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Parental Factors Associated with Child or Adolescent Medication Adherence: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11040501. [PMID: 36833035 PMCID: PMC9957533 DOI: 10.3390/healthcare11040501] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Medication adherence, especially among children and adolescents with psychiatric disorders, is often seen as a major treatment challenge. The purpose of this study is to systematically review studies addressing specific aspects of parental factors that are positively or negatively associated with medication adherence among children and adolescents with psychiatric disorders. A systematic literature search of English language publications, from inception through December 2021, was conducted from PubMed, Scopus, and MEDLINE databases. This review has complied with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. A total of 23 studies (77,188 participants) met inclusion criteria. Nonadherence rates ranged between 8% to 69%. Parents' socioeconomic background, family living status and functioning, parents' perception and attitude towards the importance of medication taking in treating psychiatric disorders, and parents' mental health status are significant parental characteristics associated with medication adherence in children and adolescents with psychiatric disorders. In conclusion, by identifying specific parental characteristics related to the medication adherence of children and adolescents with psychiatric disorders, targeted interventions on parents could be developed to guide parents in improving their child's medication adherence.
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Benarous X, Cottin G, Lahaye H, de la Rivière SG, Guilé JM, Speranza M, Bonnot O, Cohen D. Efficacy, Tolerability, and Acceptance of Long-Lasting Antipsychotics in Children and Adolescents: A Systematic Review. J Child Adolesc Psychopharmacol 2022; 32:312-327. [PMID: 35613381 DOI: 10.1089/cap.2021.0124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objectives: While long-lasting antipsychotics (LLA) were specifically developed to address the problem of adherence in patients with chronic psychiatric disorders, their role in pediatric populations is not clear. Methods: To document the efficacy, tolerance, and acceptance of LLAs in children and adolescents, a literature search was conducted using several databases for published studies (PubMed, PsycINFO) from January 1965 to December 2020. Twenty-two studies were identified (16 case reports/series, 3 open label studies, 2 controlled studies, and 1 retrospective analysis of national database). Results: Demographic features were widely heterogeneous across studies (total N = 480, 58% male, mean age = 15.0 ± 1.8). Case reports/series presented positive therapeutic outcomes in noncompliant youths with severe mental illness. Three open-label one-arm studies supported the clinical efficacy of risperidone long-acting injection in patients previously stabilized with oral risperidone. One study showed lower clinical symptoms and higher functioning at 12 months in youths treated for an acute psychotic episode with paliperidone palmitate compared to oral risperidone. The types and rates of side effects of LLA were comparable to those observed for oral antipsychotics. Two studies suggested better metabolic and neurological tolerance of LLA compared to an oral form. Preliminary evidence supported a satisfactory level of treatment satisfaction in patients treated with LLA and their families, while concerns were raised regarding practical administration in outpatient services. However, the average quality of the evidence based on the RoB2 tool was low. Conclusions: The level of evidence was low for the efficacy of LLA in pediatric populations and very low for the tolerance and acceptance. It concerned mostly the effect of risperidone long-acting injection in adolescents with psychotic disorders. Randomized maintenance clinical trials using noninferiority analysis would be more appropriate for further research.
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Affiliation(s)
- Xavier Benarous
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France.,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Guillaume Cottin
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France.,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Hélène Lahaye
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France.,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Sébastien Garny de la Rivière
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France.,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Jean-Marc Guilé
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France.,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Mario Speranza
- Department of Child and Adolescent Psychiatry, Versailles University Hospital, Versailles, France
| | - Olivier Bonnot
- Department of Child and Adolescent Psychiatry, Nantes University Hospital, Nantes, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France.,CNRS UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonne University, Paris, France
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Suk JW, Soltis-Vaughan B, Mahato K, Hwang S. Practical and Ethical Issues in Pediatric Psychopharmacology: Introductory Considerations. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210913-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Missing from the Narrative: A Seven-Decade Scoping Review of the Inclusion of Black Autistic Women and Girls in Autism Research. Behav Anal Pract 2021; 15:1093-1105. [PMID: 36605161 PMCID: PMC9745006 DOI: 10.1007/s40617-021-00654-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 01/09/2023] Open
Abstract
The intersectional experiences of Black autistic women and girls (BAWG) are missing from medical and educational research on autism spectrum disorder (ASD). Understanding the intersectional experiences of BAWG is important due to the rising prevalence of autism in Black children and girls (Centers for Disease Control and Prevention (CDC), 2020) and the concurrent lack of availability of culturally relevant autism-related interventions (Maenner et al., 2020; West et al., 2016). Intersectionality is the study of the overlapping discrimination produced by systems of oppression (Collins, 2019; Crenshaw, 1989, 1991) and allows the researcher to simultaneously address race and disability in special education (Artiles, 2013). In this scoping review, the authors used the PRISMA-ScR checklist (Tricco et al., 2018) and Arskey and O'Malley's (2005) framework to investigate the degree to which autism-related research (ARR) has included the intersectional experiences of BAWG. Utilizing narrative synthesis, strengths and gaps across the current body of literature are identified in order to set new directions for intersectional ARR. Overall, the authors found that across a 77-year period, three studies foregrounded BAWG and none addressed intersectionality as measured through criteria advanced by García and Ortiz (2013). These results reveal the scholarly neglect BAWG face in ARR, discourse, policy, and practice. A future agenda including research, practice, and policy priorities is identified and discussed.
