Drug and alcohol trajectories among adults with schizophrenia: data from the CATIE study

Employment Trends in Rhode Island From 2011 to 2017 for Adults With Intellectual Disability and Developmental Disabilities

This study reports on state-level data in Rhode Island on employment and non-work activities of adults with intellectual and developmental disabilities receiving services between 2011 and 2017. The goal was to examine the complex patterns of change over time in individual-level employment outcomes and the potential short-term impacts of a consent decree entered into by the state of Rhode Island to address integrated employment outcomes. Findings suggest that policy initiatives such as the consent decree can lead to reductions in reliance on facility-based work, but also highlight the importance of planning for the transition to competitive, integrated employment and not simply a shift toward non-work activities. Further, the data support the notion that the best predictor of integrated employment over time is previous experiences in integrated employment (not facility-based or other work or non-work activities), suggesting the role of ongoing supported employment and transition services that create and support the maintenance of integrated employment.

Visualization of Categorical Longitudinal and Times Series Data

Plotting growth curves is a powerful graphical approach used in exploratory data analysis for continuous longitudinal data. However, plotted growth curves for multiple participants rapidly become uninterpretable with categorical data. Categorical data define specific states (e.g., being single, married, divorced), and these states do not necessarily need to represent any hierarchical order. Thus, a trajectory becomes a sequence of states rather than a continuum. We introduce a horizontal line plot that uses shade or color to differentiate between states on a categorical longitudinal variable for multiple participants. With appropriate sorting, stacking the horizontal lines that represent each participant can reveal important patterns such as the shape of, or heterogeneity in, the trajectories. We illustrate the plotting techniques for large sample sizes, observed groups, the exploration of unobserved latent classes, large numbers of time points such as are found with intensive longitudinal designs or multivariate time series data, individually varying times observation, unique numbers of observations, and missing data. We used the R package longCatEDA to create the illustrations. Illustrative data include both simulated data and alcohol consumption data in adult schizophrenics from the Clinical Antipsychotic Trials of Intervention Effectiveness.

Hostility in schizophrenia: An integrated analysis of the combined Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and the European First Episode Schizophrenia Trial (EUFEST) studies

Phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study enrolled a sample of 1493 chronic schizophrenia patients. The European First Episode Schizophrenia Trial (EUFEST) enrolled 498 patients. We have combined these two samples to study the effects of hostility on study discontinuation as well as to examine correlates and predictors of hostility. Individual data from 1154 patients with complete data were used for analyses. Survival analysis demonstrated that higher hostility was associated with earlier all-cause treatment discontinuation. Furthermore, regression analysis indicated that increased hostility was associated with more severe positive symptoms, lower adherence to pharmacological treatment, younger age, impaired insight, and more drug or alcohol consumption. The clinical implications of the results point to the importance of establishing therapeutic alliance while managing patient's symptoms of hostility with antipsychotics such as olanzapine combined with psychosocial interventions to improve insight and reduce substance use.

Treatment adherence in schizophrenia: a patient-level meta-analysis of combined CATIE and EUFEST studies

The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) obtained a sample of 1493 chronic schizophrenia patients. The European First Episode Schizophrenia Trial (EUFEST) studied a sample of 498 patients. We have combined these two samples to study the predictors and correlates of adherence to treatment. Here we report on adherence to pharmacological treatment at the six and twelve month assessments of these trials with a combined subsample of 1154 schizophrenia patients. Individual patients׳ data were used for analyses. We used logistic regression to examine the effects of substance use, akathisia, parkinsonism, dyskinesia, hostility, and insight on pharmacological adherence. The results showed that reduced adherence to pharmacological treatment was associated with substance use (p=0.0003), higher levels of hostility (p=0.0002), and impaired insight (p<0.0001). Furthermore, poor adherence to study medication was associated with earlier discontinuation in the combined data. The clinical implications of the results point to the importance of routine assessments and interventions to address patients׳ insight and comorbid substance use and the establishment of therapeutic alliance.

Latent class analysis of discordance between results of drug use assessments in the CATIE data

OBJECTIVE

The primary aim is to examine concordant/discordant results of drug use assessments in adults with schizophrenia.

METHODS

Latent class analysis and multinomial logistic regression were used to examine concordance/discordance between drug use measures and identify characteristics differentiating participants across classes.

RESULTS

Four classes - non-users, users, probable users, and RIA discordant - fit best. Age, sex, race/ethnicity, and psychiatric symptoms differed significantly across classes.

CONCLUSIONS

Findings showed that discordance between results occurs at non-trivial rates and is, in part, attributable to individual characteristics. Results suggest the need for strategies to limit discordance and improve detection of drug use in adults with schizophrenia.