to carefully consider the gaps in knowledge, suggesting interventions by using established instruments and clinical strategies to resolve the identified barriers for improving medication adherence. Compliance should be targeted at various levels, including the entire family tree and the treatment team.
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Affiliation(s)
- Shikha Verma
- From Evolve Treatment Center-PC, Danville, California, and Centerstone of Kentucky, Louisville
| | - Ruchita Agrawal
- From Evolve Treatment Center-PC, Danville, California, and Centerstone of Kentucky, Louisville
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11
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Geiger CK, Cohen JL, Sommers BD. Association Between Medicaid Prescription Drug Limits and Access to Medications and Health Care Use Among Young Adults With Disabilities. JAMA HEALTH FORUM 2021; 2:e211048. [PMID: 35977173 PMCID: PMC8796920 DOI: 10.1001/jamahealthforum.2021.1048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/17/2021] [Indexed: 11/22/2022] Open
Abstract
Question Are policies that cap monthly prescriptions in Medicaid associated with access to medication and health care use among young adults with disabilities in Arkansas and Texas? Findings In this cohort study using difference-in-differences analysis of 28 046 young adults with disabilities, including 8214 in states with a 3-drug limit at age 21 years, the 3-drug limit was associated with lower monthly prescriptions for medications used to treat mental health conditions and higher inpatient admissions among all individuals with disabilities in states with the drug cap policy compared with those in states without this policy. Meaning In this study, state drug cap policies in Medicaid were associated with lower access to medications and higher use of inpatient care. Importance Prescription drugs are necessary for managing complex physical and mental health conditions for more than 10 million Medicaid beneficiaries with disabilities. However, some state Medicaid programs limit the number of prescription drugs that beneficiaries can obtain monthly, which may decrease access to essential medications. Objective To examine the association between exposure to the 3-drug limit at age 21 years in Arkansas and Texas and prescription drug and health care use among beneficiaries with disabilities enrolled in Medicaid. Design, Setting, and Participants In this cohort study of 28 046 young adults with disabilities, difference-in-differences analysis was performed using Medicaid Analytic eXtract claims data from January 1, 2007, to December 31, 2012. Analyses were completed December 1, 2020. The analyses included Medicaid beneficiaries with disabilities in Arkansas and Texas (ie, drug cap states) or 15 comparison states without drug cap policies who became age 21 years during the study period and were continuously enrolled in fee-for-service Medicaid in the year before and after that point. Exposures Exposure to the 3-drug prescription limit at age 21 years in 2 drug cap states. Main Outcomes and Measures Monthly total prescriptions and prescriptions for drugs to treat mental health conditions, total prescription drug spending, and inpatient and emergency department visits and spending in the 12 months before and after becoming age 21 years. Results Among 28 046 young adults with disabilities, 8214 (29.3%) resided in drug cap states and were subject to the 3-drug limit at age 21 years. Most individuals were male (drug cap states: 61.4%, comparison states: 60.6%), and the minority were White individuals (drug cap states: 36.7%, comparison states: 49.4%). More than one-half of individuals with disabilities were diagnosed with a mental health condition before age 21 years (drug cap states: 57.0%, comparison states: 60.0%). In the year before the analyzed individuals became aged 21 years, the mean (SD) number of prescriptions per beneficiary per month was 1.58 (2.16) in drug cap states vs 1.82 (1.91) in comparison states. The drug cap policy was associated with 19.6% (95% CI, −21.3% to −17.8%; P < .001) fewer monthly prescriptions and 16.5% (95% CI, −21.9% to −10.8%; P < .001) fewer prescriptions for drugs for mental health conditions but was not associated with total prescription drug spending. The drug cap policy was associated with 13.6% (95% CI, 1.9% to 26.6%; P = .02) more inpatient admissions. Conclusions and Relevance In this cohort study of young adults with disabilities, drug cap policies were associated with lower rates of access to important medications and higher rates of hospitalization among individuals in states with drug cap policies vs those without these policies.
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Affiliation(s)
- Caroline K. Geiger
- Harvard University, Interfaculty Initiative in Health Policy, Cambridge, Massachusetts
- Genentech, Inc, South San Francisco, California
| | - Jessica L. Cohen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Benjamin D. Sommers
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Harvard Medical School/Brigham & Women’s Hospital, Boston, Massachusetts
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12
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Framer A. What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications. Ther Adv Psychopharmacol 2021; 11:2045125321991274. [PMID: 33796265 PMCID: PMC7970174 DOI: 10.1177/2045125321991274] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 01/08/2021] [Indexed: 12/22/2022] Open
Abstract
Although psychiatric drug withdrawal syndromes have been recognized since the 1950s - recent studies confirm antidepressant withdrawal syndrome incidence upwards of 40% - medical information about how to safely go off the drugs has been lacking. To fill this gap, over the last 25 years, patients have developed a robust Internet-based subculture of peer support for tapering off psychiatric drugs and recovering from withdrawal syndrome. This account from the founder of such an online community covers lessons learned from thousands of patients regarding common experiences with medical providers, identification of adverse drug reactions, risk factors for withdrawal, tapering techniques, withdrawal symptoms, protracted withdrawal syndrome, and strategies to cope with symptoms, in the context of the existing scientific literature.
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Affiliation(s)
- Adele Framer
- SurvivingAntidepressants.org, San Francisco,
California, USA
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13
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Zisman-Ilani Y, Hurford I, Bowen A, Salzer M, Thomas EC. Evaluating the feasibility of a decision aid to promote shared decision making among young adults with first-episode psychosis: protocol for a pilot study. Pilot Feasibility Stud 2021; 7:22. [PMID: 33431018 PMCID: PMC7798319 DOI: 10.1186/s40814-020-00757-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Young adults ages 18 to 25 with first episode psychosis (FEP) have an increased risk of discontinuation antipsychotic medications and psychiatric service disengagement that lead to symptom exacerbation and deterioration. We seek to (1) examine the feasibility, usability, and potential impact of a Shared Decision Making (SDM) Antipsychotic Medication Decision Aid (DA) on decision-making, adherence to the decision made, and service engagement among young adults with FEP and (2) understand the role of additional patient-level factors on SDM. METHODS A randomized controlled trial is being conducted in a coordinated specialty care community program for FEP in an urban setting. Eligible patients are randomly assigned to receive an intervention, the Antipsychotic Medication Decision Aid, or treatment as usual. Patients receive their assigned intervention before their medication appointment with the psychiatrist and complete four interviews: before the appointment (T0), after the appointment (T1), and at 3- and 6-month follow-ups (T2 and T3). The study staff and participating psychiatrists are not blinded to the intervention. The data are de-identified to maintain blinding during the analysis process. The primary aims are feasibility of intervention delivery and research procedures and preliminary impact of the intervention on SDM-related outcomes, medication adherence, and service engagement. As a secondary aim, we will explore the contribution of personality and motivation variables, clinical relationships, cognitive functioning, and mental-health-related stigma to SDM. If the sample size permits, we plan to conduct parametric tests such as independent-samples t tests at T1 to compare differences in SDM, adherence, and engagement scales. In the case of a small sample size, we will use non-parametric tests and descriptive statistics. DISCUSSION This protocol outlines the methodology for a feasibility pilot comparing the effect of a novel SDM Antipsychotic Medication encounter DA with treatment as usual on SDM, medication adherence, and service engagement in FEP care. SDM is endorsed as a framework for use in FEP and antipsychotic pharmacotherapy, but its impact on adherence and health outcomes is unclear. Understanding the potential contribution of an SDM Antipsychotic Medication DA compared with usual care in psychosis pharmacotherapy is critical. The study will help answer several key questions new to SDM research, including the contribution of personality and clinical relationships to SDM in mental health and psychosis in particular. The study will serve to gather feasibility data to inform future studies and scale-up. TRIAL REGISTRATION Ethics approval was obtained through Temple University's institutional review board (IRB) and the City of Philadelphia's Department of Public Health IRB. The study has been retrospectively registered with ClinicalTrials.gov as NCT04373590 on 29 April 2020. https://clinicaltrials.gov/ct2/show/NCT04373590?term=NCT04373590&draw=2&rank=1.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Science, College of Public Health, Temple University, Philadelphia, PA, USA.
| | - Irene Hurford
- Psychosis Education, Assessment, Care and Empowerment (PEACE), Horizon House, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea Bowen
- Psychosis Education, Assessment, Care and Empowerment (PEACE), Horizon House, Philadelphia, PA, USA
| | - Mark Salzer
- Department of Social and Behavioral Science, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Elizabeth C Thomas
- Department of Social and Behavioral Science, College of Public Health, Temple University, Philadelphia, PA, USA
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14
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Silvia RJ, Lee KC, Bostwick JR, Cobb CD, Goldstone LW, Moore TD, Payne GH, Ho JL. Assessment of the current practice of psychiatric pharmacists in the United States. Ment Health Clin 2020; 10:346-353. [PMID: 33224692 PMCID: PMC7653732 DOI: 10.9740/mhc.2020.11.346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction A comprehensive review of psychiatric pharmacy practice has never been performed in the United States. As psychiatric pharmacists become more involved in mental illness treatment, determining the current state of practice is important to help advance the specialty. The Professional Affairs Committee of the College of Psychiatric and Neurologic Pharmacists (CPNP) was charged with performing this review to define current psychiatric pharmacy practice. Methods An electronic survey was sent to all pharmacist members of CPNP and all nonmember Board Certified Psychiatric Pharmacists (BCPPs) in the United States in late summer 2019. The survey consisted of 36 questions across multiple domains to obtain information about respondents' education and training background, practice setting and type, and information about prescriptive authority and other areas. An initial e-mail invitation was sent along with 2 reminder e-mails over the subsequent 2 weeks. Results A total of 334 of 1015 pharmacists completed the survey (32.9%). Responders completed a postgraduate residency 77.8% of the time, and 88.3% were BCPP. Practice settings were split evenly between inpatient and outpatient practices or a combination of the 2. Among respondents, 46.5% reported having prescriptive authority as part of their practice, and 41.3% reported treating nonpsychiatric as well as psychiatric illnesses. Prescriptive authority was more likely in outpatient practices and in those treating nonpsychiatric illnesses. Discussion The current practice of psychiatric pharmacy is incredibly varied in terms of practice setting, activities performed, and services provided. Further exploration is needed to help determine the optimal role of psychiatric pharmacists.
