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Klein RJ, Gyorda JA, Jacobson NC. Anxiety, depression, and substance experimentation in childhood. PLoS One 2022; 17:e0265239. [PMID: 35609016 PMCID: PMC9129013 DOI: 10.1371/journal.pone.0265239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
Previous research has demonstrated that adults with comorbid depressive and anxiety disorders are significantly more likely to show pathological use of drugs or alcohol. Few studies, however, have examined associations of this type in children. A better understanding of the relationships between affective disorders and substance experimentation in childhood could help clarify the complex ways in which pathological substance use symptoms develop early in life. The present study included 11,785 children (Mage = 9.9) participating in the Adolescent Brain Cognitive Development (ABCD) study. Depressive and anxiety disorder diagnoses were evaluated as concurrent predictors of experimentation with alcohol and tobacco. A series of linear regressions revealed that children with either depressive or anxiety disorders were significantly more likely to experiment with alcohol or tobacco. However, children with both depressive and anxiety diagnoses were not more likely to experiment than children without a diagnosis. These results suggest that anxiety or depressive diagnoses in childhood may be associated with a greater likelihood of substance experimentation, but severe psychological distress may suppress these effects.
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Affiliation(s)
- Robert J. Klein
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America
| | - Joseph A. Gyorda
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America
| | - Nicholas C. Jacobson
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America
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2
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Okoli CTC, Abufarsakh B, Otachi JK. Quit and win contests in community-dwelling mental and behavioral health populations: A systematic review and pilot feasibility findings. Public Health Nurs 2021; 38:517-527. [PMID: 33427320 DOI: 10.1111/phn.12865] [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: 09/15/2020] [Revised: 11/23/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with mental illnesses (MI) benefit from incentives to promote tobacco cessation. "Quit and Win" contests are community-based approaches that incentivize cessation. However, little is known about "Quit and Win" contest effectiveness among people with MI. AIM To examine the utility of "Quit and Win" contests among people with MI. METHOD This study had two phases: (a) a systematic literature review to explore the potential effectiveness of "Quit and Win" contests for people with MI and (b) a pilot feasibility study of implementing a "Quit and Win" contest among people with MI from a community mental health program (CMHP). RESULTS In phase 1, no reviewed study specifically included people with MI in their sample. Of the four cohort and five randomized controlled studies in the review, the mean reported participant quit rates at the end of "Quit and Win" contests were 76.8% and 28.3%, respectively. In phase 2, within a CMHP, four out of seven participants completed a "Quit and Win" contest, and one individual achieved cessation. CONCLUSION People with MI may benefit from incentive-based tobacco cessation programs. Implementing a "Quit and Win" contests within a CMHP is important and requires more studies to determine feasibility and effectiveness.
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Affiliation(s)
| | | | - Janet K Otachi
- University of Kentucky College of Social Work, Lexington, KY, USA
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3
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Victor G, Sightes E, Watson DP, Ray B, Bailey K, Robision L, Fears G, Edwards R, Salyers M. Designing and implementing an intervention for returning citizens living with substance use disorder: discovering the benefits of peer recovery coach involvement in pilot clinical trial decision-making. JOURNAL OF OFFENDER REHABILITATION 2021; 60:138-158. [PMID: 33551628 PMCID: PMC7861566 DOI: 10.1080/10509674.2020.1863301] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Peer-facilitated services in behavioral health care remain underutilized within criminal justice-involved community organizations, and there is little guidance for how to best involve peer workers in behavioral health-focused research activities. This paper described lessons learned regarding implementation of peer recovery coaches (PRCs) as part of development and pilot research on Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT), a peer-facilitated substance use disorder (SUD) intervention for returning citizens. Qualitative data were collected from learning meetings with key stakeholders and group interviews with SUPPORT clinical trial participants and PRCs. Transcripts were analyzed to identify key decisions made impacting the development, implementation, and/or revision of the SUPPORT intervention and pilot clinical trial protocols. Analysis demonstrated that PRC involvement drove many of the decisions made regarding modifications to the original intervention and trial protocols, while benefitting client-level interactions and by influencing the non-profit agency and its connection to stakeholders. Moreover, PRCs improved the research design by refining the incentive structure and data collection plans. PRC involvement also contributed to the development of more recovery-oriented resources and catering support services to the unique needs of justice-involved individuals. Discussed were the implications for the role of PRCs in justice-involved behavioral health research and treatment.
