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Howe J, MacPhee M, Duddy C, Habib H, Wong G, Jacklin S, Oduola S, Upthegrove R, Carlish M, Allen K, Patterson E, Maidment I. A realist review of medication optimisation of community dwelling service users with serious mental illness. BMJ Qual Saf 2023:bmjqs-2023-016615. [PMID: 38071586 DOI: 10.1136/bmjqs-2023-016615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/14/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Severe mental illness (SMI) incorporates schizophrenia, bipolar disorder, non-organic psychosis, personality disorder or any other severe and enduring mental health illness. Medication, particularly antipsychotics and mood stabilisers are the main treatment options. Medication optimisation is a hallmark of medication safety, characterised by the use of collaborative, person-centred approaches. There is very little published research describing medication optimisation with people living with SMI. OBJECTIVE Published literature and two stakeholder groups were employed to answer: What works for whom and in what circumstances to optimise medication use with people living with SMI in the community? METHODS A five-stage realist review was co-conducted with a lived experience group of individuals living with SMI and a practitioner group caring for individuals with SMI. An initial programme theory was developed. A formal literature search was conducted across eight bibliographic databases, and literature were screened for relevance to programme theory refinement. In total 60 papers contributed to the review. 42 papers were from the original database search with 18 papers identified from additional database searches and citation searches conducted based on stakeholder recommendations. RESULTS Our programme theory represents a continuum from a service user's initial diagnosis of SMI to therapeutic alliance development with practitioners, followed by mutual exchange of information, shared decision-making and medication optimisation. Accompanying the programme theory are 11 context-mechanism-outcome configurations that propose evidence-informed contextual factors and mechanisms that either facilitate or impede medication optimisation. Two mid-range theories highlighted in this review are supported decision-making and trust formation. CONCLUSIONS Supported decision-making and trust are foundational to overcoming stigma and establishing 'safety' and comfort between service users and practitioners. Avenues for future research include the influence of stigma and equity across cultural and ethnic groups with individuals with SMI; and use of trained supports, such as peer support workers. PROSPERO REGISTRATION NUMBER CRD42021280980.
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Affiliation(s)
- Jo Howe
- Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Maura MacPhee
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire Duddy
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hafsah Habib
- Pharmacy School, Aston University College of Health and Life Sciences, Birmingham, UK
| | - Geoff Wong
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Jacklin
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Sheri Oduola
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Max Carlish
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Katherine Allen
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Emma Patterson
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Ian Maidment
- Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
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Howe J, Lindsey L. The role of pharmacists in supporting service users to optimise antipsychotic medication. Int J Clin Pharm 2023; 45:1293-1298. [PMID: 37704913 PMCID: PMC10600309 DOI: 10.1007/s11096-023-01630-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/22/2023] [Indexed: 09/15/2023]
Abstract
Pharmacists have a contribution to make in improving optimising medication use for people on antipsychotic medication. The rates of prescribing antipsychotics have increased in England with an 18% rise from 2015 to 2020. People on antipsychotic medication are not treated as equal partners in conversations about their medications. This can leave people to make decisions about their antipsychotic medications without input from their prescribers which can have significant consequences for individuals. Involving people in the decision-making process, as experts on their own condition, has the potential to improve treatment outcomes. The evidence suggests that involving pharmacists in supporting people with serious mental illnesses will lead to improved clinical outcomes. Key areas for pharmacist involvement are providing information, education and counselling on antipsychotic medication and the side effects and reducing polypharmacy especially when antipsychotics are prescribed off license.
