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Gentsch AT, Reed MK, Cunningham A, Chang AM, Kahn S, Kovalsky D, Doty AMB, Mills G, Hollander JE, Rising KL. "Once I take that one bite": the consideration of harm reduction as a strategy to support dietary change for patients with diabetes. BMC Endocr Disord 2024; 24:3. [PMID: 38166864 PMCID: PMC10759378 DOI: 10.1186/s12902-023-01529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Despite well-established guidelines to treat diabetes, many people with diabetes struggle to manage their disease. For many, this struggle is related to challenges achieving nutrition-related lifestyle changes. We examined how people with diabetes describe barriers to maintaining a healthy diet and considered the benefits of using a harm reduction approach to assist patients to achieve nutrition-related goals. METHODS This is a secondary analysis of 89 interviews conducted with adults who had type 1 or type 2 diabetes. Interviews were analyzed using a content analysis approach. Themes regarding food or diet were initially captured in a "food" node. Data in the food node were then sub-coded for this analysis, again using a content analysis approach. RESULTS Participants frequently used addiction language to talk about their relationship with food, at times referring to themselves as "an addict" and describing food as "their drug." Participants perceived their unhealthy food choices either as a sign of weakness or as "cheating." They also identified food's ability to comfort them and an unwillingness to change as particular challenges to sustaining a healthier diet. CONCLUSION Participants often described their relationship with food through an addiction lens. A harm reduction approach has been associated with positive outcomes among those with substance abuse disorder. Patient-centered communication incorporating the harm reduction model may improve the patient-clinician relationship and thus improve patient outcomes and quality-of-life while reducing health-related stigma in diabetes care. Future work should explore the effectiveness of this approach in patients with diabetes. TRIAL REGISTRATION Registered on ClinicalTrials.gov, NCT02792777. Registration information submitted 02/06/2016, with the registration first posted on the ClinicalTrials.gov website 08/06/2016. Data collection began on 29/04/2016.
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Affiliation(s)
- Alexzandra T Gentsch
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA.
| | - Megan K Reed
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amy Cunningham
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Anna Marie Chang
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
| | - Stephanie Kahn
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
| | - Danielle Kovalsky
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
- Present address: Department of Emergency Medicine, Tower Health Hospital, West Reading, USA
| | - Amanda M B Doty
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
| | - Geoffrey Mills
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Judd E Hollander
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
| | - Kristin L Rising
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
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Watts M, Murphy E, Keogh B, Downes C, Doyle L, Higgins A. Deciding to discontinue prescribed psychotropic medication: A qualitative study of service users' experiences. Int J Ment Health Nurs 2021; 30 Suppl 1:1395-1406. [PMID: 34101332 DOI: 10.1111/inm.12894] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
Many mental health service users decide to discontinue their psychotropic medication at some stage in the treatment process; however, few studies have captured these experiences. This study aimed to explore people's experiences of coming off medication. A qualitative descriptive design and individual interviews with 23 people who experienced coming off medication were employed. COREQ checklist was used. Data were analysed using inductive and deductive approaches and six major themes were developed. Findings suggest that while medication was useful for many in the short-term, the adverse effects had significant impact and contributed to the decision to come off medication. Participants also reported being driven by a questioning of the biomedical model of treatment and the belief that there were other strategies to manage their distress. Mixed experiences of support from healthcare professionals for the medication cessation process were reported. The discontinuation process was often difficult resulting in changes in mood and behaviour which for many culminated in relapse of distress, rehospitalization and return to medication. To support the process of coming off and staying off medication, participants identified a range of useful strategies but particularly highlighted the importance of peer support. Findings from this study demonstrate the importance of mental health nurses having a collaborative discussion with service users which may support safer decision-making and lessen the risk of people discontinuing medication abruptly. Finding also indicates a need for robust studies that develop and test interventions to support people who wish to discontinue psychotropic medications.