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Sanchez M, Lytle S, Neudecker M, McVoy M. Medication Adherence in Pediatric Patients with Bipolar Disorder: A Systematic Review. J Child Adolesc Psychopharmacol 2021; 31:86-94. [PMID: 33465006 DOI: 10.1089/cap.2020.0098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Pediatric bipolar disorder is a severe disabling condition affecting 1%-3% of youth worldwide. Both acute and maintenance treatment with medications are mainstays of treatment. It is well established in adult literature that adherence to medications improves outcomes and many adult studies have examined factors impacting adherence. This systematic review set out to identify the current state of research examining adherence to medications and characteristics influencing adherence in pediatric bipolar disorder. Methods: We performed a systematic literature review in the Medline, PsycINFO, CINAHL, EMBASE, Wiley Clinical Trials, and Cochrane databases. New research regarding characteristics and measurement of adherence to psychotropic medication for bipolar disorder (I, II, or not otherwise specified) in patients ≤18 years old were included for review. Exclusion criteria included no bipolar diagnosis, inclusion of patients >18 years old, no pharmacologic treatment, and lack of adherence measurements. Results: Initial search generated 439 articles after duplicate removal. One hundred thirty-three full-text articles were reviewed, 16 underwent additional review and 6 were selected for final inclusion. The majority of articles were excluded for patients >18 years old. Included articles were extremely heterogeneous for multiple measures, including methodology, determination of adherence, adherence rates, and characteristics influencing adherence. Of medications evaluated, 6/6 studies included mood stabilizers, 4/6 antidepressants, 3/6 antipsychotics, and 2/6 psychostimulants. Three out of six articles included patients <12 years old. Some significant factors affecting adherence included polypharmacy, comorbid psychiatric diagnoses, socioeconomic status, sex, family history and functioning, side effects, race, stability of bipolar diagnosis, and number of follow-up visits attended. Conclusions: Pediatric-specific information on medication adherence in bipolar disorder is very limited. Information on patient characteristics that may influence adherence rates is critical to target interventions to improve adherence. No articles reported on interventions to improve adherence. Given the different psychosocial situations of pediatric patients versus adults, it is likely that targets for improving adherence differ in pediatric patients.
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Affiliation(s)
- Matthew Sanchez
- Department of Child and Adolescent Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sarah Lytle
- Department of Child and Adolescent Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mandy Neudecker
- Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Molly McVoy
- Department of Child and Adolescent Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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6
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Chakrabarti S. Treatment Attitudes and Adherence Among Patients with Bipolar Disorder: A Systematic Review of Quantitative and Qualitative Studies. Harv Rev Psychiatry 2020; 27:290-302. [PMID: 31385812 DOI: 10.1097/hrp.0000000000000228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Systematic reviews about treatment attitudes of patients influencing adherence in bipolar disorder (BD) are rare. METHODS A systematic review was conducted according to the PRISMA guidelines and principles of thematic synthesis. Selectively identified quantitative and qualitative studies were used to examine the attitude-adherence relationship in BD, the types and correlates of treatment attitudes, and the impact of psychosocial interventions on attitudes. RESULTS The final list of 163 articles included 114 observational reports (incorporating 21 psychosocial intervention trials), 45 qualitative/descriptive studies, and 4 patient surveys. A positive association between treatment attitudes and adherence was found in most quantitative and qualitative studies, though the strength of the relationship was unclear. Thematic analysis of qualitative studies suggested that patient attitudes influencing adherence were based on perceived advantages and disadvantages of treatment. The principal correlates of patients' attitudes were family attitudes, the clinician-patient alliance, social support, and patients' knowledge of BD. Though negative attitudes such as denial, concerns about adverse treatment consequences, and stigmatizing effects of treatment were common, many patients believed treatment to be beneficial and necessary. The limited data on the effect of psychosocial interventions indicated that treatments selectively targeting attitudes enhanced adherence. LIMITATIONS The studies were heterogeneous in design; the quality was uneven (fair to poor); and the risk of bias moderate to high. CONCLUSIONS Despite these flaws, awareness of the existing evidence on the attitude-adherence association and other aspects of treatment attitudes in BD can help in efforts to address nonadherence in BD.