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Affiliation(s)
- Jo Howe
- School of Pharmacy, Aston University, Birmingham, B4 7ET, England.
| | - Laura Lindsey
- Faculty of Medical Sciences, School of Pharmacy, Newcastle University, Newcastle upon Tyne, NE1 7RU, England
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Thananowan N, Vongsirimas N, Kedcham A. Mediating Roles of Intimate Partner Violence, Stress, and Social Support on Depressive Symptoms Among Thai Women. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP6697-NP6719. [PMID: 33086916 DOI: 10.1177/0886260520967140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Prior research has shown that intimate partner violence (IPV), stress, and social support are associated with depressive symptoms. However, a possible mediating role of these variables linking depressive symptoms has not been fully investigated in Thailand. This study was conducted to assess the mediating roles of IPV, stress, and social support in the relationships between childhood abuse (CA), number of sexual partners (NSP), and depressive symptoms among 400 Thai women attending gynecology clinics. Results indicated that IPV was significantly positively correlated with stress and depressive symptoms but negatively correlated with social support. CA and NSP were significantly positively correlated with IPV, stress, and depressive symptoms, but negatively correlated with social support. Structural equation models (SEMs) showed that not only did IPV severity exhibit significantly indirect effect on depressive symptoms (β = .178; p < .05), but it also had a significant, positive total effect on depressive symptoms (β = .252; p < .05). In particular, IPV severity had the fully mediating effect on depressive symptoms through social support (β = -.204; p < .05) and stress (β = .158; p < .05). CA severity and NSP exhibited the significant indirect effect on depressive symptoms through IPV severity, stress, and social support. All the models analyzed showed that stress had an important mediator role (β = .583; p < .05) on depressive symptoms. The model fitted very well to the empirical data and explained 53% of variance. Findings affirmed the important role of these mediators as well as the need to design interventions for reducing stress or increasing support for women experiencing IPV. Utilizing an empowerment approach among female outpatients to decrease stress and depressive symptoms is recommended.
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Affiliation(s)
| | | | - Akadet Kedcham
- Bansomdejchaopraya Rajabhat University, Bangkok, Thailand
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Lessard-Deschênes C, Goulet MH. The therapeutic relationship in the context of involuntary treatment orders: The perspective of nurses and patients. J Psychiatr Ment Health Nurs 2022; 29:287-296. [PMID: 34551167 DOI: 10.1111/jpm.12800] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/01/2021] [Accepted: 09/17/2021] [Indexed: 02/03/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Involuntary treatment orders are increasingly being used around the world to allow the treatment of individuals living with a mental illness deemed incapable of giving consent and who are actively refusing treatment. The use of involuntary treatment orders can impact the nurse-patient therapeutic relationship, which is essential to offer quality care and promote recovery. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Nurses and patients do not agree on the possibility to develop a therapeutic relationship, with nurses believing they can build a bond with the patients despite the challenges imposed by the involuntary treatment order, and patients rejecting this possibility. Nurses caring for patients on involuntary treatment orders feel obligated to apply the conditions of this measure, even if it damages the relationship with their patients. This difficult aspect of their work leads them to question their role in relation to the management of involuntary treatment orders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses need to be aware of the reasons why patients on involuntary treatment orders do not believe in the possibility of building a therapeutic relationship. Nurses need to reflect on and express their concerns about the damaging effects that managing involuntary treatment orders conditions can have on the nurse-patient therapeutic relationship. ABSTRACT: Introduction Involuntary treatment orders (ITO) can impact the nurse-patient therapeutic relationship (TR) negatively. Despite the increasing use of ITOs around the world, few studies have explored their influence on the TR from the perspectives of nurses and patients. Aim To describe the TR in the context of ITOs as reported by nurses and individuals living with a mental illness. Method Secondary data analysis of qualitative interviews with nurses (n = 9) and patients (n = 6) was performed using content analysis. Results Participants described the TR as fundamentally embedded in a power imbalance amplified by the ITO, which was discussed through the conflicting roles of nurses, the legal constraints imposed on patients and nurses, the complex relation between the ITO and the TR, and the influence of mental healthcare settings' context. Discussion Nurses and patients' views were opposed, questioning the authenticity of the relationship. Implications for Practice Nurses should be aware of the patients' lack of faith in the TR to ensure that they are sensitive to patients' behaviours that may falsely suggest that a relationship is established. Further studies should explore ways to alleviate the burden of the management of ITOs on nurses and allow for a trusting relationship to be build.