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Affiliation(s)
- Mike Watts
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Esther Murphy
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Carmel Downes
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Geretsegger C, Pichler EM, Gimpl K, Aichhorn W, Stelzig R, Grabher-Stoeffler G, Hiemke C, Zernig G. Non-adherence to psychotropic medication assessed by plasma level in newly admitted psychiatric patients: Prevalence before acute admission. Psychiatry Clin Neurosci 2019; 73:175-178. [PMID: 30552718 DOI: 10.1111/pcn.12809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 12/06/2018] [Accepted: 12/12/2018] [Indexed: 01/01/2023]
Abstract
AIMS Non-adherence or partial adherence to psychotropic medication is found in 18-70% of patients. Many previously used methods for the assessment of adherence (e.g. questionnaires, pill counts, and electronic systems), however, might underreport actual rates of non-adherence to medication. The aim of this study was to quantify adherence using plasma level. METHODS We conducted a 6-week prospective study of all consecutive admitted patients at the Paracelsus Medical University of Salzburg, Clinics of Psychiatry and Psychotherapy, who had been treated with antipsychotics/antidepressants prior to admission (pre-medication dosage in 161 of 233). Plasma drug levels were determined and compared with expected levels based on known preadmission dosing regimens and average pharmacokinetic data. RESULTS Seventy-three percent of the patients had actual plasma levels clearly below or above the intended level. Significantly more patients with schizophrenia (66%) did not take the medication as prescribed, when compared with patients with affective disorders (47%) or those with other psychiatric diagnoses (41%). Only 27% (44 of 161) of the patients had plasma level in the expected range based on the dosage. CONCLUSION The risk of partial adherence or non-adherence is expected in two-thirds of patients with schizophrenia, half of patients with affective disorders, and approximately 40% of patients with other psychiatric diagnoses. Given that admitting psychiatrists could not provide an accurate assessment of patient adherence, it is strongly suggested that clinical judgment be supplemented with the actual monitoring of adherence - and further optimization of pharmacotherapy - by means of therapeutic drug monitoring.
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Affiliation(s)
- Christian Geretsegger
- University Clinics of Psychiatry and Psychotherapy, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Eva-Maria Pichler
- University Clinics of Psychiatry and Psychotherapy, Paracelsus Medical University Salzburg, Salzburg, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Kathrin Gimpl
- University Clinics of Psychiatry and Psychotherapy, Paracelsus Medical University Salzburg, Salzburg, Austria.,Division of experimental Psychiatry and Psychotherapy, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Aichhorn
- University Clinics of Psychiatry and Psychotherapy, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Renate Stelzig
- University Clinics of Psychiatry and Psychotherapy, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gerald Zernig
- Division of experimental Psychiatry and Psychotherapy, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
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Modanloo M. The challenge of increasing adherence in schizophrenia: Focusing future research on changing attitudes of patients. Asian J Psychiatr 2018; 36:28. [PMID: 29886403 DOI: 10.1016/j.ajp.2018.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Mahnaz Modanloo
- Nursing Research Center, Golestan University of Medical Scienses, Gorgan, Iran.
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Saini P, Chantler K, Kapur N. GPs' views and perspectives on patient non-adherence to treatment in primary care prior to suicide. J Ment Health 2017. [PMID: 28635435 DOI: 10.1080/09638237.2017.1294736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Individuals who do not adhere to their treatment regimens may be at greater risk of suicide but these issues are relatively unexplored in primary care services. AIM To explore GPs' views and perspectives on the reasons why patients who were in contact with mental health services in the year prior to suicide was non-adherent to treatment prior to their death. METHOD In total, 198 semi-structured face-to-face interviews with GPs of people who had died by suicide. Interviews were transcribed verbatim and analyzed using a thematic approach. RESULTS The following themes were conceptualized from GP interviews: (i) "Lack of insight or denial?" relates to what GPs perceived as their patients lack of insight into their psychiatric illness; (ii) "Lack of treatment choices" discusses GPs' understanding of patient treatment choices; (iii) "Services for comorbidity and dual diagnosis" refers to treatment availability for suicidal patients with two or more mental health diagnoses. CONCLUSIONS For suicide prevention, it is crucial for health professionals to assess patients and manage the possible causes of non-adherence. Policies for increasing treatment adherence, improving services for dual diagnosis, or providing alternative treatments to meet individual patient needs may help to achieve the best health outcomes and could potentially prevent suicide.