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Affiliation(s)
- Grant Victor
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202
| | - Emily Sightes
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202
| | - Dennis P Watson
- Lighthouse Institute, Chestnut Health Systems, 1003 Martin Luther King Jr Dr, Bloomington, IL 61701
| | - Bradley Ray
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202
| | - Katie Bailey
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202
| | - Lisa Robision
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, 818 S. Wolcott, Chicago, IL 60612
| | - Gina Fears
- Public Advocates in Community re-Entry, 2855 N. Keystone Ave., Indianapolis, IN 46218
| | - Rhiannon Edwards
- Public Advocates in Community re-Entry, 2855 N. Keystone Ave., Indianapolis, IN 46218
| | - Michelle Salyers
- Departement of Psychology, 402 N. Blackford St., Indianapolis, IN 46202
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4
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Haga SB. Toward digital-based interventions for medication adherence and safety. Expert Opin Drug Saf 2020; 19:735-746. [DOI: 10.1080/14740338.2020.1764935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Susanne B Haga
- Duke School of Medicine, Center for Applied Genomics and Precision Medicine, Durham, NC, USA
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Jawad I, Watson S, Haddad PM, Talbot PS, McAllister-Williams RH. Medication nonadherence in bipolar disorder: a narrative review. Ther Adv Psychopharmacol 2018; 8:349-363. [PMID: 30524703 PMCID: PMC6278745 DOI: 10.1177/2045125318804364] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/01/2018] [Indexed: 12/14/2022] Open
Abstract
A number of effective maintenance medication options exist for bipolar disorder (BD) and these are regarded as the foundation of long-term treatment in BD. However, nonadherence to medication is common in BD. For example, a large data base study in the United States of America (USA) showed that approximately half of patients with BD were nonadherent with lithium and maintenance medications over a 12 month period. Such nonadherence carries a high risk of relapse due to the recurrent nature of the illness and the fact that abrupt cessation of treatment, particularly lithium, may cause rebound depression and mania. Indeed, medication nonadherence in BD is associated with significantly increased risks of relapse, recurrence, hospitalization and suicide attempts and a decreased likelihood of achieving remission and recovery, as well as with higher overall treatment costs. Factors associated with nonadherence include adverse effects of medication, complex medication regimens, negative patient attitudes to medication, poor insight, rapid-cycling BD, comorbid substance misuse and a poor therapeutic alliance. Clinicians should routinely enquire about nonadherence in a nonjudgmental fashion. Potential steps to improve adherence include simple pragmatic strategies related to prescribing including shared decision-making, psychoeducation with a clear focus on adherence, reminders (traditional and digital), potentially using a depot rather than an oral antipsychotic, managing comorbid substance misuse and improving therapeutic alliance. Financial incentives have been shown to improve adherence to depot antipsychotics, but this approach raises ethical issues and its long-term effectiveness is unknown. Often a combination of approaches will be required. The strategies that are adopted need to be patient specific, reflecting that nonadherence has no single cause, and chosen by the patient and clinician working together.