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Affiliation(s)
- Subho Chakrabarti
- From the Department of Psychiatry, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh (India)
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Goldstein TR, Krantz ML, Fersch-Podrat RK, Hotkowski NJ, Merranko J, Sobel L, Axelson D, Birmaher B, Douaihy A. A brief motivational intervention for enhancing medication adherence for adolescents with bipolar disorder: A pilot randomized trial. J Affect Disord 2020; 265:1-9. [PMID: 31957686 PMCID: PMC8713513 DOI: 10.1016/j.jad.2020.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Youth with bipolar disorder (BP) exhibit poor medication adherence, contributing to affective recurrence. Brief Motivational Interventions (BMIs) improve adherence among adolescents with chronic conditions. METHODS In an open pilot series, we developed a 3-session BMI for BP adolescents targeting medication adherence and conducted a pilot randomized trial comparing Standard Care (SC) versus SC+BMI. Participants include 43 adolescents with BP prescribed psychotropic medications. We assessed medication adherence objectively via bluetooth-enabled electronic pillbox (MedTracker). A blinded evaluator assessed mood symptoms at intake, 3- and 6-months. RESULTS The BMI was well-received. Average objective medication adherence increased with time in SC+BMI, but decreased in SC-Alone (p < 0.0001). Adolescents' baseline self-rated expectation of improvement with treatment moderated the effect of treatment on improvement in adherence over time (p = 0.003). Across groups, poor adherence predicted increased likelihood of depression and hypo/mania symptoms in the subsequent two weeks; medication adherence mediated the effect of the BMI on the likelihood of depressive symptoms (p = 0.007). LIMITATIONS Electronic pillbox use (across groups) may enhance adherence, resulting in overestimates compared with naturalistic conditions. This pilot randomized trial may have been underpowered to detect some group differences. CONCLUSIONS A BMI offers promise as a disseminable adjunctive intervention for improving medication adherence for adolescents with BP. Future studies with larger samples can establish efficacy. NCT03203720.
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Affiliation(s)
- Tina R. Goldstein
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Megan L. Krantz
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Nina J. Hotkowski
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John Merranko
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Loren Sobel
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David Axelson
- Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio
| | - Boris Birmaher
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Antoine Douaihy
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Chakrabarti S. Treatment alliance and adherence in bipolar disorder. World J Psychiatry 2018; 8:114-124. [PMID: 30425942 PMCID: PMC6230924 DOI: 10.5498/wjp.v8.i5.114] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/07/2018] [Accepted: 10/23/2018] [Indexed: 02/05/2023] Open
Abstract
The clinician patient relationship lies at the core of psychiatric practice and delivery of mental health care services. The concept of treatment alliance in psychiatry has its origins in psychotherapy, but has also been influenced by several other constructs such as patient-centred care (PCC) and shared decision-making (SDM). Similarly, there has been a shift in conceptualization of treatment-adherence in psychiatric disorders including bipolar disorder (BD) from illness-centred and clinician-centred approaches to patient-centred ones. Moreover, the traditional compliance based models are being replaced by those based on concordance between clinicians and patients. Newer theories of adherence in BD place considerable emphasis on patient related factors and the clinician patient alliance is considered to be one of the principal determinants of treatment-adherence in BD. Likewise, current notions of treatment alliance in BD also stress the importance of equal and collaborative relationships, sensitivity to patients' viewpoints, sharing of knowledge, and mutual responsibility and agreement regarding decisions related to treatment. Accumulated evidence from quantitative research, descriptive accounts, qualitative studies and trials of psychosocial interventions indicates that efficacious treatment alliances have a positive influence on adherence in BD. Then again, research on the alliance-adherence link in BD lags behind the existing literature on the subject in other medical and psychiatric conditions in terms of the size and quality of the evidence, the consistency of its findings and clarity about underlying processes mediating this link. Nevertheless, the elements of an effective alliance which could have a positive impact on adherence in BD are reasonably clear and include PCC, collaborative relationships, SDM, open communication, trust, support, and stability and continuity of the relationship. Therefore, clinicians involved in the care of BD would do well to follow these principles and improve their interpersonal and communication skills in order to build productive alliances with their patients. This could go a long way in confronting the ubiquitous problem of non-adherence in BD. The role of future research in firmly establishing the alliance-adherence connection and uncovering the processes underlying this association will also be vital in devising effective ways to manage non-adherence in BD.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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9
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Niemeyer L, Schumm L, Mechler K, Jennen-Steinmetz C, Dittmann RW, Häge A. "When I Stop My Medication, Everything Goes Wrong": Content Analysis of Interviews with Adolescent Patients Treated with Psychotropic Medication. J Child Adolesc Psychopharmacol 2018; 28:655-662. [PMID: 30148662 DOI: 10.1089/cap.2018.0072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Medication nonadherence constitutes a major problem in adolescent psychiatry. Previous studies have identified various factors associated with nonadherent behavior. The aim of this study is to explore adolescents' health beliefs and subjective perceptions relating to psychotropic medication, and to statistically link these to reported medication adherence. METHODS The findings presented in this study are part of the multicenter SEMA study (Subjective Experience and Medication Adherence in Adolescents with Psychiatric Disorders). Patients 12-18 years of age were included, who had been treated with a psychotropic medication for at least 2 weeks. The validated MARS (Medication Adherence Rating Scale) and the QATT (Questionnaire on Attitudes Toward Treatment) were used to measure adherence, and a qualitative semi-structured interview was conducted to examine patients' subjective experiences and perceptions. A conventional content analysis was conducted, and Fisher's exact tests were performed to analyze group differences between completely adherent and not completely adherent patients. RESULTS A total of 64 patients were included in the study. 40.6% (n = 26) were classified as not completely adherent. Distribution patterns of answers to 7 out of 64 questions showed statistically significant group differences between completely and not completely adherent patients. Patients with lower adherence reported the following: feeling worse after taking medication; a lower sense of self-efficacy concerning the improvement of their symptoms; a less trustful physician-patient relationship; a worsened attitude toward medication after experiencing adverse events/"side effects"; less support from their relatives; and fewer individuals in their family who were fully informed about their condition. CONCLUSIONS To our knowledge, this is the first interview-based study to investigate subjective experiences and health beliefs of adolescents with psychiatric disorders and to correlate these findings with rates of medication adherence. The study results will be useful for the development of tools and approaches to increase medication adherence, for example, psychoeducation programs and personalized treatment concepts.