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Affiliation(s)
- Clara Lessard-Deschênes
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Marie-Hélène Goulet
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
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Mental Health Nurses’ Tacit Knowledge of Strategies for Improving Medication Adherence for Schizophrenia: A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10030492. [PMID: 35326970 PMCID: PMC8955025 DOI: 10.3390/healthcare10030492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/01/2023] Open
Abstract
Non-adherence to medication among patients with schizophrenia is an important clinical issue with very complex reasons. Since medication administration is an essential nursing responsibility, improving strategies for patient medication compliance must be fully understood. This study aimed to explore the strategies mental health nurses (MHNs) implement in clinically improving patients with schizophrenia and to describe the nurses’ tacit knowledge of application strategies. A qualitative study with purposeful sampling was used. Twenty-five experienced MHNs in a psychiatric hospital in central Taiwan were given an in-depth interview. The texts were content-analyzed using NVivo 12 Pro software. MHNs promote medication adherence among patients with schizophrenia using the following strategies: establishing a conversational relationship, overall assessment of non-adherence to medication, understanding the disease and adjusting the concept of medication, incorporating interpersonal connection feedback, and building supportive resources. This study explored the strategies of MHNs that incorporated knowledge in managing treatment adherence in patients with schizophrenia. The findings add knowledge to clinical nursing practice about medication adherence among patients with schizophrenia.
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Averous P, Charbonnier E, Dany L. Assessment of illness representations in mental disorders: A mini review. Encephale 2021; 47:137-142. [PMID: 33589282 DOI: 10.1016/j.encep.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/10/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
Abstract
Health beliefs, and especially illness representations, have been widely used to understand clinical outcomes and psychosocial adjustment in people with physical diseases. However, this area of research has been under-explored in the field of mental health, and the few studies that have been conducted have used very different methods. Therefore, the aim of our study was to identify the tools and methods that have been used to evaluate illness representations in psychiatry. To this end, a mini review has been conducted and 58 articles were retained. This mini review highlights that the quantitative method is the most used, and that the scales mobilised are often adapted for the study, but not validated. Indeed, multiple modifications and adaptations have been made by the authors (e.g. deletion of subscales, addition of items), which lead to questions about the reliability of what is measured. In the future, it is essential to have a validated generic tool for mental disorders, which could be based on the Illness perceptions questionnaire for schizophrenia.
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Affiliation(s)
- P Averous
- Aix Marseille Univ, Aix-en-Provence, France; UNIV. NIMES, APSY-V, Nîmes cedex 1, France.
| | | | - L Dany
- Aix Marseille Univ, Aix-en-Provence, France; APHM, Timone, Service d'Oncologie Médicale, Marseille, France
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Averous P, Charbonnier E, Dany L. Relationship Between Illness Representations, Psychosocial Adjustment, and Treatment Outcomes in Mental Disorders: A Mini Review. Front Psychol 2020; 11:1167. [PMID: 32612557 PMCID: PMC7309516 DOI: 10.3389/fpsyg.2020.01167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/06/2020] [Indexed: 01/04/2023] Open
Abstract
Understanding and improving the psychosocial adjustments (e.g., quality of life, depression) and treatment outcomes (e.g., adherence, beliefs about treatments) of people with mental disorders are major health issues. The self-regulation model (SRM) postulates that illness representations play a central role on adjustment and treatment of people with physical illnesses. Recently, the SRM has been used with people with mental disorders. However, the manifestations of somatic and psychiatric disorders can be very different. Therefore, the use of SRM in the field of mental health is very complex. This difficulty, as well as the growing interest for illness representations in the field of mental health, justifies the utility to conduct a review on this topic. The current review shows that illness representations are related to psychosocial adjustment and/or treatment outcomes for people with various mental disorders [e.g., psychotic disorders, mood disorder, posttraumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD)]. However, some limitations to the applicability of SRM to mental disorders have been highlighted. These limitations should be considered in future studies.