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Affiliation(s)
- Ibrahim Jawad
- Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Stuart Watson
- Northern Centre for Mood Disorders and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter M Haddad
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Peter S Talbot
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic, Health Science Centre, Manchester, UK
| | - R Hamish McAllister-Williams
- Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Northern Centre for Mood Disorders and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
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Minami H, Brinkman HR, Nahvi S, Arnsten JH, Rivera-Mindt M, Wetter DW, Bloom EL, Price LH, Vieira C, Donnelly R, McClain LM, Kennedy KA, D'Aquila E, Fine M, McCarthy DE, Graham Thomas J, Hecht J, Brown RA. Rationale, design and pilot feasibility results of a smartphone-assisted, mindfulness-based intervention for smokers with mood disorders: Project mSMART MIND. Contemp Clin Trials 2018; 66:36-44. [PMID: 29288740 PMCID: PMC5841579 DOI: 10.1016/j.cct.2017.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/22/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although individuals with psychiatric disorders are disproportionately affected by cigarette smoking, few outpatient mental health treatment facilities offer smoking cessation services. In this paper, we describe the development of a smartphone-assisted mindfulness smoking cessation intervention with contingency management (SMI-CM), as well as the design and methods of an ongoing pilot randomized controlled trial (RCT) targeting smokers receiving outpatient psychiatric treatment. We also report the results of an open-label pilot feasibility study. METHODS In phase 1, we developed and pilot-tested SMI-CM, which includes a smartphone intervention app that prompts participants to practice mindfulness, complete ecological momentary assessment (EMA) reports 5 times per day, and submit carbon monoxide (CO) videos twice per day. Participants earned incentives if submitted videos showed CO≤6ppm. In phase 2, smokers receiving outpatient treatment for mood disorders are randomized to receive SMI-CM or enhanced standard treatment plus non-contingent CM (EST). RESULTS The results from the pilot feasibility study (N=8) showed that participants practiced mindfulness an average of 3.4times/day (≥3min), completed 72.3% of prompted EMA reports, and submitted 68.0% of requested CO videos. Participants reported that the program was helpful overall (M=4.85/5) and that daily mindfulness practice was helpful for both managing mood and quitting smoking (Ms=4.50/5). CONCLUSIONS The results from the feasibility study indicated high levels of acceptability and satisfaction with SMI-CM. The ongoing RCT will allow evaluation of the efficacy and mechanisms of action underlying SMI-CM for improving cessation rates among smokers with mood disorders.
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Affiliation(s)
| | | | - Shadi Nahvi
- Albert Einstein College of Medicine, Montefiore Medical Center, United States
| | - Julia H Arnsten
- Albert Einstein College of Medicine, Montefiore Medical Center, United States
| | | | | | - Erika Litvin Bloom
- Rhode Island Hospital, Alpert Medical School of Brown University, United States
| | - Lawrence H Price
- Butler Hospital, Alpert Medical School of Brown University, United States
| | | | | | | | | | | | | | - Danielle E McCarthy
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States
| | - J Graham Thomas
- Weight Control and Diabetes Research Center, Alpert Medical School of Brown University, United States
| | - Jacki Hecht
- University of Texas at Austin, United States
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Priebe S, Bremner SA, Lauber C, Henderson C, Burns T. Financial incentives to improve adherence to antipsychotic maintenance medication in non-adherent patients: a cluster randomised controlled trial. Health Technol Assess 2018; 20:1-122. [PMID: 27682868 DOI: 10.3310/hta20700] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Poor adherence to long-term antipsychotic injectable (LAI) medication in patients with psychotic disorders is associated with a range of negative outcomes. No psychosocial intervention has been found to be consistently effective in improving adherence. OBJECTIVES To test whether or not offering financial incentives is effective and cost-effective in improving adherence and to explore patient and clinician experiences with such incentives. DESIGN A cluster randomised controlled trial with economic and nested qualitative evaluation. The intervention period lasted for 12 months with 24 months' follow-up. The unit of randomisation was mental health teams in the community. SETTING Community teams in secondary mental health care. PARTICIPANTS Patients with a diagnosis of schizophrenia, schizoaffective psychosis or bipolar illness, receiving ≤ 75% of their prescribed LAI medication. In total, 73 teams with 141 patients (intervention n = 78 and control n = 63) were included. INTERVENTIONS Participants in the intervention group received £15 for each LAI medication. Patients in the control group received treatment as usual. MAIN OUTCOME MEASURES PRIMARY OUTCOME adherence to LAI medication (the percentage of received out of those prescribed). SECONDARY OUTCOMES percentage of patients with at least 95% adherence; clinical global improvement; subjective quality of life; satisfaction with medication; hospitalisation; adverse events; and costs. Qualitative evaluation: semistructured interviews with patients in the intervention group and their clinicians. RESULTS PRIMARY OUTCOME outcome data were available for 131 patients. Baseline adherence was 69% in the intervention group and 67% in the control group. During the intervention period, adherence was significantly higher in the intervention group than in the control group (85% vs. 71%) [adjusted mean difference 11.5%, 95% confidence interval (CI) 3.9% to 19.0%; p = 0.003]. Secondary outcome: patients in the intervention group showed statistically significant improvement in adherence of at least 95% (adjusted odds ratio 8.21, 95% CI 