A selected review of the literature and an empirical analysis of drug treatment compliance by schizophrenic patients

Schizophrenia hospitalization in the US 2005-2014: Examination of trends in demographics, length of stay, and cost

Primarily we aimed to examine the crude and standardized schizophrenia hospitalization trend from 2005 to 2014. We hypothesized that there will be a statistically significant linear trend in hospitalization rates for schizophrenia from 2005 to 2014. Secondarily we also examined trends in hospitalization by race/ethnicity, age, gender, as well as trends in hospitalization Length of Stay (LOS) and inflation adjusted cost.In this observational study, we used Nationwide Inpatient Sample data and International Classification of Diseases, Eleventh Revisions codes for Schizophrenia, which revealed 6,122,284 cases for this study. Outcomes included crude and standardized hospitalization rates, race/ethnicity, age, cost, and LOS. The analysis included descriptive statistics, indirect standardization, Rao-Scott Chi-Square test, t-test, and adjusted linear regression trend.Hospitalizations were most prevalent for individuals ages 45-64 (38.8%), African Americans were overrepresented (25.8% of hospitalizations), and the gender distribution was nearly equivalent. Mean LOS was 9.08 days (95% confidence interval 8.71-9.45). Medicare was the primary payer for most hospitalizations (55.4%), with most of the costs ranging from $10,000-$49,999 (57.1%). The crude hospitalization rates ranged from 790-1142/100,000 admissions, while the US 2010 census standardized rates were 380-552/100,000 from 2005-2014. Linear regression trend analysis showed no significant difference in trend for race/ethnicity, age, nor gender (P > .001). The hospitalizations' overall rates increased while LOS significantly decreased, while hospitalization costs and Charlson's co-morbidity index increased (P < .001).From 2005-2014, the overall US hospitalization rates significantly increased. Over this period, observed disparities in hospitalizations for middle-aged and African Americans were unchanged, and LOS has gone down while costs have gone up. Further studies addressing the important disparities in race/ethnicity and age and reducing costs of acute hospitalization are needed.

Predicting Adherence to Medications by Hispanics with Schizophrenia

Casefile data of 100 male and 93female Hispanics with schizophrenia were analyzed to evaluate the impact on the patient's adherence to medication regimen of biodemographic, social support, and treatment variables, and whether the patient's therapist was also Hispanic and spoke Spanish. Results revealed that older and more motivated patients were more likely to adhere to theirmedication. As predicted, those who had greaterfamily support and who were of higher socioeconomic level were also more likely to adhere. Those whose first therapist was of the same ethnicity as the patient (ie., also Hispanic) were more likely to adhere. No relationship was obtained between adherence and patient's level of acculturation, or the extensiveness of treatment: Adherence was less likely whether the therapist spoke Spanish. Implications of these resultsfor mental health practitioners are discussed

Factors that influence patients' attitudes to antipsychotic medication

OBJECTIVE

The aim of this study was to investigate the attitudes to medication in relation to insight, purpose in life, symptoms and sociodemographic factors among a cohort of stable patients with a diagnosis of schizophrenia and schizoaffective disorder.

METHOD

We included 70 patients with a diagnosis of schizophrenia and schizoaffective disorder attending a Dublin suburban mental health service. All participants were 18 years or older and were excluded if they had a learning disability, acquired brain injury resulting in unconsciousness, and psychosis secondary to a general medical condition or illicit substance misuse. All participants were given self report questionnaires which included Drug Attitude Inventory (DAI-30), Birchwood Insight Scale, and Purpose in Life test. Symptoms were assessed using the Scale for Assessment of Positive and Negative symptoms. All data was analysed using the Statistical Package for the Social Sciences.

RESULTS

We found that 86% (n = 60) of the participants had positive attitudes to medication, and 82% (n = 58) had good insight into their illness. Only 27% (n = 19) were found to have a definite purpose in life. There was a significant negative relationship between attitudes to medication and delusions (r = -0.25, n = 70, p < 0.05) and a significant positive relationship between insight and attitudes to medication (r = 0.0.28, n = 70, p < 0.05).

CONCLUSION

Many factors are involved in the multifaceted issue of attitudes to medication. Researchers must realise that these factors do not remain constant and may change with time and over the course of illness and treatment.

Psychiatric health care provider attitudes towards implantable medication

Medication nonadherence is a major problem in psychiatry. Introduction of implantable psychiatric medication could alleviate the need to take daily medication, significantly decreasing the rate of nonadherence. This survey assessed psychiatric health care professionals' opinions regarding implants. An email was sent to potential participants including an explanation of the study and a link to an online survey. Email addresses of faculty in the Department of Psychiatry were obtained from websites of United States medical schools. To assess which provider characteristics were most important in consideration of implants, logistic regression models were employed. For assessing which patient characteristics were associated with providers' opinions, logistic regression models using generalized estimating equations tested associations between patient factors and implant decision. Eighty-six percent of respondents supported implants for a subset of patients. Four provider characteristics influenced support for implants including type of work, caseload, percent of patients with schizophrenia and percent of patients with bipolar disorder. Seven patient characteristics significantly influenced provider opinions including illness severity, length of illness, medication compliance, diagnosis, type of medication, family support, and patient age. Although dozens of factors influence the future of implants, the surveyed population showed moderate to strong support for this novel treatment.