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Affiliation(s)
- Pooja Saini
- a Department of Health Services Research , NIHR CLAHRC NWC, University of Liverpool , Liverpool , UK
| | - Khatidja Chantler
- b School of Social Work, University of Central Lancashire , Preston , UK , and
| | - Navneet Kapur
- c Centre for Mental Health and Risk, University of Manchester , Manchester , UK
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Tonin FS, Wiens A, Fernandez-Llimos F, Pontarolo R. Iloperidone in the treatment of schizophrenia: an evidence-based review of its place in therapy. CORE EVIDENCE 2016; 11:49-61. [PMID: 28008301 PMCID: PMC5167526 DOI: 10.2147/ce.s114094] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction Schizophrenia is a chronic and debilitating mental disorder that affects the patient’s and their family’s quality of life, as well as financial costs and health care settings. Despite the variety of available antipsychotics, optimal treatment outcomes are not always achieved. Novel drugs, such as iloperidone, can provide more effective, tolerable and safer strategies. Aim To review the evidence for the clinical impact of iloperidone on the treatment of patients with schizophrenia. Evidence review Clinical trials, observational studies and meta-analyses reached a common consensus that iloperidone is as effective as haloperidol, risperidone and ziprasidone in reducing schizophrenia symptoms. Similar amounts of adverse events and discontinuations were observed with iloperidone compared to placebo and active treatments. Common adverse events are mild and include dizziness, hypotension, dry mouth and weight gain. Iloperidone can induce extension of QTc interval, and clinicians should be aware of its contraindications. In long-term trials, iloperidone also showed promising safety and tolerability profiles. The low propensity to cause akathisia, extrapyramidal symptoms (EPS), increased prolactin levels or changes to metabolic laboratory parameters support its use in practice. Results showed that iloperidone prevents relapse in stabilized patients, with a time to relapse superior to placebo and similar to haloperidol. Patients using a prior antipsychotic (eg, risperidone and aripiprazole) can easily switch to iloperidone with no serious impact on safety or efficacy. However, the acquisition costs of iloperidone may hamper its use. Further evidence comparing iloperidone with other antipsychotics, and pharmacoeconomic studies would be welcome. Place in therapy Considering just the clinical profile of iloperidone, it represents a promising drug for treating schizophrenia, particularly in patients who are intolerant to previous antipsychotics, as well as being suitable as first-line therapy. Cost-effectiveness comparisons are needed to justify its use in clinical practice.
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Affiliation(s)
| | - Astrid Wiens
- Department of Pharmacy, Federal University of Parana, Curitiba, Brazil
| | - Fernando Fernandez-Llimos
- Department of Social Pharmacy, Faculty of Pharmacy, Research Institute for Medicines (iMed.ULisboa), Universidade de Lisboa, Lisbon, Portugal
| | - Roberto Pontarolo
- Department of Pharmacy, Federal University of Parana, Curitiba, Brazil
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Timlin U, Hakko H, Riala K, Räsänen P, Kyngäs H. Adherence of 13-17 Year Old Adolescents to Medicinal and Non-pharmacological Treatment in Psychiatric Inpatient Care: Special Focus on Relative Clinical and Family Factors. Child Psychiatry Hum Dev 2015; 46:725-35. [PMID: 25307994 DOI: 10.1007/s10578-014-0514-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Clinical studies investigating adolescents' adherence to medicinal and non-pharmacological treatment in hospitalized psychiatric populations are few. In our study of 13-17 year old adolescents admitted to psychiatric inpatient care, the patients' adherence to treatment in general, and to medicinal and non-pharmacological treatment individually, was examined, with special focus on family and clinical factors. Data on adherence was collected from patients' hospital records. A step-wise logistic regression analysis was used to find the significant predictors of adherence to treatment. Good family or social network relational functioning and use of special services at school were positively related to adherence in adolescents. Involuntary treatment and self-mutilative behavior were related to non-adherence to treatment. The results indicate the importance of addressing adherence to treatment in adolescent psychiatric inpatients. More studies with larger samples are needed to investigate this area further.
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Affiliation(s)
- Ulla Timlin
- Institute of Health Sciences, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland,
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Bressington D, White J. Recovery from psychosis: physical health, antipsychotic medication and the daily dilemmas for mental health nurses. J Psychiatr Ment Health Nurs 2015; 22:549-57. [PMID: 26234190 DOI: 10.1111/jpm.12249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- D Bressington
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - J White
- Faculty of Health and Social Care, University of Hull, Hull, HU6 7RX
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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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del Barrio LR, Cyr C, Benisty L, Richard P. Gaining Autonomy & [corrected] Medication Management (GAM): new perspectives on well-being, quality of life and psychiatric medication. CIENCIA & SAUDE COLETIVA 2014; 18:2879-87. [PMID: 24061014 DOI: 10.1590/s1413-81232013001000012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 05/19/2013] [Indexed: 11/21/2022] Open
Abstract
Autonomous Medication Management (GAM) is an innovative approach developed in partnership with medication users. It takes their subjective experience into account and strives to place the individual at the center of pharmacological treatment in psychiatry with a view to improving well-being and quality of life. It creates spaces of open dialogue on the issue of medication amongst users, physicians and their family and friends. This article is derived from a research study and presents the principles, practices and main impacts of GAM on how people relate to their medications and the physicians who prescribe them. The major positive effects were the users' clearer understanding of their experience of taking psychiatric medication and their rights, the reduction or elimination of sudden and unsupervised treatment interruptions and the users' sense of having more control over their treatment. It includes inner experience and life, an improved relationship with professionals and space for negotiation with the physician and, lastly, changes to prescriptions that significantly improved well-being and recovery. The distinguishing features of GAM are described and compared with other approaches, giving a voice to people who take medication.
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Current World Literature. Curr Opin Allergy Clin Immunol 2012; 12:440-5. [DOI: 10.1097/aci.0b013e328356708d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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