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González-Rodríguez A, Monreal JA, Mv MVS. Factors Influencing Adherence to Antipsychotic Medications in Women with Delusional Disorder: A Narrative Review. Curr Pharm Des 2022; 28:1282-1293. [PMID: 35272589 DOI: 10.2174/1381612828666220310151625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/29/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Adherence to medication regimens is of great importance in psychiatry because drugs sometimes need to be taken for long durations in order to maintain health and function. OBJECTIVE To review influences on adherence to antipsychotic medications, the treatment of choice for delusional disorder (DD), and to focus on adherence in women with DD. METHOD A non-systematic narrative review of papers published since 2000 using PubMed and Google Scholar and focusing on women with DD and medication adherence. RESULTS Several factors have been identified as exerting influence on adherence in women with persistent delusional symptoms who are treated with antipsychotics. Personality features, intensity of delusion, perception of adverse effects, and cognitive impairment are patient factors. Clinical time spent with the patient, clarity of communication and regular drug monitoring are responsibilities of the health provider. Factors that neither patient nor clinician can control are the social determinants of health such as poverty, easy access to healthcare, and cultural variables. CONCLUSIONS There has been little investigation into factors that influence adherence in the target population discussed here -e.g. women with DD. Preliminary results of this literature search indicate that solutions from outside the field of DD may apply to this population. Overall, a solid therapeutic alliance appears to be the best hedge against non-adherence.
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Affiliation(s)
- Alexandre González-Rodríguez
- Department of Mental Health. Mutua Terrassa University Hospital. University of Barcelona. Terrassa, Barcelona, Spain
| | - José Antonio Monreal
- Department of Mental Health. Mutua Terrassa University Hospital. University of Barcelona. Institut de Neurociències. UAB. CIBERSAM, Terrassa, Barcelona, Spain
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Marques-Teixeira J, Amorim G, Pires AC. Results from PSIPROSPER: A multicenter retrospective study to analyze the impact of treatment with paliperidone palmitate 1-month on clinical outcomes and hospital resource utilization in adult patients with schizophrenia in Portugal. Front Psychiatry 2022; 13:992256. [PMID: 36386977 PMCID: PMC9663469 DOI: 10.3389/fpsyt.2022.992256] [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] [Received: 07/12/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Schizophrenia is a chronic psychiatric disorder with a significant impact worldwide. The early onset and its relapsing nature pose a significant challenge to patients and caregivers. The PSIPROSPER study aimed to characterize the real-world context of schizophrenia treatment in Portugal and to measure the impact of including paliperidone palmitate 1-month formulation (PP1M) in the clinical outcomes (relapses and hospitalizations) and healthcare resource utilization, in a context in which payment scheme in Portugal allows for patients to receive free antipsychotics if prescribed at public hospitals. METHODS This was a multicenter, retrospective, observational study. Male and female adults with a diagnosis of schizophrenia who initiated treatment with PP1M after a minimum of 12 months on an Oral Antipsychotic (OAP), and with complete medical charts, were consecutively included. A mirror-image design over 24 months allowed the comparison of outcomes before and after the PP1M introduction. RESULTS Out of the 51 patients included, 80.4% were male, with a mean age of 34 (±9.8) years. Around 92% of patients were being treated with PP1M at inclusion. Lack of adherence to previous OAP was the main driver for PP1M initiation. Only 9.8% of patients were hospitalized during the PP1M period vs. 64.7% during the OAP period (p < 0.0001). The mean number of hospitalizations (0.1) was significantly lower during the PP1M period (p < 0.0001). Type of treatment was the only variable found to be significant in predicting a lower hospitalization rate and a lower risk of hospitalization. Relapses were significantly lower (p < 0.0001) in PP1M (21.6%) vs. OAP (83.7%). Similarly, the mean change in the number of relapses (p < 0.0001) showed significantly better outcomes in PP1M. CONCLUSION This study supports PP1M as part of schizophrenia treatment in Portugal. Given the lower number of relapses and hospitalizations observed in schizophrenia patients treated with PP1M when compared to OAP-treated patients, this real-world study seems to provide further evidence to support the use of PP1M to treat this condition, in line with previous research. In the context of scarce public resources, these benefits should be carefully considered by healthcare decision-makers to ensure optimal value-based treatment strategies.
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Stip E, Grignon S, Roy MA, Bloom D, Osman O, Amiri L, Abdel Aziz K, Javaid SF, Arnone D. From QAAPAPLE 1 to QAAPAPLE 2: how do we move from one algorithm to another one with Long Acting Antipsychotics (LAIs). Expert Rev Neurother 2020; 20:1325-1332. [PMID: 32962466 DOI: 10.1080/14737175.2020.1826930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In 2011, the authors published an algorithm summarizing practice guidelines related to the use of long-acting antipsychotics (LAIs) called the Québec Algorithme Antipsychotique à Action Prolongée (QAAPAPLE), and proposed that it be revised every 5-10 years to update it according to most recent scientific knowledge. Therefore, a re-evaluation of the algorithm was conducted to determine which recommendations were still relevant and which needed modification. METHODS The authors conducted a two-fold approach: a review of the literature to include new evidence since 2011 (controlled trials, meta-analyses, and practice guidelines); and a participatory component involving electronic surveys, conferences, encounters with opinion leadres, and patients' representatives. RESULTS Overall, prescribers tended to make decisions based on personal experience and conversations with colleagues rather than consulting evidence-based guidelines. To test if the algorithm was useful worldwide, it was presented in the United Arab Emirates, where the feedback was in agreement with the algorithm and its limitations. CONCLUSIONS Since its initial publication, the QAAPAPLE algorithm has been updated to guide clinicians on the use of LAIs. The new algorithm has also been assessed outside Canada to test its generalizability worldwide, and indicated its flexibility, efficiency, and user-friendliness in order to guide clinicians on the use of LAIs.
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Affiliation(s)
- Emmanuel Stip
- College of Medicine and Health Sciences, United Arab Emirates University , Al Ain, United Arab Emirates.,Centre Hospitalier Universitaire de Montreal (CHUM), Institute Universitaireen Santé Mentale de Montréal, Université de Montreal, Montreal, Canada
| | - Sylvain Grignon
- Department of Psychiatry, University of Sherbrooke , Sherbrooke, QC, Canada.,Department of Psychiatry, University of Laval , Quebec, QC, Canada
| | - Marc André Roy
- Department of Psychiatry, University of Laval , Quebec, QC, Canada.,Department of Psychiatry, McGill University , Montreal, QC, Canada
| | - David Bloom
- Department of Psychiatry, McGill University , Montreal, QC, Canada
| | - Ossama Osman
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, the University of Texas Health Science Center , Texas, USA
| | - Leena Amiri
- College of Medicine and Health Sciences, United Arab Emirates University , Al Ain, United Arab Emirates
| | - Karim Abdel Aziz
- College of Medicine and Health Sciences, United Arab Emirates University , Al Ain, United Arab Emirates
| | - Syed Fahad Javaid
- College of Medicine and Health Sciences, United Arab Emirates University , Al Ain, United Arab Emirates
| | - Danilo Arnone
- College of Medicine and Health Sciences, United Arab Emirates University , Al Ain, United Arab Emirates.,Kings' College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK
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