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Affiliation(s)
- Richard J Silvia
- Professor of Clinical Pharmacy, University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California.,Clinical Professor, University of Michigan College of Pharmacy, Ann Arbor, Michigan.,Psychiatric Pharmacist, Capita Consulting, Billings, Montana.,Associate Professor of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California.,National Pharmacy Benefits Management Program Manager, Clinical Practice Integration and Model Advancement, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC.,Technology Director, College of Psychiatric and Neurologic Pharmacists, Lincoln, Nebraska.,Clinical Pharmacy Specialist (Psychiatry), Kaiser Permanente of the Mid-Atlantic States, Burke, Virginia
| | - Kelly C Lee
- Professor of Clinical Pharmacy, University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California
| | - Jolene R Bostwick
- Clinical Professor, University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Carla D Cobb
- Psychiatric Pharmacist, Capita Consulting, Billings, Montana
| | - Lisa W Goldstone
- Associate Professor of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California
| | - Tera D Moore
- National Pharmacy Benefits Management Program Manager, Clinical Practice Integration and Model Advancement, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Gregory H Payne
- Technology Director, College of Psychiatric and Neurologic Pharmacists, Lincoln, Nebraska
| | - Jessica L Ho
- Clinical Pharmacy Specialist (Psychiatry), Kaiser Permanente of the Mid-Atlantic States, Burke, Virginia
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15
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Hendrickson RC, Thomas RG, Schork NJ, Raskind MA. Optimizing Aggregated N-Of-1 Trial Designs for Predictive Biomarker Validation: Statistical Methods and Theoretical Findings. Front Digit Health 2020; 2:13. [PMID: 34713026 PMCID: PMC8521797 DOI: 10.3389/fdgth.2020.00013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022] Open
Abstract
Background and Significance: Parallel-group randomized controlled trials (PG-RCTs) are the gold standard for detecting differences in mean improvement across treatment conditions. However, PG-RCTs provide limited information about individuals, making them poorly optimized for quantifying the relationship of a biomarker measured at baseline with treatment response. In N-of-1 trials, an individual subject moves between treatment conditions to determine their specific response to each treatment. Aggregated N-of-1 trials analyze a cohort of such participants, and can be designed to optimize both statistical power and clinical or logistical constraints, such as allowing all participants to begin with an open-label stabilization phase to facilitate the enrollment of more acutely symptomatic participants. Here, we describe a set of statistical simulation studies comparing the power of four different trial designs to detect a relationship between a predictive biomarker measured at baseline and subjects' specific response to the PTSD pharmacotherapeutic agent prazosin. Methods: Data was simulated from 4 trial designs: (1) open-label; (2) open-label + blinded discontinuation; (3) traditional crossover; and (4) open label + blinded discontinuation + brief crossover (the N-of-1 design). Designs were matched in length and assessments. The primary outcome, analyzed with a linear mixed effects model, was whether a statistically significant association between biomarker value and response to prazosin was detected with 5% Type I error. Simulations were repeated 1,000 times to determine power and bias, with varied parameters. Results: Trial designs 2 & 4 had substantially higher power with fewer subjects than open label design. Trial design 4 also had higher power than trial design 2. Trial design 4 had slightly lower power than the traditional crossover design, although power declined much more rapidly as carryover was introduced. Conclusions: These results suggest that an aggregated N-of-1 trial design beginning with an open label titration phase may provide superior power over open label or open label and blinded discontinuation designs, and similar power to a traditional crossover design, in detecting an association between a predictive biomarker and the clinical response to the PTSD pharmacotherapeutic prazosin. This is achieved while allowing all participants to spend the first 8 weeks of the trial on open-label active treatment.
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Affiliation(s)
- Rebecca C Hendrickson
- VISN 20 Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Ronald G Thomas
- Department of Biostatistics, University of California, San Diego, San Diego, CA, United States
| | - Nicholas J Schork
- Quantitative Medicine and Systems Biology, The Translational Genomics Research Institute (TGen), Phoenix, AZ, United States.,The Joint City of Hope/TGen IMPACT Center (NJS), City of Hope National Medical Center, Duarte, CA, United States
| | - Murray A Raskind
- VISN 20 Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
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16
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Migoya-Borja M, Delgado-Gómez D, Carmona-Camacho R, Porras-Segovia A, López-Moriñigo JD, Sánchez-Alonso M, Albarracín García L, Guerra N, Barrigón ML, Alegría M, Baca-García E. Feasibility of a Virtual Reality-Based Psychoeducational Tool (VRight) for Depressive Patients. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2020; 23:246-252. [DOI: 10.1089/cyber.2019.0497] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Marta Migoya-Borja
- Department of Psychiatry, University Hospital Jimenez Díaz Foundation, Madrid, Spain
| | | | | | | | | | | | | | - Nuria Guerra
- Department of Psychiatry, University Hospital Jimenez Díaz Foundation, Madrid, Spain
| | - María Luisa Barrigón
- Department of Psychiatry, University Hospital Jimenez Díaz Foundation, Madrid, Spain
- Department of Psychiatry, Madrid Autonomous University, Madrid, Spain
| | - Margarita Alegría
- Massachusetts General Hospital, Disparities Research Unit and Harvard Medical School, Boston, Massachusetts
| | - Enrique Baca-García
- Department of Psychiatry, University Hospital Jimenez Díaz Foundation, Madrid, Spain
- Department of Psychiatry, Madrid Autonomous University, Madrid, Spain
- Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain
- Department of Psychiatry, General Hospital of Villalba, Madrid, Spain
- Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain
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17
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Tamblyn R, Bates DW, Buckeridge DL, Dixon WG, Girard N, Haas JS, Habib B, Iqbal U, Li J, Sheppard T. Multinational Investigation of Fracture Risk with Antidepressant Use by Class, Drug, and Indication. J Am Geriatr Soc 2020; 68:1494-1503. [PMID: 32181493 PMCID: PMC7383967 DOI: 10.1111/jgs.16404] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Antidepressants increase the risk of falls and fracture in older adults. However, risk estimates vary considerably even in comparable populations, limiting the usefulness of current evidence for clinical decision making. Our aim was to apply a common protocol to cohorts of older antidepressant users in multiple jurisdictions to estimate fracture risk associated with different antidepressant classes, drugs, doses, and potential treatment indications. DESIGN Retrospective (2009–2014) cohort study. SETTING Five jurisdictions in the United States, Canada, United Kingdom, and Taiwan. PARTICIPANTS Older antidepressant users—subjects were followed from first antidepressant prescription or dispensation to first fracture or until the end of follow‐up. MEASUREMENTS The risk of fractures with antidepressants was estimated by multivariable Cox proportional hazards models using time‐varying measures of antidepressant dose and use vs nonuse, adjusting for patient characteristics. RESULTS Between 42.9% and 55.6% of study cohorts were 75 years and older, and 29.3% to 45.4% were men. Selective serotonin reuptake inhibitors (SSRIs) (48.4%‐60.0%) were the predominant class used in North America compared with tricyclic antidepressants (TCAs) in the United Kingdom and Taiwan (49.6%‐53.6%). Fracture rates varied from 37.67 to 107.18 per 1,000. The SSRIs citalopram (hazard ratio [HR] = 1.23; 95% confidence interval [CI] = 1.11‐1.36 to HR = 1.43; 95% CI = 1.11‐1.84) and sertraline (HR = 1.36; 95% CI = 1.10‐1.68), the SNRI duloxetine (HR = 1.41; 95% CI = 1.06‐1.88), TCAs doxepin (HR = 1.36; 95% CI = 1.00‐1.86) and imipramine (HR = 1.16; 95% CI = 1.05‐1.28), and atypicals (HR = 1.34; 95% CI = 1.14‐1.58) increased fracture risk in some but not all jurisdictions. In the United States and the United Kingdom, fracture risk with all classes was higher when prescribed for depression than chronic pain, a trend that is likely explained by drug choice. CONCLUSION The fracture risk for patients may be reduced by selecting paroxetine, an SSRI with lower risk than citalopram, the SNRI venlafaxine over duloxetine, and the TCA amitriptyline over imipramine or doxepin. There is uncertainty about the risk associated with the atypical antidepressants. J Am Geriatr Soc 68:1494‐1503, 2020.
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Affiliation(s)
- Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | | | - David L Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - William G Dixon
- Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Nadyne Girard
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | | | - Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - Usman Iqbal
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Master's Program in Global Health and Development, PhD Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Jack Li
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, Taipei Wanfang Hospital, Taipei, Taiwan
| | - Therese Sheppard
- Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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18
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Conley VM, Daack-Hirsch S, Halbmaier K, Shaw L. Bringing Personalized Medicine to a PACT Program: A Quality Improvement Project. J Am Psychiatr Nurses Assoc 2020; 26:77-85. [PMID: 30688546 DOI: 10.1177/1078390319826687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION: Programs for assertive community treatment (PACT) serve persons with severe mental illness who have been unsuccessful with traditional outpatient services. Many PACT clients struggle to obtain symptom relief with medications that often have poor efficacy and undesired side effects, which can result in nonadherence, relapse, and increased health care utilization with associated costs. AIMS: This quality improvement project aimed to improve client and PACT program outcomes by incorporating pharmacogenomic testing into the psychopharmacological decision-making process. METHODS: The project used a pre-posttest design with each client serving as their own control to evaluate changes in clients' symptoms and program outcomes resulting from pharmacogenomics-guided medication management. RESULTS: Following project implementation, clients' symptoms were decreased and both engagement in care and stability in the community increased. Psychiatric hospitalizations and associated costs decreased. CONCLUSIONS: This project suggests utility for using pharmacogenomics testing to personalize care for persons with severe mental illness.