The long term--maximising potential for rehabilitation in patients with schizophrenia

Patients with schizophrenia show low employment rates and low Quality of Life (QoL), and rehabilitation aims to maximise daily functioning, improve social interactions, and develop employment prospects. Evaluation of long-term treatment effectiveness should address these issues. Choice of medication can influence patient compliance and adverse experience of side effects may act as a barrier to rehabilitation. The Schizophrenia Trial of Aripiprazole (STAR), in which patients were randomised to receive 26 weeks of the atypical antipsychotic, aripiprazole (n=284) or standard of care medication (n=271) showed that aripiprazole demonstrated significantly better effectiveness in terms of Investigator Assessment Questionnaire (IAQ) total score. Like other atypical antipsychotic agents, aripiprazole shows a low rate of extrapyramidal adverse events. In addition, unlike the majority of other agents, aripiprazole treatment has a low risk of weight gain, translating into health-related QoL benefits. In summary, newer, atypical agents may improve efficacy, patient satisfaction, and aid long-term rehabilitation.

Medical-claims databases in the design of a health-outcomes comparison of quetiapine ('Seroquel') and usual-care antipsychotic medication

Treating schizophrenia is expensive. Preventing rehospitalization of patients with schizophrenia provides an attractive opportunity for cost savings, especially for patients with 'revolving-door' or multiple-episode schizophrenia. Reducing the occurrence of extrapyramidal symptoms and other adverse events associated with standard antipsychotic agents may increase compliance and reduce the rate of rehospitalization of patients with schizophrenia. Quetiapine ('Seroquel', ICI 204,636, Zeneca Pharmaceuticals) is a new dibenzothiazepine antipsychotic agent with a low propensity for extrapyramidal symptoms. We describe here a unique methodology to compare quetiapine with usual-care medications in real-world treatment settings. The trial objective is to determine if therapy with this new atypical antipsychotic agent can reduce the rate of rehospitalization and, therefore, treatment costs. Using two secondary medical-claims databases, we defined the minimal threshold for revolving-door status as 1.0 admission per year; this definition allows our trial to focus on the subpopulation of schizophrenic patients with the greatest potential for cost savings by either the new atypical antipsychotic quetiapine or usual-care therapy. We describe here the approach used in our trial.

Influence of antipsychotic profile on cost of treatment of schizophrenia: A decision analysis approach

Schizophrenia affects around 1% of the population but accounts for a much larger proportion of healthcare costs. New atypical antipsychotics are perceived as expensive because of higher drug costs, even though such drug costs account for only a small percentage of the total cost of care. However, if these agents reduce other types of treatment costs they could prove to be highly cost-effective. This paper presents a health economic model for the treatment of an acute episode of chronic schizophrenia and its subsequent control through maintenance treatment. Simulation experiments, using cost data reported for England, indicate that the most important treatment cost is care setting: treatments enabling patients to move from expensive inpatient and sheltered accommodation to less expensive settings represent the largest potential cost saving. Atypical antipsychotics with improved efficacy in negative symptoms and/or cognitive function may facilitate this and thus lead to substantial savings. Enhanced efficacy in positive symptoms, and improvements in compliance and relapse rates also have an influence on the cost of treating schizophrenia. Model predictions suggest that reported clinical profiles of atypical antipsychotics could lead to significant savings and large improvements in effectiveness over conventional therapy. Prospective studies are required to confirm these findings.

Characteristics of clients with schizophrenia who express certainty or uncertainty about continuing treatment with depot neuroleptic medication

In this exploratory study, the factors corresponding to clients' certainty or uncertainty in continuing with depot neuroleptic medication for schizophrenia were examined. Ninety-four participants from a tertiary care schizophrenia clinic received an educational intervention aid containing information about treatment risks and benefits and were interviewed to elicit their levels of decisional conflict, self-efficacy, and emotional support, as well as expectations of risks and benefits of treatment. Eighty-seven percent of participants decided to continue treatment. Clients who expressed uncertainty (10%) about continuing with treatment had higher levels of decisional conflict (p = .000), lower levels of decision self-efficacy (p = .037) and decision emotional control (p = .003), lower expectations of hospitalization if treatment was stopped (p = .04) as well as lower expectations of benefits and higher expectations of side effects (p = .04), if treatment continued. In addition, reasons identified by participants for certainty or uncertainty were reported. The research may be useful in increasing the awareness of clinicians about the factors contributing to treatment decision making by clients diagnosed with schizophrenia and ultimately improve collaborative decision making.