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So YK, Chan CY, Fung SC, Lui TT, Lau FC, Chan KW, Lee HM, Lui SY, Hui LM, Chen E, Chang WC. Rates and correlates of medication non-adherence behaviors and attitudes in adult patients with early psychosis. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1215-1225. [PMID: 37833425 DOI: 10.1007/s00127-023-02563-4] [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: 06/21/2022] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE Literature on antipsychotic medication adherence in early psychosis primarily assessed adherence behaviors and focused on young patients. There is a paucity of research investigating negative medication attitude and its determinants in the early illness course, particularly in older-aged sample. We aimed to examine prevalence and correlates of medication non-adherence behaviors and negative medication attitudes separately in adult patients with early psychosis. METHODS One hundred ninety-nine Chinese early psychosis patients aged 26-55 years who had received three-year treatment for first psychotic episode in Hong Kong were examined. Assessments encompassing socio-demographics, premorbid adjustment, clinical and treatment profiles, self-stigma and therapeutic alliance were conducted. Patients were evaluated with Medication Compliance Questionnaire, which is a modified Chinese-translated version of Medication Adherence Rating Scale and includes items measuring adherence behaviors and attitudes towards medications. RESULTS Rates of medication non-adherence and negative attitude towards medications were 38.7% and 50.8%, respectively. Multivariate regression analysis showed that more severe positive symptoms, greater self-stigma and negative medication attitude were independently associated with medication non-adherence. Negative attitude towards medications was significantly associated with younger age, higher educational attainment, diagnosis of other psychotic disorders, poorer insight, greater self-stigma and less satisfaction with communication with healthcare staff, which represented an index reflecting suboptimal therapeutic alliance. CONCLUSION Antipsychotic non-adherence and negative medication attitudes are frequently observed in adult early psychosis patients. Our findings indicate that poor insight, elevated self-stigma and suboptimal therapeutic alliance may constitute potential treatment targets for promoting medication adherence and rectifying negative medication attitudes in the early illness stage.
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Affiliation(s)
- Yuen Kiu So
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ching Yui Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Shi Cheng Fung
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tsz Ting Lui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Fu Chun Lau
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kit Wa Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ho Ming Lee
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sai Yu Lui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lai Ming Hui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Eric Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong.
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Dai N, Huang B, Gao T, Zheng Y, Shi C, Pu C, Yu X. Initial attitudes toward a drug predict medication adherence in first-episode patients with schizophrenia: a 1-year prospective study in China. BMC Psychiatry 2023; 23:907. [PMID: 38053101 PMCID: PMC10696849 DOI: 10.1186/s12888-023-05419-y] [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: 10/30/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Patients' attitudes toward medication have been shown to be a predictor of nonadherence to antipsychotic treatment. However, most previous studies that explored this relationship used a cross-sectional design. It is important to explore the association of attitudes toward drugs with discontinuation at different time points during antipsychotic treatment. In this study, we investigated the association of attitudes toward drugs (measured by the Drug Attitude Inventory (DAI-10)) with adherence at seven time points (baseline, 4 weeks, 8 weeks, 12 weeks, 26 weeks, 39 weeks, and 52 weeks) during 1 year of treatment. Factors that were potentially associated with attitudes toward drugs at the time point of interest were also studied. METHODS Demographic characteristics, psychopathology, social functioning, and attitudes toward drugs (measured by the DAI-10) were collected at baseline, 4 weeks, 8 weeks, 12 weeks, 26 weeks, 39 weeks and 52 weeks. The association of attitudes toward drugs (measured by DAI-10) with adherence at the seven time points was calculated using the Mann‒Whitney U test. The optimal cutoff point for the DAI-10 was then determined using receiver operating characteristic (ROC) analysis. Cox regression analysis was conducted to further investigate the association of DAI-10 scores with discontinuation, controlling for potential confounding variables. We used multiple regression analysis to identify the factors associated with DAI-10 scores. RESULTS Among the six time points, only baseline DAI-10 total scores were significantly different between the completed and discontinued groups (p = 0.004). Female sex and a baseline DAI-10 total score greater than - 1 were found to be independent protective factors against discontinuation of antipsychotic drug treatments during the 1-year follow-up. At baseline, the severity of the disease (CGI-s) and insight regarding the disease were shown to be associated with DAI-10 total scores. CONCLUSION Attitudes toward antipsychotic drugs at baseline were shown to play a crucial role in predicting treatment discontinuation. TRIAL REGISTRATION The data were collected from a clinical trial and the clinical trials.gov ID of the study is NCT01057849.