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Affiliation(s)
- Virginia M Conley
- Virginia M. Conley, PhD, ARNP, FNP-BC, PMHNP-BC, FAANP, The University of Iowa, Iowa City, IA, USA; Eyerly Ball Community Mental Health Services, Des Moines, IA, USA
| | | | - Katie Halbmaier
- Katie Halbmaier, DNP, ARNP, FNP-BC, The University of Iowa, Iowa City, IA, USA
| | - Lisa Shaw
- Lisa Shah, PhD, RN, University of Pittsburg, Pittsburg, PA, USA
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19
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De las Cuevas C, de Leon J. Self-Report for Measuring and Predicting Medication Adherence: Experts' Experience in Predicting Adherence in Stable Psychiatric Outpatients and in Pharmacokinetics. Patient Prefer Adherence 2020; 14:1823-1842. [PMID: 33116427 PMCID: PMC7555336 DOI: 10.2147/ppa.s242693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/25/2020] [Indexed: 12/18/2022] Open
Abstract
THE PROBLEM Poor adherence to appropriately prescribed medication is a global challenge for psychiatrists. PRIOR STUDIES Measuring adherence is complicated. In our recent three-country naturalistic study including more than 1000 patients and their adherence to multiple medication prescriptions at the same time, patients' self-report of adherence to each specific drug was the only practical option for measuring adherence. Systematic literature reviews provide inconsistent results for sociodemographic, clinical and medication variables as predictors of adherence to psychiatric drugs. Our studies over the last 10 years in relatively stable psychiatric outpatients have shown that some self-reported health beliefs had consistent, strong effects and a better predictive role. Three dimensions of these health beliefs are characteristics of the individual: 1) attitudes toward psychiatric medication such as pharmacophobia (fear of taking drugs or medicines), 2) health locus of control (the belief patients have about who or what agent determines the state of their health), 3) psychological reactance (an emotional reaction in direct contradiction to rules or regulations that threaten or suppress certain freedoms in behavior). They can be measured by the Patient Health Beliefs Questionnaire on Psychiatric Treatment. The attitude toward each specific medication can be measured by the necessity-concern framework and summarized as the presence or absence of skepticism about that drug. After 25 years conducting pharmacokinetic studies in psychiatric drugs, particularly antipsychotics, we have limited understanding of how to use blood levels to predict the effects of non-adherence or to establish it. EXPERT OPINION ON FUTURE STUDIES Future studies to predict adherence should include the inpatient setting and explore insight. Studying the pharmacokinetics associated with non-adherence in each psychiatric drug is a major challenge. Medication adherence is a complex and dynamic process changing over time in the same patient. Personalizing adherence using psychological or pharmacological variables are in their initial stages.
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Affiliation(s)
- Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, University of La Laguna, San Cristóbal de La Laguna, Canary Islands, Spain
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Correspondence: Carlos De las CuevasDepartment of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna,, Campus de Ofra s/n, San Cristóbal de La Laguna, Canary Islands, SpainTel +34-922-316502Fax +34-922-319353 Email
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
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20
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van Haaften KA, Grigg EK, Kolus C, Hart L, Kogan LR. A survey of dog owners’ perceptions on the use of psychoactive medications and alternatives for the treatment of canine behavior problems. J Vet Behav 2020. [DOI: 10.1016/j.jveb.2019.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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21
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Moreno-Pino F, Porras-Segovia A, López-Esteban P, Artés A, Baca-García E. Validation of Fitbit Charge 2 and Fitbit Alta HR Against Polysomnography for Assessing Sleep in Adults With Obstructive Sleep Apnea. J Clin Sleep Med 2019; 15:1645-1653. [PMID: 31739855 PMCID: PMC6853383 DOI: 10.5664/jcsm.8032] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Consumer wearable devices may be a helpful method of assessing sleep, but validation is required for their use in clinical practice. Our aim was to validate two models of Fitbit sleep trackers that rely on both accelerometer and heart rate sensors against polysomnography in participants with obstructive sleep apnea (OSA). METHODS Participants were adults presenting with symptoms of OSA and attending our outpatient sleep clinic. A polysomnography (PSG) was applied to all participants at the same time they were wearing a Fitbit sleep tracker. Using paired t tests and Bland-Altman plots, we compared the sleep measures provided by the wearable devices with those obtained by PSG. Since Fitbit devices' automatic detection of sleep start time can cause bias, we performed a correction using Huber loss function-based linear regression and a leave-one-out strategy. RESULTS Our sample consisted of 65 patients. Diagnosis of OSA was confirmed on 55 (84.6%). There were statistically significant differences between PSG and Fitbit measures for all sleep outcomes but rapid eye movement sleep. Fitbit devices overestimated total sleep time, and underestimated wake after sleep onset and sleep onset latency. After correction of bias, Fitbit-delivered measures of sleep onset latency did not significantly differ of those provided by PSG. CONCLUSIONS Fitbit wearable devices showed an acceptable sensitivity but poor specificity. Consumer sleep trackers still have insufficient accuracy for clinical settings, especially in clinical populations. Solving technical issues and optimizing clinically-oriented features could make them apt for their use in clinical practice in a nondistant future.
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Affiliation(s)
- Fernando Moreno-Pino
- Universidad Carlos III de Madrid, Leganés, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- *Contributed equally
| | - Alejandro Porras-Segovia
- Universidad Carlos III de Madrid, Leganés, Spain
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain
- International School for Postgraduate Studies, University of Granada, Granada, Spain
| | | | - Antonio Artés
- Universidad Carlos III de Madrid, Leganés, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Enrique Baca-García
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain
- Department of Psychiatry, Madrid Autonomous University, Madrid, Spain
- Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain
- Department of Psychiatry, General Hospital of Villalba, Madrid, Spain
- Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain
- Universidad Catolica del Maule, Talca, Chile
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22
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Walter KH, Otis NP, Glassman LH, Ray TN, Michalewicz-Kragh B, Kobayashi Elliott KT, Thomsen CJ. Comparison of surf and hike therapy for active duty service members with major depressive disorder: Study protocol for a randomized controlled trial of novel interventions in a naturalistic setting. Contemp Clin Trials Commun 2019; 16:100435. [PMID: 31485546 PMCID: PMC6717066 DOI: 10.1016/j.conctc.2019.100435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/31/2019] [Accepted: 08/19/2019] [Indexed: 01/04/2023] Open
Abstract
Many active duty service members suffer from major depressive disorder (MDD). Although traditional treatments exist, alternative approaches may also be effective in treating depressive symptoms. Previous research has shown that physical activity has significant positive effects on depression symptoms in individuals with MDD, and that these benefits may be enhanced when physical activity occurs in a natural environment. Even though physical activity (i.e., hiking, walking) in natural environments has been shown to reduce depressive symptoms, water-based activity occurring in a natural environment (e.g., surfing) may produce even greater improvements in depressive symptoms. We detail an ongoing randomized controlled trial (RCT) comparing the efficacy of surf therapy and hike therapy with respect to immediate and longer-term psychological, physical, and functional outcomes in active duty service members with MDD. We describe the methodological development of this RCT evaluating novel treatment approaches and discuss considerations for evaluating physical activity interventions in a naturalistic setting.
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Affiliation(s)
- Kristen H Walter
- Leidos, 140 Sylvester Road, San Diego, CA, 92106-3521, United States.,Health and Behavioral Sciences Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, United States
| | - Nicholas P Otis
- Leidos, 140 Sylvester Road, San Diego, CA, 92106-3521, United States.,Health and Behavioral Sciences Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, United States
| | - Lisa H Glassman
- Leidos, 140 Sylvester Road, San Diego, CA, 92106-3521, United States.,Health and Behavioral Sciences Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, United States
| | - Travis N Ray
- Leidos, 140 Sylvester Road, San Diego, CA, 92106-3521, United States.,Health and Behavioral Sciences Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, United States
| | | | | | - Cynthia J Thomsen
- Health and Behavioral Sciences Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, United States
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Irigoyen M, Porras-Segovia A, Galván L, Puigdevall M, Giner L, De Leon S, Baca-García E. Predictors of re-attempt in a cohort of suicide attempters: A survival analysis. J Affect Disord 2019; 247:20-28. [PMID: 30640026 DOI: 10.1016/j.jad.2018.12.050] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/07/2018] [Accepted: 12/16/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Suicide prevention is one of the greatest challenges in mental health policies. Since a previous suicide attempt is the main predictor of future suicidal behaviour, clinical management of suicide attempters is vital for lowering mortality. Psychopharmacological interventions are still nonspecific, and their effectiveness have often been questioned. In this study, we aim to identify predictors of suicide re-attempt in a cohort of suicide attempters, with particular focus on different aspects of psychopharmacological treatment. METHODS This is a prospective study. Adults presenting with a suicide attempt were approached to take part in our study, resulting in a final sample of 371 participants. Participants were followed from inclusion to next suicide attempt, death by other causes, loss of the patient, or after a maximum of two years. We conducted Kaplan-Meier survival analyses and a multivariate Cox regression model for several exposure variables. RESULTS During the study period, 70 participants (18,9%) re-attempted. 60% of re-attempts occurred within the first 6 months. Three factors were independently associated with risk of re-attempt in the Multivariate Cox regression model: diagnosis of a Cluster B personality disorder, good treatment compliance, and at least one previous suicide attempt prior to the index event. LIMITATIONS Indication bias precludes a clear interpretation of our results regarding psychopharmacological treatment. Poor adherence may also be a consequence of relapse rather than just one of its causes. CONCLUSIONS A correct psychopharmacological treatment is insufficient to prevent re-attempts in populations at risk. Strategies to increase compliance should be taken into account as part of prevention programs.
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Affiliation(s)
- María Irigoyen
- Hospital Universitario Santa María de Lleida, Lérida, Spain; Institut de Recerca Biomèdica de Lleida, Lérida, Spain
| | | | - Leonardo Galván
- Hospital Universitario Santa María de Lleida, Lérida, Spain; Psychiatry Department, Universidad de Lleida, Lérida, Spain
| | | | - Lucas Giner
- Psychiatry Department, Universidad de Sevilla, Sevilla, Spain
| | | | - Enrique Baca-García
- Hospital Universitario Fundación Jiménez-Díaz, Madrid, Spain; Psychiatry Department, Autonoma University of Madrid, Madrid, Spain; Department of Psychiatry, University Hospital Rey Juan Carlos, Madrid, Spain; Department of Psychiatry, General Hospital of Villalba, Madrid, Spain; Department of Psychiatry, University Hospital Infanta Elena, Madrid, Spain; CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain; Universidad Católica del Maule, Talca, Chile.