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Affiliation(s)
- Priscillia Averous
- Aix Marseille Univ, LPS, Aix-en-Provence, France.,UNIV. NIMES, EA 7352 CHROME, Nîmes, France
| | | | - Lionel Dany
- Aix Marseille Univ, LPS, Aix-en-Provence, France.,APHM, Timone, Service d'Oncologie Médicale, Marseille, France
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Dou L, Hu L, Zhang N, Cutler H, Wang Y, Li S. Factors Associated with Medication Adherence Among Patients with Severe Mental Disorders in China: A Propensity Score Matching Study. Patient Prefer Adherence 2020; 14:1329-1339. [PMID: 32801663 PMCID: PMC7402865 DOI: 10.2147/ppa.s255934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/26/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The 686 project provides free essential drugs and follow-up for poor SMD patients, with the purpose of improving patients' medication adherence and reducing the occurrence of dangerous behaviors. The objective of this research was to determine the factors that influence medication adherence in patients with severe mental disorders (SMD) and analyze whether the 686 program significantly improved patient medication adherence. METHODS This study was conducted among SMD patients in 686 project and non-project SMD patients in the same community in 11 cities in Shandong Province of China. The data collected included basic patient information and disease treatment information. Medication adherence was divided into good adherence and poor adherence. Propensity score matching (1:1 match) was performed to adjust for differences in baseline characteristics. RESULTS One thousand two hundred ninety-two patients receiving free medication assistance policy (686 project group) and 1292 non-policy patients (control group) were analyzed. Patients who received the 686 project group had significantly better medication adherence than the non-policy group patients (92.6% vs.61.2%). Older age and consolidation period were associated with poor adherence, and education level was the positive determinant for adherence. CONCLUSION The 686 project could improve medication adherence to patients with SMD. Additional research will pay attention to medication adherence of patients who are elderly, in consolidation period and lower education levels. It should strengthen the guidance and supervision of patients' medication and strengthen the health education of family members and patients.
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Affiliation(s)
- Lei Dou
- School of Health Care Management, Shandong University, Jinan250012, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan250012, People’s Republic of China
| | - Lili Hu
- Shandong Mental Health Center, Jinan, 250000, People’s Republic of China
| | - Nan Zhang
- School of Health Care Management, Shandong University, Jinan250012, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan250012, People’s Republic of China
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan250117, People’s Republic of China
| | - Henry Cutler
- Centre for the Health Economy Macquarie University, Sydney, 2109, Australia
| | - Yan Wang
- Health Commission of Shandong Province, Jinan250014, People’s Republic of China
| | - Shunping Li
- School of Health Care Management, Shandong University, Jinan250012, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan250012, People’s Republic of China
- Correspondence: Shunping Li School of Health Care Management, Shandong University, Wenhua Xi Road 44, Jinan, Shandong Province250012, People’s Republic of ChinaTel +86-131-8893-4998 Email
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Youngcharoen P, Saraboon Y, Aree-Ue S. Factors influencing health status in older people with knee osteoarthritis. Jpn J Nurs Sci 2019; 17:e12262. [PMID: 31617329 DOI: 10.1111/jjns.12262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/24/2018] [Accepted: 01/20/2019] [Indexed: 11/27/2022]
Abstract
AIM To examine a causal model of health status among older people with knee osteoarthritis. METHODS A cross-sectional, correlational design was used with a convenience sample of 220 older Thai people with knee osteoarthritis (mean age 68.96 years; SD = 6.22). Participants were asked to complete a demographic questionnaire, the Pain Catastrophizing Scale, the Tampa Scale of Kinesiophobia, The Medical Outcomes Study Social Support Survey, and the Arthritis Impact Measurement Scales 2-Short Form. Structural Equation Model was used to examine a hypothesized model. RESULTS Using Chi-square, hypothesized model was statistically nonsignificant. A model of health status fitted with the empirical data and explained 19.2% of variance. Pain catastrophizing had negative direct effect on self-efficacy and health status. Pain catastrophizing also had negative indirect effect on health status through self-efficacy. Self-efficacy and social support had positive direct effects on health status. However, pain-related fear had no direct or indirect effect on health status. CONCLUSION Lower level of pain catastrophizing can improve self-efficacy. Increasing of self-efficacy and social support can then lead to improvement on health status. This study highlighted the effect of psychosocial factors on health status. It is necessary to develop a program to minimize pain catastrophizing, improve social support, and promote self-efficacy to improve the health status of older people with knee osteoarthritis.