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Affiliation(s)
- Larissa Niemeyer
- 1 Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg , Mannheim, Germany
| | - Lucca Schumm
- 1 Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg , Mannheim, Germany
| | - Konstantin Mechler
- 1 Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg , Mannheim, Germany
| | - Christine Jennen-Steinmetz
- 2 Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg , Mannheim, Germany
| | - Ralf W Dittmann
- 1 Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg , Mannheim, Germany
| | - Alexander Häge
- 1 Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg , Mannheim, Germany
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Edgcomb JB, Zima B. Medication Adherence Among Children and Adolescents with Severe Mental Illness: A Systematic Review and Meta-Analysis. J Child Adolesc Psychopharmacol 2018; 28:508-520. [PMID: 30040434 DOI: 10.1089/cap.2018.0040] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis of studies investigating predictors of medication adherence in children and adolescents with severe mental illness (SMI). METHOD A systematic literature search was conducted in PubMed/MEDLINE, Web of Science, and PsycINFO from 1980 through October 1st, 2017, for original peer-reviewed articles that investigated predictors of adherence to psychopharmacologic treatment among children (≤18-years-old) with a primary psychotic disorder, bipolar disorder, depression, recent suicide attempt, or psychiatric hospitalization. Effect sizes (ESs) for individual predictors were extracted and combined using DerSimonian-Laird random-effects meta-analysis. Meta-regression and moderator analyses were conducted to investigate subgroups. This review complied with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. RESULTS A total of 28 studies (n = 180,870) met inclusion criteria; 65.9% (±20.9%) of children and adolescents with SMI were medication adherent. Adherence was associated with patient and family attitudes toward care, adherence to psychotherapy, and insight. Nonadherence was associated with illness severity, substance use, and attention-deficit/hyperactivity disorder. Heterogeneity was moderate-to-large for most ES estimates (I2 > 50%). Age, sex, underlying diagnosis, and study methodology emerged as significant moderators. CONCLUSION Medication nonadherence among youth with SMI is highly prevalent. Children and adolescents with more severe illness and higher comorbidity burden are at greater risk for nonadherence. Positive interpersonal care processes and adherence to nonpharmacological treatment may be protective. These findings inform development of a risk profile for nonadherence among youth with SMI. Future prospective research is needed to address the shortcomings in the existing literature and inform interventions to improve adherence.
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Affiliation(s)
- Juliet Beni Edgcomb
- 1 Department of Psychiatry and Behavioral Sciences, University of California , Los Angeles, Los Angeles, California
| | - Bonnie Zima
- 2 Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, University of California , Los Angeles, Los Angeles, California
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Chakrabarti S. Medication non-adherence in bipolar disorder: Review of rates, demographic and clinical predictors. World J Meta-Anal 2017; 5:103-123. [DOI: 10.13105/wjma.v5.i4.103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/24/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To conduct a systematic search for all studies examining rates and demographic and illness-related determinants of medication non-adherence in bipolar disorder (BD).
METHODS A comprehensive literature search was undertaken of six English-language databases to identify published articles on medication non-adherence in BD from inception till December 2016. Any article, either a review or an original-research article was examined for its relevance to the subject. All such articles were manually searched to locate any further articles containing relevant information. Studies were included only if they had adequately described the patient sample, assessment methods and statistical procedures, presented their results systematically and their conclusions were congruent with the results.
RESULTS The initial search yielded 249 articles on the subject; of these 198 articles were included. Of the 162 original-research studies, 132 had provided information on rates of medication non-adherence in BD. There was a wide variation in rates ranging from universal adherence (100%) to almost universal non-adherence (96%); this discrepancy was more due to methodological differences than true variations in rates. Notwithstanding the significant discrepancies in methodology, based on these 132 studies mean rates of 41.5%-43% and median rates of 40%-41% were obtained for medication non-adherence in BD. Rates of adherence with mood stabilizers were significantly lower than those for antipsychotics, or for medications of all classes. None of the demographic attributes were unequivocally linked to medication non-adherence in BD. Similarly, medication-related variables such as type of medications, doses, treatment regimens and side effects did not demonstrate consistent associations with non-adherence. Among clinical characteristics the presence of comorbid substance use disorder and absence of insight were the only two factors clearly linked to non-adherence in BD.