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24
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Tu TTH, Takenoshita M, Matsuoka H, Watanabe T, Suga T, Aota Y, Abiko Y, Toyofuku A. Current management strategies for the pain of elderly patients with burning mouth syndrome: a critical review. Biopsychosoc Med 2019; 13:1. [PMID: 30733824 PMCID: PMC6357406 DOI: 10.1186/s13030-019-0142-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022] Open
Abstract
Burning Mouth Syndrome (BMS), a chronic intraoral burning sensation or dysesthesia without clinically evident causes, is one of the most common medically unexplained oral symptoms/syndromes. Even though the clinical features of BMS have been astonishingly common and consistent throughout the world for hundreds of years, BMS remains an enigma and has evolved to more intractable condition. In fact, there is a large and growing number of elderly BMS patients for whom the disease is accompanied by systemic diseases, in addition to aging physical change, which makes the diagnosis and treatment of BMS more difficult. Because the biggest barrier preventing us from finding the core pathophysiology and best therapy for BMS seems to be its heterogeneity, this syndrome remains challenging for clinicians. In this review, we discuss currently hopeful management strategies, including central neuromodulators (Tricyclic Antidepressants - TCAs, Serotonin, and Norepinephrine Reuptake Inhibitors - SNRIs, Selective Serotonin Reuptake Inhibitors - SSRIs, Clonazepam) and solutions for applying non-pharmacology approaches. Moreover, we also emphasize the important role of patient education and anxiety management to improve the patients’ quality of life. A combination of optimized medication with a short-term supportive psychotherapeutic approach might be a useful solution.
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Affiliation(s)
- Trang T H Tu
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Miho Takenoshita
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Hirofumi Matsuoka
- 2Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Takeshi Watanabe
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Takayuki Suga
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Yuma Aota
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
| | - Yoshihiro Abiko
- 3Division of Oral Medicine and Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Akira Toyofuku
- 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549 Japan
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25
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De Las Cuevas C, de Leon J. Development and validation of the Patient's Health Belief Questionnaire on Psychiatric Treatment. Patient Prefer Adherence 2019; 13:527-536. [PMID: 31040653 PMCID: PMC6462159 DOI: 10.2147/ppa.s201144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Our previous studies with regard to adherence to psychiatric medications measured pharmacophobia, psychological reactance, and locus of control using a 42-item questionnaire requiring ~1.5 hours for completion. This study aims to develop the Patient's Health Belief Questionnaire on Psychiatric Treatment, a 17-item inventory which requires only 15 minutes to complete. METHODS Our new questionnaire with five subscales was based on 17 items from three previously validated scales (on pharmacophobia, psychological reactance, and locus of control). In 588 consecutive Spanish psychiatric outpatients taking 1,114 psychiatric medications, we studied the responses to the questionnaire; to validate it, medication adherence was assessed by the Sidorkiewicz tool. RESULTS Validation of the construct was addressed by performing two exploratory factor analyses independent of each other (one for the eight-item section measuring the attitudes of patients toward psychotropic drugs and one for the nine-item section measuring perceived health locus of control [HLOC]), which led to five subscales that were called Positive and Negative Aspects of Medications, Doctor-HLOC, Internal-HLOC, and Psychological Reactance. The five subscales showed better internal consistency when corrected by number of items than the original 17-item scale. Logistic regression models of the continuous scores, dichotomized subscales, and Chi-squared Automatic Interaction Detector (CHAID) analysis indicated that all five subscales help in predicting adequate adherence, although the various subscales behave differently in different analyses. CONCLUSION Future studies need to verify and further extend the preliminary findings of this study that the questionnaire may have construct and predictive validity.
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Affiliation(s)
- Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, Canary Islands, Spain,
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
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26
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Sheehan R, Strydom A, Brown E, Marston L, Hassiotis A. Association of Focused Medication Review With Optimization of Psychotropic Drug Prescribing: A Systematic Review and Meta-analysis. JAMA Netw Open 2018; 1:e183750. [PMID: 30646263 PMCID: PMC6324597 DOI: 10.1001/jamanetworkopen.2018.3750] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Medication review has been proposed to achieve improved use of psychotropic drugs, but benefits have not been confirmed. OBJECTIVE To synthesize evidence for focused psychotropic medication review in medication optimization. DATA SOURCES Medline, PsycINFO, EMBASE, and CINAHL Plus were searched from inception to February 2018 using the index terms "drug utilization review" and "psychotropic drugs" and synonyms. Additional articles were retrieved using citation tracking and reference checking. STUDY SELECTION Full-length, peer-reviewed articles that reported focused psychotropic medication review were included. Inclusion was determined against prespecified criteria and assessed independently. DATA EXTRACTION AND SYNTHESIS Study quality was assessed using National Institutes for Health appraisal tools and informed a structured synthesis of results. Meta-analysis using a random effects model was conducted. MAIN OUTCOMES AND MEASURES Change in the number or dosage of psychotropic medications, change in clinical parameters, change in patient-reported outcomes, and economic data were collected. RESULTS A total of 26 studies met the inclusion criteria. Four studies were randomized clinical trials (n = 712 participants), while the remainder were before-after studies (n = 7844 participants). Most studies were conducted in elderly individuals, people with dementia, and adults with intellectual disability. Focused psychotropic medication review is a complex intervention; the professional(s) involved, target drug, degree of integration with usual care, and participant involvement varied greatly among the studies. Meta-analysis included 3 studies (n = 652 participants). Psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs compared with control (pooled odds ratio, 0.24; 95% CI, 0.14-0.39) in elderly participants with cognitive impairment living in nursing homes. Before-after studies consistently reported a change in psychotropic drug prescribing after medication review, regardless of the population. Studies that reported the effects of psychotropic medication review on clinical outcomes failed to demonstrate benefit. Economic implications of focused psychotropic medication review were not adequately assessed. The quality of evidence is poor and studies are at risk of bias. CONCLUSIONS AND RELEVANCE Focused psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs, but has not been shown to improve clinical outcomes or to provide economic benefit. More robust evidence is needed before programs of focused psychotropic medication review can be recommended as part of routine care for any patient group.
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Affiliation(s)
- Rory Sheehan
- Division of Psychiatry, University College London, London, United Kingdom
| | - André Strydom
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Emma Brown
- Division of Psychiatry, University College London, London, United Kingdom
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London, United Kingdom
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27
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Walter F, Carr MJ, Mok PL, Antonsen S, Pedersen CB, Shaw J, Webb RT. Suicide Methods and Specific Types of Accidental Death and Fatal Poisoning Among Discharged Psychiatric Patients: A National Cohort Study. J Clin Psychiatry 2018; 79:17m11809. [PMID: 30289629 PMCID: PMC6193537 DOI: 10.4088/jcp.17m11809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 04/05/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Persons discharged from inpatient psychiatric units are at greatly elevated risk of dying unnaturally. We conducted a comprehensive examination of specific causes of unnatural death post-discharge in a national register-based cohort. METHOD A cohort of 1,683,645 Danish residents born 1967-1996 was followed from their 15th birthday until death, emigration, or December 31, 2011, whichever came first. Survival analysis techniques were used to estimate incidence rate ratios (IRRs) comparing risk for persons with and without psychiatric admission history in relation to (a) suicide method, (b) accidental death type, (c) fatal poisoning type, and (d) homicide. RESULTS More than half (52.5%, n = 711) of all unnatural deaths post-discharge were fatal poisonings, compared with less than a fifth (17.0%, n = 1,012) among persons in the general population not admitted. Just 6.8% (n = 92) of all unnatural deaths post-discharge were due to transport accidents-the most common unnatural death type in the general population (53.4%, n = 3,184). Suicide risk was 32 times higher among discharged patients (IRR 32.3; 95% CI, 29.2-35.8) and was even higher during the first year post-discharge (IRR 70.4; 95% CI, 59.7-83.0). Among the suicide methods examined, relative risk values were significantly larger for intentional self-poisoning (IRR 40.8; 95% CI, 33.9-49.1) than for "violent" suicide methods (IRR 29.4; 95% CI, 26.1-33.2). The greatest relative risk observed was for fatal poisoning (irrespective of intent) by psychotropic medication (IRR 93.7; 95% CI, 62.5-140.5). The highest post-discharge mortality rate was for accidental self-poisoning among persons diagnosed with a psychoactive substance abuse disorder: 290.1 per 100,000 person-years. CONCLUSIONS Closer liaison between inpatient services and community care, more effective early treatment for comorbid substance abuse, enhanced psychosocial assessment following self-harm, and tighter medication surveillance could decrease risk of unnatural death post-discharge.
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Affiliation(s)
| | | | | | - Sussie Antonsen
- Centre for Integrated Register-Based Research and National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Carsten B Pedersen
- Centre for Integrated Register-Based Research and National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Jenny Shaw
- Centre for Mental Health & Safety, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Roger T Webb
- Centre for Mental Health & Safety, The University of Manchester and Manchester Academic Health Sciences Centre (MAHSC), Jean McFarlane Bldg, Oxford Rd, Manchester, UK M13 9PL. .,Centre for Mental Health & Safety, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Manchester, United Kingdom
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28
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Pilhatsch M, Glenn T, Rasgon N, Alda M, Sagduyu K, Grof P, Munoz R, Marsh W, Monteith S, Severus E, Bauer R, Ritter P, Whybrow PC, Bauer M. Regularity of self-reported daily dosage of mood stabilizers and antipsychotics in patients with bipolar disorder. Int J Bipolar Disord 2018; 6:10. [PMID: 29713845 PMCID: PMC6161976 DOI: 10.1186/s40345-018-0118-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/16/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Polypharmacy is often prescribed for bipolar disorder, yet medication non-adherence remains a serious problem. This study investigated the regularity in the daily dosage taken of mood stabilizers and second generation antipsychotics. METHODS Daily self-reported data on medications taken and mood were available from 241 patients with a diagnosis of bipolar disorder who received treatment as usual. Patients who took the same mood stabilizer or second generation antipsychotic for ≥ 100 days were included. Approximate entropy was used to determine serial regularity in daily dosage taken. Generalized estimating equations were used to estimate if demographic or clinical variables were associated with regularity. RESULTS There were 422 analysis periods available from the 241 patients. Patients took drugs on 84.4% of days. Considerable irregularity was found, mostly due to single-day omissions and dosage changes. Drug holidays (missing 3 or more consecutive days) were found in 35.8% of the analysis periods. Irregularity was associated with an increasing total number of psychotropic drugs taken (p = 0.009), the pill burden (p = 0.026), and the percent of days depressed (p = 0.049). CONCLUSION Despite low missing percent of days, daily drug dosage may be irregular primarily due to single day omissions and dosage changes. Drug holidays are common. Physicians should expect to see partial adherence in clinical practice, especially with complex drug regimens. Daily dosage irregularity may impact the continuity of drug action, contribute to individual variation in treatment response, and needs further study.