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Affiliation(s)
- Phichpraorn Youngcharoen
- Division of Adult and Gerontological Nursing, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yuwadee Saraboon
- School of Health Nursing, Mahidol University Amnatcharoen Campus, Amnatcharoen, Thailand
| | - Suparb Aree-Ue
- Division of Adult and Gerontological Nursing, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Browne J, Nagendra A, Kurtz M, Berry K, Penn DL. The relationship between the therapeutic alliance and client variables in individual treatment for schizophrenia spectrum disorders and early psychosis: Narrative review. Clin Psychol Rev 2019; 71:51-62. [PMID: 31146249 DOI: 10.1016/j.cpr.2019.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 03/30/2019] [Accepted: 05/19/2019] [Indexed: 12/31/2022]
Abstract
Given the high rates of treatment disengagement and medication nonadherence in individuals with schizophrenia spectrum disorders and early psychosis, fostering a strong alliance in treatment is critical. Moreover, the role of the therapeutic alliance extends beyond that in traditional psychotherapy because of the multifaceted nature of treatment. Thus, this review provides a comprehensive discussion of the relationship between the alliance and client variables across various provider types and individual treatments. This review summarizes existing research on (a) client correlates/predictors of the therapeutic alliance and on (b) the relationship between the alliance and client treatment outcomes in individual treatment for schizophrenia spectrum disorders and early psychosis. Parallel literature searches were conducted using PubMed and PsycINFO databases, which yielded 1202 potential studies with 84 studies meeting inclusion criteria. With regard to correlates/predictors, the existing evidence suggests that better insight, medication adherence, social support, and recovery variables were related to better client-rated alliance. Better medication adherence and recovery variables as well as less severe symptoms were related to better provider-rated alliance. In terms of alliance-outcome relationships, evidence suggests that a strong provider-rated alliance was predictive of improved functioning and medication and treatment adherence. There was some limited evidence that better client-rated alliance was related to improved recovery outcomes. Despite mixed results and heterogeneity among studies, this review suggests that a strong alliance can be beneficial in individual schizophrenia treatment. Thus, training and supervision of providers should emphasize developing a positive alliance, particularly with clients for whom developing an alliance may be difficult.
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Affiliation(s)
- Julia Browne
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Arundati Nagendra
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew Kurtz
- Department of Psychology and Neuroscience and Behavior, Wesleyan University, Middletown, CT, USA
| | - Katherine Berry
- School of Health Sciences, University of Manchester, Manchester, UK
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
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Hsieh WL, Lee SK, Chien WT, Liu WI, Lai CY, Liu CY. Mediating Effect Of The Motivation For Medication Use On Disease Management And Medication Adherence Among Community-Dwelling Patients With Schizophrenia. Patient Prefer Adherence 2019; 13:1877-1887. [PMID: 31806936 PMCID: PMC6842316 DOI: 10.2147/ppa.s218553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/19/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Nearly half of patients with schizophrenia do not adhere to the long-term medical treatment needed to manage their disease. Programs to promote medication adherence include promotion of motivation as a critical element to influence task performance. PURPOSE This study investigated the mediating effect of motivation for medication use on disease management and medication adherence in schizophrenia. METHODS This cross-sectional, descriptive correlational study enrolled a convenience sample of 373 community-dwelling patients with schizophrenia in the northern and central regions of Taiwan. Data were collected with questionnaires and a series of validated assessment tools. Hierarchical regression was used to analyze the mediating effect of motivation for medication use on disease management and medication adherence. RESULTS The medication adherence rate of the patients was 47.2%. The mediating effect of motivation for medication use on therapeutic alliance and medication adherence was 50%, whereas that on insight and medication adherence was 41% and that on medical social support and medication adherence was 72%. CONCLUSION Developing a medication motivation care model may be more effective than promoting therapeutic alliance, insight, or medical social support for promoting medication adherence. It also had greater impact on preventing relapses of community-dwelling patients with schizophrenia.