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Affiliation(s)
- Nan Dai
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, China
| | - Bingjie Huang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51 Huayuan North Road, Beijing, China
| | - Tianqi Gao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51 Huayuan North Road, Beijing, China
| | - Yue Zheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51 Huayuan North Road, Beijing, China
| | - Chuan Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51 Huayuan North Road, Beijing, China
| | - Chengcheng Pu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51 Huayuan North Road, Beijing, China.
| | - Xin Yu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51 Huayuan North Road, Beijing, China.
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Misdrahi D, Dupuy M, Dansou Y, Boyer L, Berna F, Capdevielle D, Chereau I, Coulon N, D'Amato T, Dubertret C, Leignier S, Llorca PM, Lançon C, Mallet J, Passerieux C, Pignon B, Rey R, Schürhoff F, Swendsen J, Urbach M, Szöke A, Godin O, Fond G. Predictors of medication adherence in a large 1-year prospective cohort of individuals with schizophrenia: insights from the multicentric FACE-SZ dataset. Transl Psychiatry 2023; 13:341. [PMID: 37935695 PMCID: PMC10630458 DOI: 10.1038/s41398-023-02640-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
Schizophrenia is characterized by the most salient medication adherence problems among severe mental disorders, but limited prospective data are available to predict and improve adherence in this population. This investigation aims to identify predictors of medication adherence over a 1-year period in a large national cohort using clustering analysis. Outpatients were recruited from ten Schizophrenia Expert Centers and were evaluated with a day-long standardized battery including clinician and patient-rated medication adherence measures. A two-step cluster analysis and multivariate logistic regression were conducted to identify medication adherence profiles based on the Medication Adherence rating Scale (MARS) and baseline predictors. A total of 485 participants were included in the study and medication adherence was significantly improved at the 1-year follow-up. Higher depressive scores, lower insight, history of suicide attempt, younger age and alcohol use disorder were all associated with poorer adherence at 1 year. Among the 203 patients with initially poor adherence, 86 (42%) switched to good adherence at the 1-year follow-up, whereas 117 patients (58%) remained poorly adherent. Targeting younger patients with low insight, history of suicide, alcohol use disorder and depressive disorders should be prioritized through literacy and educational therapy programs. Adherence is a construct that can vary considerably from year to year in schizophrenia, and therefore may be amenable to interventions for its improvement. However, caution is also warranted as nearly one in five patients with initially good adherence experienced worsened adherence 1 year later.
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Affiliation(s)
- David Misdrahi
- Fondation FondaMental, F-94010, Créteil, France.
- University of Bordeaux, Aquitaine Institute for Cognitive and Integrative Neuroscience (CNRS UMR 5287-INCIA), Bordeaux, France.
- Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France.
| | - Maud Dupuy
- Fondation FondaMental, F-94010, Créteil, France
- University of Bordeaux, Aquitaine Institute for Cognitive and Integrative Neuroscience (CNRS UMR 5287-INCIA), Bordeaux, France
| | - Yecodji Dansou
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Laurent Boyer
- Fondation FondaMental, F-94010, Créteil, France
- AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Fabrice Berna
- Fondation FondaMental, F-94010, Créteil, France
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Delphine Capdevielle
- Fondation FondaMental, F-94010, Créteil, France
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, F-94010, Créteil, France
- University of Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, F-63000, Clermont-Ferrand, France
| | - Nathalie Coulon
- Fondation FondaMental, F-94010, Créteil, France
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), CH Alpes Isère, Bordeaux, France
| | - Thierry D'Amato
- Fondation FondaMental, F-94010, Créteil, France
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678, Bron Cedex, France
| | - Caroline Dubertret
- Fondation FondaMental, F-94010, Créteil, France
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France
- Université Paris Cité, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Sylvain Leignier
- Fondation FondaMental, F-94010, Créteil, France
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), CH Alpes Isère, Bordeaux, France
| | - Pierre Michel Llorca
- Fondation FondaMental, F-94010, Créteil, France
- University of Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, F-63000, Clermont-Ferrand, France
| | - Christophe Lançon
- Fondation FondaMental, F-94010, Créteil, France
- AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Jasmina Mallet
- Fondation FondaMental, F-94010, Créteil, France
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France