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Affiliation(s)
- Maximilian Pilhatsch
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Tasha Glenn
- ChronoRecord Association Inc., Fullerton, CA, USA
| | - Natalie Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Kemal Sagduyu
- Department of Psychiatry, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Paul Grof
- Mood Disorders Center of Ottawa, University of Toronto, Toronto, Canada
| | - Rodrigo Munoz
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Wendy Marsh
- Department of Psychiatry, University of Massachusetts, Worcester, MA, USA
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Rita Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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29
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Tseliou F, Donnelly M, O'Reilly D. Screening for psychiatric morbidity in the population - a comparison of the GHQ-12 and self-reported medication use. Int J Popul Data Sci 2018; 3:414. [PMID: 32934999 PMCID: PMC7299495 DOI: 10.23889/ijpds.v3i1.414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Uptake of psychotropic medication has been previously used as a proxy for assessing the prevalence of population mental health morbidity. However, it is not known how this compares with estimates derived from population screening tools. Objective To compare estimates of psychiatric morbidity derived by a validated screening instrument of psychiatric morbidity and a self-reported medication uptake measure. Methods This study used data from two recent population-wide health surveys in Northern Ireland, a country (UK) with free health services and no prescription charges. The psychiatric morbidity of 7,489 respondents was assessed using the GHQ-12 and self-reported use of medication for stress, anxiety and depression (sDAS medication). Results Overall, 19% of respondents were defined as ‘cases’ and 14.3% were taking sDAS medication. Generally, the two methods identified the same population distributions of characteristics that were associated with psychiatric morbidity though nearly as many non-cases as cases received sDAS medication (46.4% vs. 53.6%). A greater proportion of women and older people were identified as cases according to sDAS medication use, while no such variation was observed between socio-economic status and method of assessment. Conclusions This study indicates that these two methods of assessing population psychiatric morbidity provide similar estimates, despite potentially identifying different individuals as cases. It is important to note that different health care systems might be linked to variations in obstacles when accessing and using health care services. Highlights
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30
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Benson T, Corry C, O'Neill S, Murphy S, Bunting B. Use of Prescription Medication by Individuals Who Died by Suicide in Northern Ireland. Arch Suicide Res 2018; 22:139-152. [PMID: 28166453 DOI: 10.1080/13811118.2017.1289870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To understand medication use prior to suicide in relation to patterns, polypharmacy, and adherence. A total of 1,371 suicide cases were coded and latent class analysis used to identify combinations of medications prescribed prior to death. Two thirds had been prescribed medication with 30.7% prescribed 3 or more. Latent class analysis revealed three classes: Mixed medication use, primarily mental medication use, and baseline/low medication use. There are potentially high rates of medication non-adherence. Not only medication use but also non-adherence rates were high in this sample of individuals who died by suicide. Potential implications and areas for future research are discussed.
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31
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Kretchy IA, Osafo J, Agyemang SA, Appiah B, Nonvignon J. Psychological burden and caregiver-reported non-adherence to psychotropic medications among patients with schizophrenia. Psychiatry Res 2018; 259:289-294. [PMID: 29091831 DOI: 10.1016/j.psychres.2017.10.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/09/2017] [Accepted: 10/22/2017] [Indexed: 11/18/2022]
Abstract
The study examined the association between psychological distress, caregiving burden and caregiver-reported medication adherence in 444 informal family caregivers of patients with schizophrenia. Participants were assessed on the Depression, Anxiety Stress Scale, Zarit Burden Interview and the Medication Adherence Report Scale. Caregivers reported a non-adherence rate of 54.5% among patients with schizophrenia. Poor adherence to antipsychotics was significantly associated with caregiver burden (p < 0.01) and experience of anxiety (p < 0.0001). The burden of caregiving should be considered during the assessment of adherence. The findings suggest a need for culturally appropriate interventions that improve antipsychotic adherence of outpatients with schizophrenia with specific attention to the burden of the caregiver.
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Affiliation(s)
- Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana.
| | - Joseph Osafo
- Department of Psychology, School of Social Studies, College of Humanities, University of Ghana, P.O. Box LG 84, Legon, Ghana.
| | - Samuel Agyei Agyemang
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana.
| | - Bernard Appiah
- Department of Public Health Studies, School of Public Health, Texas A&M Health Science Center, 212 Adriance Lab Rd, 1266 TAMU, College Station, TX, USA.
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana.
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Holdø I, Bramness JG, Handal M, Torgersen L, Reichborn-Kjennerud T, Ystrøm E, Nordeng H, Skurtveit S. Hypnotics use in children 0-18 months: moderate agreement between mother-reported survey data and prescription registry data. J Pharm Policy Pract 2017; 10:28. [PMID: 28904801 PMCID: PMC5591515 DOI: 10.1186/s40545-017-0117-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/31/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Different methods in pharmacoepidemiology can be used to study hypnotic use in children. But neither questionnaire-based data nor prescription records can be considered a "gold standard". This study aimed to investigate the agreement between mother-reported questionnaire-based data and prescription record data for hypnotic drugs in children aged 0-18 months. The agreement was compared to the agreement for a group of antiepileptic drugs. METHODS Prescription record data were collected from the Norwegian prescription database for 47,413 children also surveyed in the Norwegian mother and child cohort between 2005 and 2009. Agreement between in the two data sources was calculated using Cohens Kappa. Multinomial logistic regression was used to calculate the effect of sociodemographic variables on discrepancies in data sources. RESULTS The agreement between mother-reported and dispensed hypnotics was less than 50% for all hypnotics. Sensitivity of reporting increased with number of filled prescriptions. The agreement of antiepileptic drugs was 92.9% in the same population. Of several sociodemographic factors only paternal educational level and maternal work situation was significantly related to agreement between prescription record and survey data. CONCLUSION There was a moderate agreement between reported use and dispensed hypnotic drugs for infants and toddlers. Results indicate that sociodemographic factors play only a minor role in explaining discrepancy.
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Affiliation(s)
- Ingvild Holdø
- Norwegian Centre of Addiction Research (SERAF), University of Oslo, Oslo, Norway
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Ottestad, Norway
| | - Marte Handal
- Domain of Mental and Physical health, Norwegian Institute of Public Health, Oslo, Norway
| | - Leila Torgersen
- Domain of Mental and Physical health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ted Reichborn-Kjennerud
- Domain of Mental and Physical health, Norwegian Institute of Public Health, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eivind Ystrøm
- Domain of Mental and Physical health, Norwegian Institute of Public Health, Oslo, Norway.,PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway.,Section of Health, Developmental and Personality Psychology, Department of Psychology, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- Domain of Mental and Physical health, Norwegian Institute of Public Health, Oslo, Norway.,PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Centre of Addiction Research (SERAF), University of Oslo, Oslo, Norway.,Domain of Mental and Physical health, Norwegian Institute of Public Health, Oslo, Norway
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Ferreira ACZ, Brusamarello T, Capistrano FC, Marin MJS, Maftum MA. A VIVÊNCIA DO PORTADOR DE TRANSTORNO MENTAL NO USO DE PSICOFÁRMACOS NA PERSPECTIVA DO PENSAMENTO COMPLEXO. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017001000016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: conhecer como o portador de transtorno mental vivencia o uso de psicofármacos. Método: pesquisa qualitativa, exploratória e descritiva que utilizou como referencial teórico o pensamento complexo de Edgar Morin. Os dados foram coletados por entrevista semiestruturada, aplicada a 26 portadores de transtorno mental com prescrição médica de psicofármacos, e submetidos à análise categorial temática. Resultados: foi identificada uma categoria central: “A vivência complexa do portador de transtorno mental no uso de psicofármacos”, que mostra as inter-relações entre as categorias temáticas: vivenciando os efeitos dos psicofármacos; utilizando os psicofármacos de modo irregular; identificando facilidades e dificuldades no uso de psicofármacos; e desenvolvendo estratégias para manutenção do uso regular de psicofármacos. Conclusão: a vivência do portador de transtorno mental no uso de psicofármacos é um processo dinâmico e complexo que engloba a multidimensionalidade, envolvendo o ser humano e seu tratamento.