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Affiliation(s)
- Wen Ling Hsieh
- Department of Nursing, Taipei Municipal Wanfang Hospital (Managed by Taipei Medical University), Taipei City, Taiwan
| | - Shih Kai Lee
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou, Taiwan
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wen I Liu
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
- Correspondence: Wen I Liu National Taipei University of Nursing and Health Sciences, No. 365, Ming-Te Road, Peitou District, Taipei City11219, TaiwanTel +886 2 2822 7101 Ext. 3184Fax +886 2 2821 3233 Email
| | - Chien Yu Lai
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Chieh Yu Liu
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
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Antidepressant adherence in United States active duty Army Soldiers: A small descriptive study. Arch Psychiatr Nurs 2018; 32:793-801. [PMID: 30454619 DOI: 10.1016/j.apnu.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/09/2018] [Accepted: 06/02/2018] [Indexed: 11/22/2022]
Abstract
While much is known about depression and antidepressant adherence associations with illness perceptions, medication beliefs, social support, and stigma in the general population, there is a dearth of knowledge among United States active duty Army Soldiers. The study objective was to explore antidepressant adherence and correlations between antidepressant adherence and illness perceptions, medication beliefs, social support, stigma and select demographic variables among Army Soldiers with depression. Results indicated age and gender were significantly correlated with and predictive of adherence. Low adherence was found. Findings suggest Soldiers who are younger and those who are female are more likely to report higher levels of adherence.
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Wade M, Tai S, Awenat Y, Haddock G. A systematic review of service-user reasons for adherence and nonadherence to neuroleptic medication in psychosis. Clin Psychol Rev 2017; 51:75-95. [DOI: 10.1016/j.cpr.2016.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/09/2016] [Accepted: 10/26/2016] [Indexed: 12/18/2022]
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14
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Tham XC, Xie H, Chng CML, Seah XY, Lopez V, Klainin-Yobas P. Factors Affecting Medication Adherence Among Adults with Schizophrenia: A Literature Review. Arch Psychiatr Nurs 2016; 30:797-809. [PMID: 27888977 DOI: 10.1016/j.apnu.2016.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/11/2016] [Accepted: 07/11/2016] [Indexed: 11/30/2022]
Abstract
This review aimed to summarize empirical evidence concerning factors relating to medication adherence among patients with schizophrenia. A comprehensive search was implemented to recruit articles which met the present eligibility criteria. Twenty-five articles were included whereby only one was a qualitative study. Greater awareness of illness (insight), previous history of medication adherence, positive attitude toward medication, types of atypical antipsychotics, less severe psychotic symptoms, and social support were identified as factors of medication adherence. Knowledge gaps and methodological limitations were also identified. Implications to clinical practice include providing psychoeducation to patients by increasing their knowledge about illness and medication.
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Affiliation(s)
| | | | | | | | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Dikec G, Kutlu Y. Effectiveness of Adherence Therapy for People With Schizophrenia in Turkey: A Controlled Study. Arch Psychiatr Nurs 2016; 30:249-56. [PMID: 26992879 DOI: 10.1016/j.apnu.2015.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 11/02/2015] [Accepted: 11/13/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study used a quasi-experimental design with a pretest-posttest control group and follow-up to determine the efficacy of adherence therapy in patients with schizophrenia in Turkey. METHODS The sample of this study consisted of patients with schizophrenia (n=30). The Questionnaire Form, Medication Adherence Rating Scale, Internalized Stigma of Mental Illness Scale, and Beck Cognitive Insight Scale were used. The patients were assigned to experimental (n=15) and control (n=15) groups using the randomization method. The experimental group received adherence therapy in eight sessions. RESULTS When the scores of the patients in the experimental and control groups were compared at the pretest, posttest, and 3- and 6-months follow ups, a significant difference was only found in the Medication Adherence Rating Scale posttest scores. CONCLUSION Adherence therapy is effective in improving adherence to treatment but is not effective with regard to insight and internalized stigma in patients with schizophrenia.