2.00 to 33.67; p = 0.003) and subjective quality of life (difference in means 0.71, 95% CI 0.26 to 1.15; p = 0.002). Follow-ups: after incentives stopped, adherence did not differ significantly between groups, neither during the first 6 months (adjusted difference in means -7.4%, 95% CI -17.0% to 2.1%; p = 0.175) nor during the period from month 7 to month 24 (difference in means -5.7%, 95% CI -13.1% to 1.7%; p = 0.130). Cost-effectiveness: the average costs of the financial incentives was £303. Overall costs per patient were somewhat higher in the intervention group, but the difference was not significant. Semistructured interviews: the majority of patients and clinicians reported positive experiences with the incentives beyond their monetary value. These included improvement in the therapeutic relationship. The majority of both patients and clinicians perceived no negative impact after the intervention was stopped after 1 year. CONCLUSIONS Financial incentives are effective in improving adherence to LAI medication. Health-care costs (including costs of the financial incentive) are unlikely to be increased substantially by this intervention. Once the incentives stop, the advantage is not maintained. The experiences of both patients and clinicians are largely, but not exclusively, positive. Whether or not financial incentives are effective for patients with more favourable background, those on oral mediation or for shorter or longer time periods remains unknown. TRIAL REGISTRATION Current Controlled Trials ISRCTN77769281. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 70. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stefan Priebe
- Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Stephen A Bremner
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House, University of Brighton, Brighton, UK
| | - Christoph Lauber
- Services Psychiatriques, Jura bernois, Bienne-Seeland, Bellelay, Switzerland
| | - Catherine Henderson
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Tom Burns
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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8
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Cather C, Pachas GN, Cieslak KM, Evins AE. Achieving Smoking Cessation in Individuals with Schizophrenia: Special Considerations. CNS Drugs 2017; 31:471-481. [PMID: 28550660 PMCID: PMC5646360 DOI: 10.1007/s40263-017-0438-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Premature mortality due to cardiovascular disease in those with schizophrenia is the largest lifespan disparity in the US and is growing; adults in the US with schizophrenia die, on average, 28 years earlier than those in the general population. The rate of smoking prevalence among individuals with schizophrenia is estimated to be from 64 to 79%. Smokers with schizophrenia have historically been excluded from most large nicotine-dependence treatment studies. However, converging evidence indicates that a majority of smokers with schizophrenia want to quit smoking, and that available pharmacotherapeutic smoking cessation aids are well tolerated by this population of smokers and are effective when combined with behavioral treatment. The aim of this review is to present updated evidence for safety and efficacy of smoking cessation interventions for those with schizophrenia spectrum illness. We also highlight implications of the very low abstinence rates for smokers with schizophrenia who receive placebo plus behavioral treatment in randomized trials, and review treatment approaches to address the high rate of rapid relapse observed upon pharmacologic treatment discontinuation in this population. Recommendations for monitoring for treatment-emergent nicotine withdrawal symptoms, side effects, and effects of cessation on antipsychotic medication are also provided. Smokers with schizophrenia spectrum disorders should be encouraged to quit smoking and should receive varenicline, bupropion with or without nicotine replacement therapy (NRT), or NRT, all in combination with behavioral treatment for at least 12 weeks. Maintenance pharmacotherapy may reduce relapse and improve sustained abstinence rates. Controlled trials in smokers with schizophrenia consistently show no greater rate of neuropsychiatric adverse events with pharmacotherapeutic cessation aids than with placebo.
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Affiliation(s)
- Corinne Cather
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford Street, Boston, MA, 02114, USA.
- Schizophrenia Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Gladys N Pachas
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford Street, Boston, MA, 02114, USA
| | - Kristina M Cieslak
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford Street, Boston, MA, 02114, USA
- Schizophrenia Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - A Eden Evins
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford Street, Boston, MA, 02114, USA
- Schizophrenia Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Tidey JW. A behavioral economic perspective on smoking persistence in serious mental illness. Prev Med 2016; 92:31-35. [PMID: 27196141 PMCID: PMC5085837 DOI: 10.1016/j.ypmed.2016.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/05/2016] [Accepted: 05/15/2016] [Indexed: 01/17/2023]
Abstract
Serious mental illness (SMI) is associated with disproportionately high rates of cigarette smoking. The identification of factors that contribute to persistent smoking in people with SMI may lead to the development and adoption of tobacco control policies and treatment approaches that help these smokers quit. This commentary examines factors underlying smoking persistence in people with SMI from the perspective of behavioral economics, a discipline that applies economic principles to understanding drug abuse and dependence. Studies, conducted in the Northeastern US within the past 30years, that compare the reinforcing effects of nicotine and the costs of smoking in smokers with and without schizophrenia and depression are discussed, and interventions that may reduce the reinforcing efficacy of nicotine and increase the costs of smoking in people with SMI are described.