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Mathan K, Sarkar S, Kattimani S, Vivek AK, Muthukrishnan V, Venkatlakshmi P. How to Improve Adherence to Medication and Follow-up in Chronic Mental Illnesses: Stakeholder Views. J Neurosci Rural Pract 2017; 8:496-498. [PMID: 28694651 PMCID: PMC5488592 DOI: 10.4103/jnrp.jnrp_289_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Kaliaperumal Mathan
- Department of Psychiatry, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, Teaching Block, All India Institute of Medical Sciences, New Delhi, India
| | - Shivanand Kattimani
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Arun Kumar Vivek
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - V Muthukrishnan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - P Venkatlakshmi
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Gauthier G, Guérin A, Zhdanava M, Jacobson W, Nomikos G, Merikle E, François C, Perez V. Treatment patterns, healthcare resource utilization, and costs following first-line antidepressant treatment in major depressive disorder: a retrospective US claims database analysis. BMC Psychiatry 2017; 17:222. [PMID: 28629442 PMCID: PMC5477263 DOI: 10.1186/s12888-017-1385-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 06/09/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Although the symptoms of major depressive disorder (MDD) are often manageable with pharmacotherapy, response to first-line antidepressant treatment is often less than optimal. This study describes long-term treatment patterns in MDD patients in the United States and quantifies the economic burden associated with different treatment patterns following first-line antidepressant therapy. METHODS MDD patients starting first-line antidepressant monotherapy and having continuous enrollment ≥12 months before and ≥24 months following the index date (i.e., the first documented prescription fill) were selected from the Truven Health Analytics MarketScan (2003-2014) database. Based on the type of first treatment change following initiation, six treatment cohorts were defined a priori ("persistence"; "discontinuation"; "switch"; "dose escalation"; "augmentation"; and "combination"). Treatment patterns through the fourth line of therapy within each cohort, healthcare resource utilization (HCRU), and cost analyses were restricted to patients with adequate treatment duration (defined as ≥42 days) in each line (analysis sub-sample, N = 21,088). HCRU and costs were described at the cohort and pattern levels. Treatment cohorts representing <5% of the analysis sub-sample were decided a priori not to be analyzed due to limited sample size. RESULTS 39,557 patients were included. Mean age was 42.1 years, 61.1% of patients were female, and mean follow-up was 4.1 years. Among the analysis sub-sample, the discontinuation (49.1%), dose escalation (37.4%), and switch (6.6%) cohorts were the most common of all treatment cohorts. First-line antidepressant discontinuation without subsequent MDD pharmacotherapy (22.9%) and cycling between discontinuation and resumption (11.2%) were the two most common treatment patterns. Median time to discontinuation was 23 weeks. The switch cohort exhibited the highest HCRU (18.9 days with medical visits per-patient-per-year) and greatest healthcare costs ($11,107 per-patient-per-year) following the index date. Treatment patterns representing a cycling on and off treatment in the switch cohort were associated with the greatest healthcare costs overall. CONCLUSION A high proportion of patients discontinue first-line antidepressant shortly after initiation. Patterns representing a cycling on and off treatment in the switch cohort were associated with the highest healthcare costs. These findings underscore challenges in effectively treating patients with MDD and a need for personalized patient management.
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Affiliation(s)
| | | | | | - William Jacobson
- Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA
| | | | | | | | - Vanessa Perez
- Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA.
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Thunander Sundbom L, Bingefors K, Hedborg K, Isacson D. Are men under-treated and women over-treated with antidepressants? Findings from a cross-sectional survey in Sweden. BJPsych Bull 2017; 41:145-150. [PMID: 28584650 PMCID: PMC5451647 DOI: 10.1192/pb.bp.116.054270] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims and method To examine gender differences in self-reported depression and prescribed antidepressants (ADs). The Hospital Anxiety and Depression Scale was used to assess depression, and information on prescribed ADs was obtained from the Swedish Prescribed Drug Register. Results Depression was reported by 11.7% of the participants (12.3% men and 11.2% women). ADs were prescribed for 7.6% of the participants (5.3% men, 9.8% women). Among men, 1.8% reported depression and used ADs, 10.5% reported depression but did not use ADs, and 3.6% used ADs but did not report depression. The corresponding figures for women were 2.6%, 8.6% and 7.2%. Clinical implications Men report depression to a greater extent than women but are prescribed ADs to a lesser extent, possibly a sign of under-treatment. Women are prescribed ADs without reporting depression more often than men, possibly a sign of over-treatment. Although the causes remain unclear, diagnostic and treatment guidelines should benefit from considering gender differences in these respects.
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De Las Cuevas C, de Leon J. Reviving Research on Medication Attitudes for Improving Pharmacotherapy: Focusing on Adherence. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 86:73-79. [PMID: 28183085 DOI: 10.1159/000450830] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/14/2016] [Indexed: 12/20/2022]
Abstract
There is little current interest in research into patients' attitudes toward medications. In the 1960s, psychiatric researchers including Uhlenhuth, Rickels and Covi focused on this area, but this research topic needs to be revived in the 21st century. The Health Belief Model may hold potential for doing this. This model was initially developed by 2 health psychologists, Rosenstock and Becker, to explain why patients did not follow medical interventions. The application of this model to study medication adherence in psychiatric outpatients has provided multiple findings including the conclusions that adherence is associated with: (1) the balance between internal and external health control beliefs, (2) psychological reactance, (3) patients' attitudes toward prescribed drug treatment in general and (4) the balance between the necessity of taking medications versus the concerns derived from adverse drug reactions (ADRs). Poor adherence is associated with several cognitive styles of patients, including: (1) high internal and external health control beliefs (patients who feel that their health is controlled both by external factors and their own beliefs), (2) higher psychological reactance, (3) pharmacophobia (present in 1/6 patients) and (4) skepticism about medications (a high concern for ADRs and a low belief in the necessity of taking medications). All of these findings suggest that shared decision-making is particularly important in fostering adherence in psychiatric patients. Two wider applications of this article can be made: (1) opening psychiatry to advances in clinical psychology and (2) expanding studies on attitudes toward medications to other medical disciplines.
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Bousman CA, Forbes M, Jayaram M, Eyre H, Reynolds CF, Berk M, Hopwood M, Ng C. Antidepressant prescribing in the precision medicine era: a prescriber's primer on pharmacogenetic tools. BMC Psychiatry 2017; 17:60. [PMID: 28178974 PMCID: PMC5299682 DOI: 10.1186/s12888-017-1230-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/04/2017] [Indexed: 12/25/2022] Open
Abstract
About half of people who take antidepressants do not respond and many experience adverse effects. These detrimental outcomes are in part a result of the impact of an individual's genetic profile on pharmacokinetics and pharmcodynamics. If known and made available to clinicians, this could improve decision-making and antidepressant therapy outcomes. This has spurred the development of numerous pharmacogenetic-based decision support tools. In this article, we provide an overview of pharmacogenetic decision support tools, with particular focus on tools relevant to antidepressants. We briefly describe the evolution and current state of antidepressant pharmacogenetic decision support tools in clinical practice, followed by the evidence-base for their use. Finally, we present a series of considerations for clinicians contemplating use of these tools and discuss the future of antidepressant pharmacogenetic decision support tools.
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Affiliation(s)
- Chad A Bousman
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia.
- Department of General Practice, The University of Melbourne, Parkville, VIC, Australia.
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorne, VIC, Australia.
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Malcolm Forbes
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia
| | - Mahesh Jayaram
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia
| | - Harris Eyre
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, Australia
- Discipline of Psychiatry, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Michael Berk
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia
| | - Chee Ng
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, 161 Barry Street, Level 3, Parkville, VIC, 3053, Australia
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Lee JC, Lewis CP, Daskalakis ZJ, Croarkin PE. Transcranial Direct Current Stimulation: Considerations for Research in Adolescent Depression. Front Psychiatry 2017; 8:91. [PMID: 28638351 PMCID: PMC5461263 DOI: 10.3389/fpsyt.2017.00091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Adolescent depression is a prevalent disorder with substantial morbidity and mortality. Current treatment interventions do not target relevant pathophysiology and are frequently ineffective, thereby leading to a substantial burden for individuals, families, and society. During adolescence, the prefrontal cortex undergoes extensive structural and functional changes. Recent work suggests that frontolimbic development in depressed adolescents is delayed or aberrant. The judicious application of non-invasive brain stimulation techniques to the prefrontal cortex may present a promising opportunity for durable interventions in adolescent depression. Transcranial direct current stimulation (tDCS) applies a low-intensity, continuous current that alters cortical excitability. While this modality does not elicit action potentials, it is thought to manipulate neuronal activity and neuroplasticity. Specifically, tDCS may modulate N-methyl-d-aspartate receptors and L-type voltage-gated calcium channels and effect changes through long-term potentiation or long-term depression-like mechanisms. This mini-review considers the neurobiological rationale for developing tDCS protocols in adolescent depression, reviews existing work in adult mood disorders, surveys the existing tDCS literature in adolescent populations, reviews safety studies, and discusses distinct ethical considerations in work with adolescents.
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Affiliation(s)
- Jonathan C Lee
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Charles P Lewis
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul E Croarkin
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Chang Z, Lichtenstein P, Långström N, Larsson H, Fazel S. Association Between Prescription of Major Psychotropic Medications and Violent Reoffending After Prison Release. JAMA 2016; 316:1798-1807. [PMID: 27802545 PMCID: PMC5100822 DOI: 10.1001/jama.2016.15380] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Individuals released from prison have high rates of violent reoffending, and there is uncertainty about whether pharmacological treatments reduce reoffending risk. Objective To investigate the associations between major classes of psychotropic medications and violent reoffending. Design, Setting, and Participants This cohort study included all released prisoners in Sweden from July 1, 2005, to December 31, 2010, through linkage of population-based registers. Rates of violent reoffending during medicated periods were compared with rates during nonmedicated periods using within-individual analyses. Follow-up ended December 31, 2013. Exposures Periods with or without dispensed prescription of psychotropic medications (antipsychotics, antidepressants, psychostimulants, drugs used in addictive disorders, and antiepileptic drugs) after prison release. Prison-based psychological treatments were investigated as a secondary exposure. Main Outcomes and Measures Violent crime after release from prison. Results The cohort included 22 275 released prisoners (mean [SD] age, 38 [13] years; 91.9% male). During follow-up (median, 4.6 years; interquartile range, 3.0-6.4 years), 4031 individuals (18.1%) had 5653 violent reoffenses. The within-individual hazard ratio (HR) associated with dispensed antipsychotics was 0.58 (95% CI, 0.39-0.88), based on 100 events in 1596 person-years during medicated periods and 1044 events in 11 026 person-years during nonmedicated periods, equating to a risk difference of 39.7 (95% CI, 11.3-57.7) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed psychostimulants was 0.62 (95% CI, 0.40-0.98), based on 94 events in 1648 person-years during medicated periods and 513 events in 4553 person-years during nonmedicated periods, equating to a risk difference of 42.8 (95% CI, 2.2-67.6) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed drugs for addictive disorders was 0.48 (95% CI, 0.23-0.97), based on 46 events in 1168 person-years during medicated periods and 1103 events in 15 725 person-years during nonmedicated periods, equating to a risk difference of 36.4 (95% CI, 2.1-54.0) fewer violent reoffenses per 1000 person-years. In contrast, antidepressants and antiepileptics were not significantly associated with violent reoffending rates (HR = 1.09 [95% CI, 0.83-1.43] and 1.14 [95% CI, 0.79-1.65], respectively). The most common prison-based program was psychological treatments for substance abuse, associated with an HR of 0.75 (95% CI, 0.63-0.89), which equated to a risk difference of 23.2 (95% CI, 10.3-34.1) fewer violent reoffenses per 1000 person-years. Conclusions and Relevance Among released prisoners in Sweden, rates of violent reoffending were lower during periods when individiduals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications. Further research is needed to understand the causal nature of this association.