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Affiliation(s)
- Gul Dikec
- Izmir University, School of Health, Nursing Department, Izmir, Turkey.
| | - Yasemin Kutlu
- Istanbul University, Florence Nightingale Nursing Faculty, Mental Health and Psychiatric Nursing Department, İstanbul, Turkey.
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Job strain and psychological distress among employed pregnant Thai women: role of social support and coping strategies. Arch Womens Ment Health 2014; 17:317-26. [PMID: 24414302 DOI: 10.1007/s00737-013-0410-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
Abstract
Most Thai women continue to work throughout their pregnancy; however, little is known about job strain and its relation to psychological distress. This study aimed to examine: (1) the direct effects of job strain, perceived workplace support, perceived family support, and coping strategies on psychological distress and (2) the moderating effect of perceived workplace support, perceived family support, and coping strategies on the relationship between job strain and psychological distress. Lazarus and Folkman's transactional model of stress and coping guided this cross-sectional study. Full-time employed pregnant women (N = 300) were recruited from three antenatal clinics in Thailand. Thai versions of the following instruments were used: the State-Anxiety Inventory and Center for Epidemiological Studies-Depression Scale (psychological distress), the Job Content Questionnaire (job strain and perceived workplace support), the Medical Outcome Study Social Support Survey (perceived family support), and the Ways of Coping Checklist-Revised (coping strategies). Job strain with other predictors explained 54% of the variance in psychological distress. In the separate hierarchical multiple linear regression models, two types of coping strategies, seeking social support and wishful thinking, moderated the effects of job strain on psychological distress. Perceived family support had a direct effect in reducing psychological distress. Job strain is a significant contributor to psychological distress. The average levels of seeking social support and wishful thinking were most beneficial in moderating the negative impact of job strain on psychological distress. Since perceived workplace and family support did not have moderating effects, stress management programs for decreasing the levels of job strain should be developed.
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Sanguanklin N, McFarlin BL, Park CG, Giurgescu C, Finnegan L, White-Traut R, Engstrom JL. Effects of the 2011 flood in Thailand on birth outcomes and perceived social support. J Obstet Gynecol Neonatal Nurs 2014; 43:435-44. [PMID: 24956975 DOI: 10.1111/1552-6909.12466] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the effects of displacement due to flooding during pregnancy on birth outcomes (infant birth weight and gestational age) and the moderating effect of perceived social support on the relationship between displacement and birth outcomes. DESIGN A descriptive, longitudinal study. SETTING A university-affiliated hospital in Pathum Thani, Thailand. PARTICIPANTS Pregnant women (N = 175) in the third trimester that had uncomplicated pregnancies and no history of mental illness. METHODS During pregnancy, the participants completed standardized measurements of depression symptoms, perceived social support, and questionnaires concerning the effect of the flood. After giving birth, infant birth weight and gestational age at birth were retrieved from delivery records. RESULTS Seventy percent (n = 123) of the participants experienced displacement during the flood. The displaced women had a mean infant birth weight of 175 grams less than that of the nondisplaced women, t(173) = -2.38, p = .02, whereas infant gestational age was not different. Displacement and other variables explained approximately 8% of the variance in infant birth weight. The interaction term between displacement and perceived social support was statistically significant and additionally explained the variance in infant birth weight, F(6, 168) = 3.24, p = .005. CONCLUSION Being displaced during pregnancy due to a natural disaster affected fetal growth rather than length of gestation. Health care providers should closely monitor maternal weight gain and fetal growth of pregnant women who experience displacement. Among the displaced women, social support was associated with higher infant birth weight; therefore, high levels of perceived social support may be protective for pregnant women who experience stressful events such as displacement from flooding.
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Tanioka T, Sakamaki S, Yasuhara Y, Tomotake M, Takase K, Watari C, Makiguchi K, Locsin R, Motoki K, Inui T. Optimal needle insertion length for intramuscular injection of risperidone long-acting injectable (RLAI). Health (London) 2013. [DOI: 10.4236/health.2013.512262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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