CONCLUSION Medication non-adherence is prevalent in about a third to half of patients with BD. Demographic, illness and treatment related factors do not predict non-adherence with certainty.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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12
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Häge A, Weymann L, Bliznak L, Märker V, Mechler K, Dittmann RW. Non-adherence to Psychotropic Medication Among Adolescents - A Systematic Review of the Literature. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 46:69-78. [PMID: 27925499 DOI: 10.1024/1422-4917/a000505] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction Whether patients take their medication as prescribed is of increasing importance in adolescent psychiatry since both the number of efficacious pharmaceutical treatments and the rate of prescriptions of psychotropic compounds are on the rise. Previous research showed high rates of medication nonadherence among both adolescents with medical disorders and adult patients with psychiatric disorders. Methods The present review was performed according to PRISMA guidelines and evaluates existing scientific literature concerning adherence to psychotropic medication among adolescents. The goal was to determine rates of nonadherence in this age group as well as the factors associated with it. Therefore, we conducted a comprehensive literature search of PubMed from its inception until 15 September 2015 using the keywords "adherence," "compliance," "adolescent," and "psychotropic medication." Results A total of 607 pertinent articles were collected and screened; 15 publications were selected for detailed review. The studies differed, among other things, regarding sample characteristics, medication type, and indications. Furthermore, the definitions of what constitutes nonadherence and the methods used to assess it varied widely. Nonadherence rates ranged from 6 % to 62 % (median 33 %). Conclusions Nonadherence to psychotropic medication is a clinically relevant problem among adolescents. Because of the methodological heterogeneity across studies and partially contradictory results, no conclusions could be drawn concerning the influence of factors such as psychopathology, medication type, side effects, the effectiveness of treatment, or family-related factors. Well-designed long-term studies of large patient samples and a consensus regarding definitions are therefore warranted. Such research would facilitate the design of tailored strategies to improve adherence in these patients.
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Affiliation(s)
- Alexander Häge
- 1 Research Group of Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Lisa Weymann
- 1 Research Group of Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Lucia Bliznak
- 1 Research Group of Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Viktoria Märker
- 2 Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Germany
| | - Konstantin Mechler
- 1 Research Group of Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Ralf W Dittmann
- 1 Research Group of Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
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Goldstein TR, Krantz M, Merranko J, Garcia M, Sobel L, Rodriguez C, Douaihy A, Axelson D, Birmaher B. Medication Adherence Among Adolescents with Bipolar Disorder. J Child Adolesc Psychopharmacol 2016; 26:864-872. [PMID: 27419273 PMCID: PMC5178003 DOI: 10.1089/cap.2016.0030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To examine medication adherence and associated factors among adolescents with bipolar disorder (BP) using both objective and subjective methods. METHOD Participants were 21 adolescents with a primary BP diagnosis recruited from a pediatric specialty clinic. All participants were prescribed at least one psychotropic medication. Self- and parent-reported adherence were assessed monthly over 6 months. Objective data on medication adherence were gathered through an electronic weekly pillbox. Demographic and clinical factors were assessed through self, parent, and physician ratings at baseline, 3, and 6 months. RESULTS Objective data indicate 41.5% of doses (58.6% of days) were not taken as prescribed over a mean of 3 months of follow-up. Subjective reports (patient, parent, and physician) significantly overestimated adherence as compared with objective data. Factors from multiple domains were associated with poorer adherence, including more daily doses, higher weight, dose timing (poorer on mornings/afternoons and weekends), less temporal proximity to medication management appointment, greater self-reported cognitive difficulties with adhering to treatment; the most potent predictor of missed doses was greater overall illness severity. CONCLUSIONS Findings provide further evidence of poor medication adherence among youth with BP, and highlight the limits of subjective report of adherence. Providers should give careful attention to adherence when making decisions regarding treatment response and changes to medication regimen when working with youth with BP.
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Affiliation(s)
- Tina R Goldstein
- 1 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Megan Krantz
- 1 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - John Merranko
- 1 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Matthew Garcia
- 1 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Loren Sobel
- 1 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Carlos Rodriguez
- 2 Hospital of Fuerteventura , Canary Health Service, Canary Islands, Spain
| | - Antoine Douaihy
- 1 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | | | - Boris Birmaher
- 1 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
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14
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Rates and predictors of adherence to psychotropic medications in children with autism spectrum disorders. J Autism Dev Disord 2015; 44:2931-48. [PMID: 24929833 DOI: 10.1007/s10803-014-2156-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Medication adherence in children is poor, particularly among those with chronic or mental health disorders. However, adherence has not been fully assessed in autism spectrum disorders (ASDs). The validated proportion of days covered method was used to quantify adherence to psychotropic medication in Medicaid-eligible children who met diagnostic criteria for ASD between 2000 and 2008 (N = 628). Among children prescribed attention deficit hyperactivity disorder (ADHD) medications, antidepressants, or antipsychotics, 44, 40 and 52 % were adherent respectively. Aggressive behaviors and abnormalities in eating, drinking, and/or sleeping, co-occurring ADHD, and the Medication Regimen Complexity Index were the most significant predictors of adherence rather than demographics or core deficits of ASD. Identifying barriers to adherence in ASD may ultimately lead to improved treatment outcomes.