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Affiliation(s)
- Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden2Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Långström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden3Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden4School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England
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Miasso AI, Telles Filho PCP, Borges TL, Pereira Júnior ADC, Giacchero Vedana KG, Shasanmi R, Escobar Gimenes FR. Adherence to Psychotropic Medications and Associated Factors in Primary Health Care. Issues Ment Health Nurs 2016; 37:775-783. [PMID: 27548290 DOI: 10.1080/01612840.2016.1214854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The study aims were to analyze patients' adherence to psychotropic medications and its association with sociodemographic factors, therapeutic regimen, presence of common mental disorders, and illness factors. A descriptive cross-sectional study was carried out in ten Primary Health Care units in Brazil. The tools were the Measurement of Treatment Adherence Test and the Self Reporting Questionnaire. Nonadherence to psychotropic drugs was 88.9%. There was association between adherence and age and among patients positive for Common Mental Disorders (97.8%). In the multivariate analysis this association was not maintained. Findings indicate strategies are needed to improve medication adherence in the Primary Health Care services. However, no strategy will be effective if patients and their families are not involved in the process.
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Affiliation(s)
- Adriana Inocenti Miasso
- a University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto - WHO Collaborating Centre for Nursing Research Development , São Paulo , Brazil
| | | | - Tatiana Longo Borges
- a University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto - WHO Collaborating Centre for Nursing Research Development , São Paulo , Brazil
| | | | - Kelly Graziani Giacchero Vedana
- a University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto - WHO Collaborating Centre for Nursing Research Development , São Paulo , Brazil
| | - Rebecca Shasanmi
- d Nursing and Public Health Research , Philadelphia , Pennsylvania , United States of America
| | - Fernanda Raphael Escobar Gimenes
- a University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto - WHO Collaborating Centre for Nursing Research Development , São Paulo , Brazil
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Ihle A, Inauen J, Scholz U, König C, Holzer B, Zimmerli L, Battegay E, Tobias R, Kliegel M. Prospective and retrospective memory are differentially related to self-rated omission and commission errors in medication adherence in multimorbidity. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:505-511. [PMID: 27450575 DOI: 10.1080/23279095.2016.1209675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We investigated the relations of self-rated omission errors (i.e., forgetting to take one's medication) and commission errors (i.e., unnecessary repetitions of medication intake because of forgetting that it has already been taken) in medication adherence in multimorbidity to prospective and retrospective memory performance. Moreover, we examined whether these relations were moderated by the number of medications that had to be taken. Eighty-four patients with multimorbidity (aged 28-84 years, M = 62.4) reported medication adherence regarding the last seven days and the number of medications they had to take. In addition, we administered psychometric tests on prospective memory (PM) and retrospective memory performance. We found that reported omission errors in medication adherence were related significantly to lower PM performance. This relationship was increased in individuals with a lower number of medications. In comparison, reported commission errors in medication adherence were related significantly to lower retrospective memory performance. This relationship was increased in individuals with a larger number of medications. Present data suggest that omission errors in medication adherence in multimorbidity may reflect primarily PM errors, particularly if few medications have to be taken, while commission errors may reflect mainly retrospective memory failures, especially with a large number of medications that need to be taken as prescribed. From an applied neuropsychological perspective, these results underline the importance of trying to enhance PM and retrospective memory performance in patients with multimorbidity.
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Affiliation(s)
- Andreas Ihle
- a Department of Psychology , University of Geneva , Geneva , Switzerland.,e Center for the Interdisciplinary Study of Gerontology and Vulnerability , University of Geneva , Geneva , Switzerland.,f Swiss National Center of Competences in Research LIVES-Overcoming Vulnerability: Life Course Perspectives
| | - Jennifer Inauen
- b Department of Psychology , University of Zurich , Zurich , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland.,i Department of Psychology , Columbia University , New York , USA
| | - Urte Scholz
- b Department of Psychology , University of Zurich , Zurich , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland
| | - Claudia König
- b Department of Psychology , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland
| | - Barbara Holzer
- c Department of Internal Medicine , University Hospital Zurich , Zurich , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland
| | - Lukas Zimmerli
- d Department of Internal Medicine , Hospital Olten , Olten , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland
| | - Edouard Battegay
- c Department of Internal Medicine , University Hospital Zurich , Zurich , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland
| | - Robert Tobias
- b Department of Psychology , University of Zurich , Zurich , Switzerland
| | - Matthias Kliegel
- a Department of Psychology , University of Geneva , Geneva , Switzerland.,e Center for the Interdisciplinary Study of Gerontology and Vulnerability , University of Geneva , Geneva , Switzerland.,f Swiss National Center of Competences in Research LIVES-Overcoming Vulnerability: Life Course Perspectives
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Govender T, Choonara YE, Kumar P, Bijukumar D, du Toit LC, Modi G, Naidoo D, Pillay V. Implantable and transdermal polymeric drug delivery technologies for the treatment of central nervous system disorders. Pharm Dev Technol 2016; 22:476-486. [PMID: 27268737 DOI: 10.1080/10837450.2016.1189937] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The complexity of the brain and the membranous blood-brain barrier (BBB) has proved to be a significant limitation to the systemic delivery of pharmaceuticals to the brain rendering them sub-therapeutic and ineffective in the treatment of neurological diseases. Apart from this, lack of innovation in product development to counteract the problem is also a major contributing factor to a poor therapeutic outcome. Various innovative strategies show potential in treating some of the neurological disorders; however, drug delivery remains the most popular. To attain therapeutic drug levels in the central nervous system, large, intolerable systemic doses are generally administered. The major factors responsible for the success maintenance therapy of neurological diseases included controlled and sustained release of neurotherapeutics, reduced frequency of administration, higher bioavailability, and patient compliances. Conventional oral or injectable formulations cannot satisfy all the requirements in many circumstances. This article reviews the therapeutic implantable polymeric and transdermal devices employed in an attempt to effectively achieve therapeutic quantities of drug across the BBB over a prolonged period, to improve patient disease prognosis.
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Affiliation(s)
- Thiresen Govender
- a Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Yahya E Choonara
- a Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Pradeep Kumar
- a Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Divya Bijukumar
- a Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Lisa C du Toit
- a Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Girish Modi
- b Division of Neurosciences, Department of Neurology, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Dinesh Naidoo
- c Division of Neurosciences, Department of Neurosurgery, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Viness Pillay
- a Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
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Colombo GL, Agabiti-Rosei E, Margonato A, Mencacci C, Montecucco CM, Trevisan R, Catapano AL. Impact of substitution among generic drugs on persistence and adherence: A retrospective claims data study from 2 Local Healthcare Units in the Lombardy Region of Italy. ATHEROSCLEROSIS SUPP 2016; 21:1-8. [DOI: 10.1016/j.atherosclerosissup.2016.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Therapeutic Drug Monitoring of Selective Serotonin Reuptake Inhibitors in Elderly Patients. Ther Drug Monit 2016; 37:546-9. [PMID: 25565671 DOI: 10.1097/ftd.0000000000000169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Elderly patients are at increased risk for elevated serum concentrations from treatment with selective serotonin reuptake inhibitors (SSRIs). The aim of this study was to examine the use of therapeutic drug monitoring (TDM) of SSRIs in elderly compared with younger patients. METHODS All serum concentration measurements of SSRIs (escitalopram, citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline) performed at our laboratory in 2011 were included. The use of TDM (relative frequency) in older versus younger patients was examined by comparing the use of TDM in patients aged 60 years or older with that in patients younger than 60 years and by evaluating the use of TDM relative to age (age groups in decennials). The number of patients with an SSRI dispensed by prescription in the same region and period (the Norwegian Prescription Database) was used as reference. Additionally, the number of samples above the upper limit of the recommended reference range in patients aged 60 years or older and patients younger than 60 years was evaluated. RESULTS TDM of an SSRI had been performed in 6333 patients. For all SSRIs, the use of TDM was significantly lower (8.2% versus 10.6% for citalopram, 10.0% versus 13.8% for escitalopram, 8.6% versus 17.0% for fluoxetine, 5.6% versus 10.3% for paroxetine, and 8.1% versus 15.0% for sertraline) in patients aged 60 years or older compared with those younger than 60 years (P < 0.001). There was a gradual decline in the use of TDM with increasing age, with a 3-fold difference between the youngest (10-19) and oldest (90+) patients (P < 0.0001). The percentage of samples above the upper limit of the recommended reference range was 2-fold higher in patients aged 60 years or older (6.7%) compared with patients younger than 60 (3.4%) years (P < 0.0001). CONCLUSIONS Clinical follow-up of patients with TDM of SSRIs is less frequent in older patients compared with younger patients. This is in contrast to the general guidelines for TDM where patients of advanced age are considered of particular importance to monitor closely.