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Affiliation(s)
- Jennifer W Tidey
- Department of Psychiatry & Human Behavior, Center for Alcohol & Addiction Studies, Brown University, Providence, RI 02912, United States.
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10
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Priebe S, Bremner SA, Pavlickova H. Discontinuing financial incentives for adherence to antipsychotic depot medication: long-term outcomes of a cluster randomised controlled trial. BMJ Open 2016; 6:e011673. [PMID: 27655261 PMCID: PMC5051432 DOI: 10.1136/bmjopen-2016-011673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES In a cluster randomised controlled trial, offering financial incentives improved adherence to antipsychotic depot medication over a 1-year period. Yet, it is unknown whether this positive effect is sustained once the incentives stop. METHODS AND ANALYSES Patients in the intervention and control group were followed up for 2 years after the intervention. Primary and secondary outcomes were assessed at 6 months and 24 months post intervention. Assessments were conducted between September 2011 and November 2014. RESULTS After the intervention period, intervention and control groups did not show any statistically significant differences in adherence, neither in the first 6 months (71% and 77%, respectively) nor in the following 18 months (68%, 74%). There were no statistically significant differences in secondary outcomes, that is, adherence ≥95% and untoward incidents either. CONCLUSIONS It may be concluded that incentives to improve adherence to antipsychotic maintenance medication are effective only for as long as they are provided. Once they are stopped, adherence returns to approximately baseline level with no sustained benefit. TRIAL REGISTRATION NUMBER ISRCTN77769281; Results.
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Affiliation(s)
- Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University London, London, UK
| | - Stephen A Bremner
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Hana Pavlickova
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University London, London, UK
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11
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Farholm A, Sørensen M. Motivation for physical activity and exercise in severe mental illness: A systematic review of intervention studies. Int J Ment Health Nurs 2016; 25:194-205. [PMID: 26916699 DOI: 10.1111/inm.12214] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/03/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Abstract
There has been increasing interest for research on motivation for physical activity (PA) and exercise among individuals with severe mental illness (SMI). The aim of this systematic review is to summarize findings from all intervention studies on PA or exercise that either include empirical data on motivational constructs or apply motivational techniques/theories in their intervention. Systematic searches of seven databases were conducted from database inception to February 2015. Studies were eligible if they: (i) included participants with SMI, (ii) had PA as part of the intervention, and (iii) reported empirical data on motivational constructs related to PA or incorporated motivational techniques/theory in their intervention. Of the 79 studies that met the inclusion criteria only one had motivation for PA as its main outcome. Nine additional interventions reported empirical data on motivational constructs. Altogether these studies yielded mixed results with respect to change in motivational constructs. Only one of those examined the association between motivation and PA, but found none. Sixty-four studies reported using motivational techniques/theory in their intervention. Motivational interviewing and goal-setting were the most popular techniques. Due to the exploratory nature of most of these studies, findings from intervention studies do not so far give very clear directions for motivational work with the patients. There is an urgent need for a more systematic theory based approach when developing strategies that target to increase engagement in PA among people with SMI.
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12
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Evins AE, Cather C, Laffer A. Treatment of tobacco use disorders in smokers with serious mental illness: toward clinical best practices. Harv Rev Psychiatry 2015; 23:90-8. [PMID: 25747922 PMCID: PMC4460830 DOI: 10.1097/hrp.0000000000000063] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Addiction to tobacco-derived nicotine remains highly prevalent in the United States, with 18% using daily, and 53% of those with serious mental illness using daily. While smokers with serious mental illness have been excluded from most large nicotine-dependence treatment studies, a growing evidence base is available to guide clinicians in assisting their patients with psychiatric illness to quit smoking. The aim of this review is to present the evidence on safety and efficacy of smoking cessation interventions for those with serious mental illness. Smokers with schizophrenia spectrum disorders should receive varenicline or bupropion with or without nicotine replacement therapy in combination with behavioral treatment. Although more research is needed, preliminary evidence suggests that varenicline in combination with behavioral support is efficacious and well tolerated for smoking cessation for those with bipolar disorder and major depressive disorder. Controlled trials have found no evidence that in patients with serious mental illness, the use of pharmacotherapeutic cessation aids worsens psychiatric symptoms or increases the rate of psychiatric adverse events. Converging evidence indicates that a majority of smokers with serious mental illness want to quit smoking and that available pharmacotherapeutic cessation aids combined with behavioral support are both effective for, and well tolerated by, these smokers.