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15
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Timlin U, Hakko H, Heino R, Kyngäs H. Factors that Affect Adolescent Adherence to Mental Health and Psychiatric Treatment: a Systematic Integrative Review of the Literature. Scand J Child Adolesc Psychiatr Psychol 2015. [DOI: 10.21307/sjcapp-2015-010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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16
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Timlin U, Hakko H, Heino R, Kyngäs H. A systematic narrative review of the literature: adherence to pharmacological and nonpharmacological treatments among adolescents with mental disorders. J Clin Nurs 2014; 23:3321-34. [PMID: 24646418 DOI: 10.1111/jocn.12589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To review current research into the adherence to mental health treatment by adolescents. BACKGROUND Nonadherence to medication among adolescents has been studied much more extensively than nonadherence to other forms of treatment. Monitoring adherence to all recommended services is essential when assessing the long-term effectiveness of different treatment programmes. Healthcare professionals who treat patients with mental illness must be able to accurately determine which of their patients are adhering to all prescribed treatments. DESIGN This is a systematic narrative literature review of the current literature. METHODS Using a narrative synthesis, the data from 15 relevant articles concerning adolescents in inpatient or outpatient mental health care were extracted and synthesised. RESULTS The reviewed papers are discussed in terms of the methods used to study treatment adherence, the working definition of adherence used in each case and the results obtained concerning adherence in adolescents. Thirty-four to sixty-seven per cent of adolescents treated are fully adherent to their medication and exhibit reasonably good follow-through for the recommended treatments. However, rates of noncompliance with medication are quite high, and significant numbers of adolescents choose to discontinue their medication. CONCLUSIONS This review synthesises current published data on adherence to mental health treatment among adolescents in order to provide practitioners and researchers with a better understanding of this important area. It is recommended that future investigations should focus on adherence in inpatient care, adherence to nonpharmacological treatments and the identification of factors that influence adherence. RELEVANCE TO CLINICAL PRACTICE The monitoring and understanding of adherence to recommended services is important. Therefore, these findings can be used by healthcare professionals who treat patients with mental illness to help them assess which of their patients are adhering to the prescribed treatments.
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Affiliation(s)
- Ulla Timlin
- Institute of Health Sciences, University of Oulu and Oulu University Hospital, Oulu, Finland
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17
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Gardner DM, Murphy AL, Kutcher S, Beaulieu S, Carandang C, Labelle A, Lalonde P, Malla A, Milliken H, O’Donovan C, Schaffer A, Soni J, Taylor VH, Williams R. Evidence review and clinical guidance for the use of ziprasidone in Canada. Ann Gen Psychiatry 2013; 12:1. [PMID: 23347694 PMCID: PMC3564821 DOI: 10.1186/1744-859x-12-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/14/2013] [Indexed: 12/17/2022] Open
Abstract
While indicated for schizophrenia and acute mania, ziprasidone's evidence base and use in clinical practice extends beyond these regulatory approvals. We, an invited panel of experts led by a working group of 3, critically examined the evidence and our collective experience regarding the effectiveness, tolerability and safety of ziprasidone across its clinical uses. There was no opportunity for manufacturer input into the content of the review. As anticipated, ziprasidone was found to be effective for its indicated uses, although its utility in mania and mixed states lacked comparative data. Beyond these uses, the available data were either unimpressive or were lacking. An attractive characteristic is its neutral effect on weight thereby providing patients with a non-obesogenic long-term treatment option. Key challenges in practice include the need for dosing on a full stomach and managing its early onset adverse effect of restlessness. Addressing these issues are critical to its long-term success.
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Affiliation(s)
- David M Gardner
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Andrea L Murphy
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Stan Kutcher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Carlo Carandang
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Alain Labelle
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Pierre Lalonde
- Centre de recherche Fernand-Seguin de l’Hôpital Louis-H. Lafontaine, Montreal, QC, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Heather Milliken
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Claire O’Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jorge Soni
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Richard Williams
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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18
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Timlin U, Riala K, Kyngäs H. Adherence to treatment among adolescents in a psychiatric ward. J Clin Nurs 2012; 22:1332-42. [DOI: 10.1111/jocn.12024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Ulla Timlin
- Institute of Health Sciences; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Kaisa Riala
- Department of Psychiatry; Oulu University Hospital; Oulu Finland
- Department of Adolescent Psychiatry; Helsinki University Central Hospital; Helsinki Finland
| | - Helvi Kyngäs
- Institute of Health Sciences; University of Oulu; Oulu Finland
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Moses T. Adolescents' commitment to continuing psychotropic medication: a preliminary investigation of considerations, contradictions, and correlates. Child Psychiatry Hum Dev 2011; 42:93-117. [PMID: 20953829 DOI: 10.1007/s10578-010-0209-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This mixed-method study examines (1) the extent to which fifty adolescents receiving wraparound treatment and prescribed psychotropic medication for various psychiatric disorders report that they would continue taking medication if the decision was entirely their own (termed "medication commitment"); (2) their general subjective experiences with medication; and (3) which medication experiences and clinical, social, and demographic factors are associated with greater medication commitment. We found that most adolescents (62%) would discontinue treatment; these "less committed" youth were more likely to report various negative medication perceptions and experiences in open-ended questions, relative to "committed" youth. Multivariate analysis indicated that significant correlates of commitment to medication were: taking antipsychotic medication, greater perceived family support, and lack of perceived coercion to take the medication; clinical or demographic factors were not significantly related to medication commitment. The results reinforce the importance of addressing youths' concerns about medication and maximizing their participation in treatment decision-making.
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Affiliation(s)
- Tally Moses
- School of Social Work, University of Wisconsin-Madison, 1350 University Ave., Madison, WI 53706, USA.