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Lemstra ME, Rogers MR. The Healthy Weights Initiative: a community-based obesity reduction program with positive impact on depressed mood scores. Psychol Res Behav Manag 2016; 9:115-24. [PMID: 27257395 PMCID: PMC4874729 DOI: 10.2147/prbm.s100308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives The risk for many chronic diseases increases with obesity. In addition to these, the risk for depression also increases. Exercise interventions for weight loss among those who are not overweight or obese have shown a moderate effect on depression, but few studies have looked at those with obesity. The objectives of this study were to determine 1) the prevalence of depressed mood in obese participants as determined by the Beck Depression Inventory II at baseline and follow-up; 2) the change in depressed mood between those who completed the program and those who did not; and 3) the differences between those whose depressed mood was alleviated after the program and those who continued to have depressed mood. Methods Depressed mood scores were calculated at baseline and follow-up for those who completed the program and for those who quit. Among those who completed the program, chi-squares were used to determine the differences between those who no longer had depressed mood and those who still had depressed mood at the end of the program, and regression analysis was used to determine the independent risk factors for still having depressed mood at program completion. Results Depressed mood prevalence decreased from 45.7% to 11.7% (P<0.000) from baseline to follow-up among those who completed the program and increased from 44.8% to 55.6% (P<0.000) among those who quit. After logistic regression, a score of <40 in general health increased the risk of still having depressed mood upon program completion (odds ratio [OR] 3.39; 95% CI 1.18–9.72; P=0.023). Conclusion Treating depressed mood among obese adults through a community-based, weight-loss program based on evidence may be an adjunct to medical treatment. More research is needed.
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Affiliation(s)
- Mark Edgar Lemstra
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marla Rochelle Rogers
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Comparison of methods to assess psychiatric medication adherence in methadone-maintained patients with co-occurring psychiatric disorder. Drug Alcohol Depend 2016; 160:212-7. [PMID: 26851987 PMCID: PMC4772726 DOI: 10.1016/j.drugalcdep.2016.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/10/2016] [Accepted: 01/14/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Adherence with psychiatric medication is a critical issue that has serious individual and public health implications. This is a secondary analysis of a large-scale clinical treatment trial of co-occurring substance use and psychiatric disorder. METHOD Participants (n=153) who received a clinically-indicated psychiatric medication ≥30 days during the 12-month study and provided corresponding data from Medication Event Monitoring System (MEMS) and Morisky Medication Taking Adherence Scale (MMAS) self-report adherence ratings were included in the analyses. Accuracy in MEMS caps openings was customized to each participant's unique required dosing schedule. RESULTS Consistent with expectations, MEMS-based adherence declined slowly over time, though MMAS scores of forgetting medication remained high and did not change over the 12-month study. MEMS caps openings were not significantly impacted by any baseline or treatment level variables, whereas MMAS scores were significantly associated with younger age and presence of an Axis I disorder and antisocial personality disorder, or any cluster B diagnoses. CONCLUSIONS Results suggest that MEMS caps may be a more objective method for monitoring adherence in patients with co-occurring substance use and psychiatric disorder relative to the MMAS self-report. Participants in this study were able to successfully use the MEMS caps for a 12-month period with <1% lost or broken caps, suggesting this comorbid population is able to use the MEMS successfully. Ultimately, these data suggest that an objective method for monitoring adherence in this treatment population yield more accurate outcomes relative to self-report.
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Ormsby SM, Smith CA, Dahlen HG, Hay PJ, Lind JM. Evaluation of an antenatal acupuncture intervention as an adjunct therapy for antenatal depression (AcuAnteDep): study protocol for a pragmatic randomised controlled trial. Trials 2016; 17:93. [PMID: 26887958 PMCID: PMC4758005 DOI: 10.1186/s13063-016-1204-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 01/28/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Depressed pregnant women face difficulty navigating a course between the potentially serious consequences of leaving depression untreated and significant limitations associated with conventional therapies, such as foetal toxicity and teratogenicity. Preliminary evidence is suggestive that acupuncture may provide a safe and effective alternative treatment option for antenatal depression; however, additional research is required. The purpose of this study is to further investigate this treatment possibility, with an additional examination of a potential biomechanistic acupuncture effect. METHODS/DESIGN In this pragmatic randomised controlled trial, we will compare individually tailored, flexible antenatal depression-oriented acupuncture with equivalent attention progressive muscle relaxation and routine antenatal depression hospital care. Eligible women at 24 weeks of gestation with Edinburgh Postnatal Depression Scale scores of 13 or more will be recruited from 2 antenatal clinics in South Western Sydney, Australia. The recruitment goal of 96 is powered to demonstrate a significant difference in Edinburgh Postnatal Depression Scale score severity between acupuncture and usual care, with intervention groups receiving weekly 1-h treatments for 8 weeks from 24 to 31 weeks of gestation. Mental health and quality-of-life assessments will occur at study commencement, intervention weeks 4 and 8 and 6 weeks post-natally via the collection of completed Edinburgh Postnatal Depression Scale scores, Depression, Stress and Anxiety Scale scores and World Health Organisation Quality of Life Scale scores. Adjustment to mothering will also be evaluated at 6 weeks post-natally using the Being a Mother Scale. A putative biomechanistic effect of acupuncture on the oxytocinergic system will additionally be examined by comparing baseline salivary hormone levels with those measured at intervention weeks 4 and 8, as well as leucocyte oxytocin receptor expression at baseline and intervention week 8. DISCUSSION Ethical approval was received in February 2015, and recruitment is underway and expected to be completed in July 2016. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12615000250538, Registered on 19 March 2015.
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Affiliation(s)
- Simone M Ormsby
- PhD Candidate, National Institute of Complementary Medicine, Western Sydney University, Building 5, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Caroline A Smith
- Professor of Complementary Medicine, National Institute of Complementary Medicine, Western Sydney University, Building 5, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Hannah G Dahlen
- Professor of Midwifery, Western Sydney University, Building EB, Parramatta Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Phillipa J Hay
- Chair of Mental Health, Western Sydney University, Building 30, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Joanne M Lind
- Associate Professor, Molecular Biology and Genetics, Western Sydney University, Building 30, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Ammerman RT, Chen J, Mallow PJ, Rizzo JA, Folger AT, Van Ginkel JB. Annual direct health care expenditures and employee absenteeism costs in high-risk, low-income mothers with major depression. J Affect Disord 2016; 190:386-394. [PMID: 26546774 DOI: 10.1016/j.jad.2015.10.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/05/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND To determine the health care and labor productivity costs associated with major depressive disorder in high-risk, low-income mothers. METHODS This study was conducted using the 1996-2011 Medical Expenditure Panel Survey (MEPS). The MEPS is a nationally-representative database that includes information on health care utilization and expenditures for the civilian, non-institutionalized population in the United States. High-risk mothers were between the ages of 18-35 years, and either unmarried, receiving Medicaid, or with incomes less than 300% of the Federal Poverty Level. Mothers were categorized as being depressed if they had an ICD-9 diagnosis code of 296 or 311 (N=2310) or not depressed (N=18,221). Insurer expenditures, out-of-pocket (OOP) expenses, and lost wage earnings were calculated. RESULTS After controlling for comorbidities, demographics, region, and year, high-risk depressed mothers were more likely to incur insurer (0.84 vs. 0.79) and OOP expenses (0.84 vs. 0.81) and to have higher insurer ($4448 vs. $3072) and OOP expenses ($794 vs. $523). Depression significantly increased the likelihood of missing work days (OR=1.40; p<0.01). Depression increased overall direct health care expenditures by $1.89 billion (range=$1.28-$2.60 billion) and indirect costs by $523 million annually, with a range of $353-$719 million. CONCLUSIONS In this high-risk population, the direct and indirect aggregate costs of depression-related to health care expenditures and lost work productivity were substantial. These findings establish a quantifiable cost for policy makers and highlight the need to target this population for prevention and treatment efforts.
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Affiliation(s)
- Robert T Ammerman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Jie Chen
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, MD, USA
| | - Peter J Mallow
- CTI Clinical Trial and Consulting, Inc., Cincinnati, OH, USA
| | - John A Rizzo
- Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Alonzo T Folger
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Judith B Van Ginkel
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Kamaradova D, Latalova K, Prasko J, Kubinek R, Vrbova K, Mainerova B, Cinculova A, Ociskova M, Holubova M, Smoldasova J, Tichackova A. Connection between self-stigma, adherence to treatment, and discontinuation of medication. Patient Prefer Adherence 2016; 10:1289-98. [PMID: 27524884 PMCID: PMC4966500 DOI: 10.2147/ppa.s99136] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Self-stigma plays a role in many areas of the patient's life. Furthermore, it also discourages therapy. The aim of our study was to examine associations between self-stigma and adherence to treatment and discontinuation of medication in patients from various diagnostic groups. METHODS This cross-sectional study involved outpatients attending the Department of Psychiatry, University Hospital Olomouc, Czech Republic. The level of self-stigma was measured with the Internalized Stigma of Mental Illness and adherence with the Drug Attitude Inventory. The patients also anonymously filled out a demographic questionnaire which included a question asking whether they had discontinued their medication in the past. RESULTS We examined data from 332 patients from six basic diagnostic categories (substance abuse disorders, schizophrenia, bipolar disorders, depressive disorders, anxiety disorders, and personality disorders). The study showed a statistically significant negative correlation between self-stigma and adherence to treatment in all diagnostic groups. Self-stigma correlated positively and adherence negatively with the severity of disorders. Another important factor affecting both variables was partnership. Self-stigma positively correlated with doses of antidepressants and adherence with doses of anxiolytics. Self-stigma also negatively correlated with education, and positively with a number of hospitalizations and number of psychiatrists visited. Adherence was further positively correlated with age and age of onset of disorders. Regression analysis showed that self-stigma was an important factor negatively influencing adherence to treatment and significantly contributing to voluntary discontinuation of drugs. The level of self-stigma did not differ between diagnostic categories. Patients suffering from schizophrenia had the lowest adherence to treatment. CONCLUSION The study showed a significant correlation between self-stigma and adherence to treatment. High levels of self-stigma are associated with discontinuation of medications without a psychiatrist's recommendation. This connection was present in all diagnostic groups.
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Affiliation(s)
- Dana Kamaradova
- Department of Psychiatry, University Hospital Olomouc
- Correspondence: Dana Kamaradova, Department of Psychiatry, University Hospital Olomouc, I.P. Pavlova 6, Olomouc, 779 00, Czech Republic, Tel +420 588 44 3519, Email
| | | | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc
| | - Radim Kubinek
- Department of Psychiatry, University Hospital Olomouc
| | | | | | | | | | - Michaela Holubova
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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