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Affiliation(s)
- A Eden Evins
- From Harvard Medical School (Drs. Evins and Cather); Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (Drs. Evins and Cather, and Ms. Laffer)
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13
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Effective Cessation Strategies for Smokers with Schizophrenia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2015; 124:133-47. [DOI: 10.1016/bs.irn.2015.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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Davidson A, Jensen M, Burgess E, Stevens A, Hayes L, Sieweke S, Stough K, Wright A, McCarty R, Eddleman L, Kim YI, Milby JB, Schumacher JE. Effects of therapeutic goal management (TGM) on treatment attendance and drug abstinence among men with co-occurring substance use and axis I mental disorders who are homeless: results of the Birmingham EARTH program. Addict Sci Clin Pract 2013; 8:17. [PMID: 24499617 PMCID: PMC3829098 DOI: 10.1186/1940-0640-8-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 10/21/2013] [Indexed: 11/21/2022] Open
Abstract
Purpose This study describes the implementation and impact of Therapeutic Goal Management (TGM) in a Substance Abuse and Mental Health Services Administration (SAMHSA)-sponsored demonstration project entitled Enhanced Addiction Recovery through Housing (EARTH). Participants The sample included 28 male participants followed at six months who completed some treatment. Forty-three percent were Caucasian, and 57% were African American. The average age of participants was 42 years. Design The relationships between TGM goal achievement, treatment attendance, and drug abstinence outcomes were studied among EARTH program participants who were homeless and met criteria for co-occurring substance use and severe DSM-IV Axis I mental disorders. Results The results revealed an overall drug abstinence rate of 72.4% over six months and significant positive relationships between TGM goal achievement and drug abstinence (r = 0.693) and TGM goal achievement and treatment attendance (r = 0.843). Conclusions This research demonstrated the relationship and potential positive impact of systematically setting, monitoring, and reinforcing personalized goals in multiple life areas on drug abstinence and treatment attendance outcomes among persons who are homeless with co-occurring substance use and other Axis I disorders in a integrated community service delivery program.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Joseph E Schumacher
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, MT 616, Birmingham, AL 35205, USA.
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15
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Priebe S, Yeeles K, Bremner S, Lauber C, Eldridge S, Ashby D, David AS, O'Connell N, Forrest A, Burns T. Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: cluster randomised controlled trial. BMJ 2013; 347:f5847. [PMID: 24100934 PMCID: PMC3805491 DOI: 10.1136/bmj.f5847] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To test whether offering financial incentives to patients with psychotic disorders is effective in improving adherence to maintenance treatment with antipsychotics. DESIGN Cluster randomised controlled trial. SETTING Community mental health teams in secondary psychiatric care in the United Kingdom. PARTICIPANTS Patients with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder, who were prescribed long acting antipsychotic (depot) injections but had received 75% or less of the prescribed injections. We randomly allocated 73 teams with a total of 141 patients. Primary outcome data were available for 35 intervention teams with 75 patients (96% of randomised) and for 31 control teams with 56 patients (89% of randomised). INTERVENTIONS Participants in the intervention group were offered £15 (€17; $22) for each depot injection over a 12 month period. Participants in the control condition received treatment as usual. MAIN OUTCOME MEASURE The primary outcome was the percentage of prescribed depot injections given during the 12 month intervention period. RESULTS 73 teams with 141 consenting patients were randomised, and outcomes were assessed for 131 patients (93%). Average baseline adherence was 69% in the intervention group and 67% in the control group. During the 12 month trial period adherence was 85% in the intervention group and 71% in the control group. The adjusted effect estimate was 11.5% (95% confidence interval 3.9% to 19.0%, P=0.003). A secondary outcome was an adherence of ≥ 95%, which was achieved in 28% of the intervention group and 5% of the control group (adjusted odds ratio 8.21, 95% confidence interval 2.00 to 33.67, P=0.003). Although differences in clinician rated clinical improvement between the groups failed to reach statistical significance, patients in the intervention group had more favourable subjective quality of life ratings (β=0.71, 95% confidence interval 0.26 to 1.15, P=0.002). The number of admissions to hospital and adverse events were low in both groups and did not show substantial differences. CONCLUSION Offering modest financial incentives to patients with psychotic disorders is an effective method for improving adherence to maintenance treatment with antipsychotics. TRIAL REGISTRATION Current Controlled Trials ISRCTN77769281.