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20
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Hamrin V, McCarthy EM, Tyson V. Pediatric Psychotropic Medication Initiation and Adherence: A Literature Review Based on Social Exchange Theory. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2010; 23:151-72. [DOI: 10.1111/j.1744-6171.2010.00237.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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21
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Munson MR, Floersch JE, Townsend L. Are Health Beliefs Related to Adherence Among Adolescents with Mood Disorders? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2009; 37:408-16. [DOI: 10.1007/s10488-009-0255-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Brunelle J, Consoli A, Tanguy ML, Huynh C, Perisse D, Deniau E, Guilé JM, Gérardin P, Cohen D. Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents: a chart review. Eur Child Adolesc Psychiatry 2009; 18:185-93. [PMID: 19129964 DOI: 10.1007/s00787-008-0715-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 07/06/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The existence of bipolar disorder type I (BD-I) during adolescence is now clearly established whereas there are still some controversies on BD-II and BD-NOS diagnosis, mainly in Europe (O'Dowd in Br Med J 29, 2006). Little is known on the phenomenology and potential short-term prognosis factors of bipolar episodes in this age population. In particular, very few studies examine this issue on inpatients in the European context of free access to care. OBJECTIVE To describe the phenomenology of acute manic and mixed episodes in hospitalized adolescents and to analyse potential predictive factors associated with clinical improvement at discharge and length of hospitalization. METHODS A total of 80 subjects, aged 12-20 years, consecutively hospitalized for a manic or mixed episode. Socio-demographic and clinical data were extracted by reviewing patients' charts. We used a multivariate analysis to evaluate short-term outcome predictors. RESULTS The sample was characterized by severe impairment, high rates of psychotic features (N = 50, 62.5%), a long duration of stay (mean 80.4 days), and an overall good improvement (86% very much or much improved). Thirty-three (41.3 %) patients had a history of depressive episodes, 13 (16.3%) had manic or brief psychotic episodes but only 3 (3.7%) had a history of attention deficit/hyperactivity disorders. More manic episodes than mixed episodes were identified in subjects with mental retardation (MR) and in subjects from migrant and/or low socio-economic families. Overall severity and female gender predicted better improvement in GAF scores. Poor insight and the existence of psychotic features predicted longer duration of stay. CONCLUSION These results suggest that severe manic and mixed episodes in adolescents with BD-I need prolonged inpatient care to improve and that socio-cultural factors and MR should be examined more closely in youth with BD.
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Affiliation(s)
- Julie Brunelle
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Groupe Hospitalier Pitié-Salpétrière, 47 Bd de l'Hôpital, PARIS cedex 13, France
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23
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Abstract
Ethnicity is reported to be an important, but often ignored factor in psychopharmacology. However, recent advances in molecular biology and the vision of 'personalised medicine' have spurred a debate on the role of ethnicity in this field. This paper reviews literature on the role of race and ethnicity in psychopharmacology. Despite considerable controversy on what the concepts of ethnicity and race actually measure, they are considered as important proxies for a person's culture, diet, beliefs, health behaviours and societal attitudes. Research has shown ethnic differences in the clinical presentation, treatment, clinical response and outcome of mental illnesses. A number of ethnically specific variations have been found in the genetic and non-genetic mechanisms affecting pharmacokinetics and dynamics of psychotropic drugs, which might underlie the previously mentioned differences in drug use and response across ethnicities. Although some of these ethnic differences could be partially explained by genetic factors, a number of ethnically based variables like culture, diet and societal attitudes could potentially have a significant, but as yet unquantified influence as well. Future research needs to address the problems with defining and accurately measuring 'ethnicity', as well as focus upon conducting studies that could guide treatments for people from diverse backgrounds.
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Affiliation(s)
- Ib Chaudhry
- School of Medicine, University of Manchester, UK.
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24
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Gully KJ, Price BL, Johnson MK. Increasing abused children's access to evidence-based treatment: diffusion via parents as consumers. CHILD MALTREATMENT 2008; 13:280-288. [PMID: 18359928 DOI: 10.1177/1077559508316042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This investigation evaluated an experimental protocol employed by nurses with parents to increase access to evidence-based mental health treatment for children who are suspected victims of abuse. The protocol was compared with typical services during forensic medical examinations, first in a quasi-experimental design, then as a randomized controlled trial. In both studies, the protocol produced a significant increase in parental reports of having discussed evidence-based treatment during a mental health appointment within 1 month after the forensic medical examination. Likewise, both studies showed that the protocol produced a significant increase in parent-reported satisfaction with the forensic medical examination. Similarly, nurses viewed the protocol favorably. These findings suggest that this approach may be sustainable as a standard component of forensic medical examinations for children who are suspected victims of abuse.