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Affiliation(s)
- Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, Newham Centre for Mental Health, London E13 8SP, UK
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Krishnan-Sarin S, Cavallo DA, Cooney JL, Schepis TS, Kong G, Liss TB, Liss AK, McMahon TJ, Nich C, Babuscio T, Rounsaville BJ, Carroll KM. An exploratory randomized controlled trial of a novel high-school-based smoking cessation intervention for adolescent smokers using abstinence-contingent incentives and cognitive behavioral therapy. Drug Alcohol Depend 2013; 132:346-51. [PMID: 23523130 PMCID: PMC3748248 DOI: 10.1016/j.drugalcdep.2013.03.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/03/2013] [Accepted: 03/04/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are few effective smoking cessation interventions for adolescent smokers. We developed a novel intervention to motivate tobacco use behavior change by (1) enhancing desire to quit through the use of abstinence-contingent incentives (CM), (2) increasing cessation skills through the use of cognitive behavioral therapy (CBT), and (3) removing cessation barriers through delivery within high schools. METHODS An exploratory four-week, randomized controlled trial was conducted in Connecticut high schools to dismantle the independent and combined effects of CM and CBT; smokers received CM alone, CBT alone, or CM+CBT. Participants included 82 adolescent smokers seeking smoking cessation treatment. The primary outcome was seven-day end-of-treatment (EOT) point prevalence (PP) abstinence, determined using self-reports confirmed using urine cotinine levels. Secondary outcomes included one-day EOT PP abstinence and cigarette use during treatment and follow up. RESULTS Among participants who initiated treatment (n=72), group differences in seven-day EOT-PP abstinence were observed (χ(2)=10.48, p<0.01) with higher abstinence in the CM+CBT (36.7%) and CM (36.3%) conditions when compared with CBT (0%). One-day EOT-PP abstinence evidenced similar effects (χ(2)=10.39, p<0.01; CM+CBT: 43%, CM: 43%, CBT: 4.3%). Survival analyses indicated differences in time to first cigarette during treatment (χ(2)=8.73, p=0.003; CBT: Day 3, CM: Day 9, CM+CBT: Day 20). At one- and three-month follow ups, while no differences were observed, the CM alone group had the slowest increase in cigarette use. CONCLUSIONS High-school, incentive-based smoking cessation interventions produce high rates of short-term abstinence among adolescent smokers; adding cognitive behavioral therapy does not appear to further enhance outcomes.
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Affiliation(s)
- Suchitra Krishnan-Sarin
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, United States.
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Park AL, McDaid D, Weiser P, Von Gottberg C, Becker T, Kilian R. Examining the cost effectiveness of interventions to promote the physical health of people with mental health problems: a systematic review. BMC Public Health 2013; 13:787. [PMID: 23988266 PMCID: PMC3765875 DOI: 10.1186/1471-2458-13-787] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 08/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently attention has begun to focus not only on assessing the effectiveness of interventions to tackle mental health problems, but also on measures to prevent physical co-morbidity. Individuals with mental health problems are at significantly increased risk of chronic physical health problems, such as cardiovascular disease or diabetes, as well as reduced life expectancy. The excess costs of co-morbid physical and mental health problems are substantial. Potentially, measures to reduce the risk of co-morbid physical health problems may represent excellent value for money. METHODS To conduct a systematic review to determine what is known about economic evaluations of actions to promote better physical health in individuals identified as having a clinically diagnosed mental disorder, but no physical co-morbidity. Systematic searches of databases were supplemented by hand searches of relevant journals and websites. RESULTS Of 1970 studies originally assessed, 11 met our inclusion criteria. In addition, five protocols for other studies were also identified. Studies looked at exercise programmes, nutritional advice, smoking, alcohol and drug cessation, and reducing the risk of blood borne infectious diseases such as HIV/AIDS and hepatitis. All of the lifestyle and smoking cessation studies focused on people with depression and anxiety disorders. Substance abuse and infectious disease prevention studies focused on people with psychoses and bipolar disorder. CONCLUSIONS There is a very small, albeit growing, literature on the cost effectiveness of interventions to promote the physical health of people with mental health problems. Most studies suggest that value for money actions in specific contexts and settings are available. Given that the success or failure of health promoting interventions can be very context specific, more studies are needed in more settings, focused on different population groups with different mental health problems and reporting intermediate and long term outcomes. There is a need to better distinguish between resource use and costs in a transparent manner, including impacts outside of the health care system. Issues such as programme fidelity, uptake and adherence should also be accounted for in economic analysis. The role of behavioural psychological techniques to influence health behaviours might also be considered.
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Affiliation(s)
- A-La Park
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
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18
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Affiliation(s)
- Stephen T Higgins
- Department of Psychiatry, University of Vermont, University Health Center Campus, 1 S. Prospect St, Burlington, VT 05401, USA.
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Bonevski B, Bryant J, Lynagh M, Paul C. Money as motivation to quit: a survey of a non-random Australian sample of socially disadvantaged smokers' views of the acceptability of cash incentives. Prev Med 2012; 55:122-6. [PMID: 22691939 DOI: 10.1016/j.ypmed.2012.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 05/31/2012] [Accepted: 06/01/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to a) assess acceptability of personal financial incentives to socially disadvantaged smokers and non-smokers; b) examine factors associated with acceptability; and c) examine preferred levels of incentive amounts. METHODS A cross-sectional touch screen computer survey was conducted between February and October 2010 in New South Wales, Australia. Participants were clients experiencing financial or social hardship and receiving emergency welfare aid from a non-government social and community service organisation. RESULTS Of 383 participants (69% response rate), 46% believed personal financial incentives were an excellent/good idea, 47% believed personal financial incentives did more good than harm and 61% agreed they would motivate smokers to quit. High acceptability ratings were associated with participants being female, current smokers, living in low socioeconomic areas, experiencing smoking-induced deprivation, making a previous quit attempt and intending to quit in the next 6 months. When asked what amount of incentive they felt would be acceptable, 23% selected amounts between $50 and $500 AUD and 37% selected amounts over $500 AUD. CONCLUSIONS Given high smoking prevalence among socially disadvantaged groups and consequent health disparities, it is imperative novel methods of encouraging smoking cessation are explored and tested. This survey found financial incentives may be an acceptable method. Further research to understand all possible positive and negative effects is warranted.
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Affiliation(s)
- B Bonevski
- Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, NSW, Australia.
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Ratliff JC, Palmese LB, Tonizzo KM, Chwastiak L, Tek C. Contingency management for the treatment of antipsychotic-induced weight gain: a randomized controlled pilot study. Obes Facts 2012; 5:919-27. [PMID: 23296213 PMCID: PMC6902254 DOI: 10.1159/000345975] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 06/06/2012] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Weight gain is common for individuals with serious mental illness (SMI) receiving antipsychotic drug therapy. Contingency management (CM) is a behavioral intervention that rewards positive performance and has demonstrated effectiveness in reducing drug use in SMI populations. This study evaluated the feasibility of using CM to promote weight loss in individuals with SMI over 8 weeks. METHOD 30 individuals (BMI ≥ 28 kg/m(2)) were randomized to one of three conditions: i) The combination of a standardized lifestyle modification (LM) program for individuals with SMI and payment for group attendance (CM(attendance)), ii) The combination of LM and payment for weight loss (CM(weight)), and iii) waitlist control (CON). After the waitlist period, those participants joined a LM group and received payment for behavioral change (CM(behavior)). RESULTS Subjects in the CM(attendance) and in the CM(weight) group lost a mean of 1.16 kg and 1.23 kg, respectively, while subjects in the CON gained a mean of 0.68 kg. Subjects receiving CM(behavior), lost a mean of 2.54 kg, which was a significant weight loss compared to the control period. CONCLUSION LM supplemented with CM may facilitate weight loss in patients taking antipsychotic medications; financial reimbursement for behavioral change may be particularly effective in this population.
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Affiliation(s)
- Joseph C Ratliff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
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