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Affiliation(s)
- Kevin J Gully
- Primary Children's Medical Center, Salt Lake City, Utah, USA
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25
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Bakare MO. Effective therapeutic dosage of antipsychotic medications in patients with psychotic symptoms: Is there a racial difference? BMC Res Notes 2008; 1:25. [PMID: 18710544 PMCID: PMC2518282 DOI: 10.1186/1756-0500-1-25] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 06/12/2008] [Indexed: 12/04/2022] Open
Abstract
Background Genetic make up had been known to influence pharmacokinetics and pharmacodynamics of psychotropic medications. Time separation in evolutionary trend in Africans, Orientals and Caucasians had been thought a possible explanation for the observed racial variation in activities of Cytochrome P 450 (CYP 450) enzymes, which are responsible for metabolism of psychotropic and other medications in human. Past studies on pharmacokinetics and pharmacodynamics of antipsychotic medications and socio-cultural factors influencing response to antipsychotic medications had consistently giving an inkling of possible racial difference in symptoms response to antipsychotic medications. Another growing body of evidence subscribing to possible racial difference in psychotic symptoms response to antipsychotic medications is the observed variation in antipsychotic medications prescription pattern and dosage across races and regions. Empirical observation had shown that dosage prescription pattern of antipsychotic medications in most Sub-Saharan African countries deviates from the standard prescription guidelines published for use in western parts of the world. Studies coming from the United States (U.S) had consistently reported a higher dosage of antipsychotic medications prescription for African-American patients compared to their Caucasian counterparts. Research on East Asia Psychotropic Prescription (REAP) study had also identified high dosage antipsychotic medications prescription pattern well above the recommended dose of 1,000 mg Chlorpromazine equivalent per day as common practices in some East Asian countries. Presentation of the Hypothesis The pertinent question is why the apparent differences in dosage prescription practices across races and regions? The possibility of racial differences in psychotic symptoms response to antipsychotic medications rather than clinicians' prescription attitudes was entertained. Testing the Hypothesis Future carefully controlled studies might be needed to test the proposed hypothesis of racial differences in psychotic symptoms response to antipsychotic medications. Implication of the Hypothesis There might be actual racial influence on psychotic symptoms response to antipsychotic medications. If future carefully controlled studies uphold the hypothesis of racial differences in psychotic symptoms response to antipsychotic medications, there might be need to draw up new treatment or prescription guidelines that would put into consideration variations in genetic make up and consequent racial differences in psychotic symptoms response to antipsychotic medications.
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Affiliation(s)
- Muideen O Bakare
- Child and Adolescent Unit, Federal Neuro-Psychiatric Hospital, New Haven, Enugu, Enugu State, Nigeria.
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26
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Troubles bipolaires à l’adolescence : actualités et controverses. Encephale 2007. [DOI: 10.1016/s0013-7006(07)78680-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pfeifer JC, Kowatch RA, DelBello MP. The use of antipsychotics in children and adolescents with bipolar disorders. Expert Opin Pharmacother 2007; 8:2673-87. [DOI: 10.1517/14656566.8.16.2673] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jonathan C Pfeifer
- The University of Cincinnati Medical Center, Cincinnati Children's Hospital Medical Center, Department of Psychiatry, MSB 7261, PO Box 670559, Cincinnati, Ohio 45267-0559, USA ;
| | - Robert A Kowatch
- The University of Cincinnati Medical Center, Cincinnati Children's Hospital Medical Center, Department of Psychiatry, MSB 7261, PO Box 670559, Cincinnati, Ohio 45267-0559, USA ;
| | - Melissa P DelBello
- The University of Cincinnati Medical Center, Cincinnati Children's Hospital Medical Center, Department of Psychiatry, MSB 7261, PO Box 670559, Cincinnati, Ohio 45267-0559, USA ;
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28
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Drotar D, Greenley RN, Demeter CA, McNamara NK, Stansbrey RJ, Calabrese JR, Stange J, Vijay P, Findling RL. Adherence to pharmacological treatment for juvenile bipolar disorder. J Am Acad Child Adolesc Psychiatry 2007; 46:831-9. [PMID: 17581447 DOI: 10.1097/chi.0b013e31805c7421] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this study was to describe the prevalence and correlates of adherence to divalproex sodium (DVPX) and lithium carbonate (Li) combination treatment during the initial stabilization treatment phase. METHOD Adherence to Li/DVPX combination therapy was measured by the presence or absence of minimum serum concentrations of DVPX (50 microg/mL) or Li (0.6 mmol/L). Secondary measures included pill count, patient/parent report, and clinical judgment. Correlates of adherence, including patient characteristics, medication side effects, and family variables, were evaluated. RESULTS One hundred seven patients (70 males and 37 females) were studied. The proportion of serum concentrations in the therapeutic range across the study period was 0.84 for DVPX and 0.66 for Li. Maternal (r = -0.31; p<.01) and paternal (r = -0.44; p < .01) hospitalization for a psychiatric disorder and less adaptive family functioning (r=-0.26; p < .05) related to treatment nonadherence for DVPX. Better treatment adherence to DVPX (r = 0.21; p < .05) and Li (r = 0.23; p < .05) was associated with a greater number of side effects, whereas male sex was associated with worse adherence to both DVPX (r= -0.24; p < .05) and Li (r = -0.22; p < .05) pharmacotherapy. Clinical response to treatment correlated with adherence to DVPX treatment (r = 0.33; p < .01). CONCLUSIONS Nonadherence may limit the statistical power of treatment efficacy studies and the effectiveness of pharmacotherapy treatment for juvenile BPD and necessitate strategies to evaluate and enhance levels of treatment adherence.
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Affiliation(s)
- Dennis Drotar
- Department of Psychiatry, Case Western Reserve University, USA.
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