- Université Paris Cité, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Christine Passerieux
- Fondation FondaMental, F-94010, Créteil, France
- Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157, Le Chesnay, France
- DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines, 94807, Villejuif, France
| | - Baptiste Pignon
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Romain Rey
- Fondation FondaMental, F-94010, Créteil, France
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678, Bron Cedex, France
| | - Franck Schürhoff
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Joel Swendsen
- Fondation FondaMental, F-94010, Créteil, France
- University of Bordeaux, Aquitaine Institute for Cognitive and Integrative Neuroscience (CNRS UMR 5287-INCIA), Bordeaux, France
| | - Mathieu Urbach
- Fondation FondaMental, F-94010, Créteil, France
- Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157, Le Chesnay, France
- DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines, 94807, Villejuif, France
| | - Andrei Szöke
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Ophélia Godin
- Fondation FondaMental, F-94010, Créteil, France
- Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Bordeaux, France
| | - Guillaume Fond
- Fondation FondaMental, F-94010, Créteil, France
- AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France
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Fernández-Miranda JJ, Díaz-Fernández S. Plasmatic Levels and Response to Variable Doses of Monthly Aripiprazole and Three-Month Paliperidone in Patients with Severe Schizophrenia. Treatment Adherence, Effectiveness, Tolerability, and Safety. Neuropsychiatr Dis Treat 2023; 19:2093-2103. [PMID: 37818449 PMCID: PMC10561761 DOI: 10.2147/ndt.s425516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/26/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction There is a need when optimizing antipsychotic treatment to know the plasmatic levels (PLs) achieved with the different doses and their relationship with effectiveness and toxicity, especially in patients with poor clinical progress. This study investigates the dose-PL-response relationship of monthly aripiprazole (AOM) and three-month paliperidone (PP3M). Methods Observational, 52-week prospective study of patients with severe schizophrenia (CGI-S ≥ 5) treated with PP3M or AOM for at least one year before their inclusion in the study (N=68). Dose-PL relationship was determined. Subjects were included in standard-dose and high-dose (above labeled) and standard/therapeutic range-PLs and high-PLs (above range) groups. Treatment adherence, effectiveness (hospitalizations, severity), tolerability and safety were assessed. PLs and clinical response were evaluated. Results No clear linear relationship was found between doses and PLs. In a considerable number of cases, standard doses achieved PLs above the therapeutic range. A significant clinical improvement was related to high PLs, without less safety, tolerability, or treatment compliance being involved. Clinical severity decreased more frequently in patients who received high doses and reached high PLs. Hospital admissions decreased significantly in those patients with high PLs. Conclusion Taking into account the absence of a linear relationship between doses and PLs, the effectiveness in people with severe schizophrenia of AOM and PP3M depends on reaching high PLs, achieved with high doses, but also with standard doses in some cases, without leading to worse treatment tolerability, safety, or adherence.
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Affiliation(s)
- Juan J Fernández-Miranda
- AGC de Salud Mental V, Hospital Universitario de Cabueñes, Servicio de Salud del Principado de Asturias (SESPA), Gijón, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Silvia Díaz-Fernández
- AGC de Salud Mental V, Hospital Universitario de Cabueñes, Servicio de Salud del Principado de Asturias (SESPA), Gijón, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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Acosta FJ, Vega D, Saavedra P. Knowledge of the treatment in schizophrenia and schizoaffective disorder and its relationship with nonadherence. ACTAS ESPANOLAS DE PSIQUIATRIA 2023; 51:157-166. [PMID: 37817735 PMCID: PMC10803874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/01/2023] [Indexed: 10/12/2023]
Abstract
Despite its potential impor- tance for adherence, knowledge of the treatment has been little studied in patients with psychosis. We performed this study to assess the possible association between knowledge of the treatment and nonadherence, unintentional nonad- herence (UNA) and intentional nonadherence (INA).
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Affiliation(s)
- Francisco J. Acosta
- Psychiatrist, PhD. Department of Mental Health. General Management of Healthcare Programs. The Ca-nary Islands Health Service, The Canary Islands. Department of Psychiatry, University Hospital of Gran Canaria Doctor Negrín, The Canary Islands, Spain. ORCID: http://orcid.org/0000-0001-5835-2795
| | - Dulcinea Vega
- Psychiatrist, PhD. University of Las Palmas de Gran Canaria; Department of Psychiatry. Insular University Hospital of Gran Canaria, The Canary Islands, Spain
| | - Pedro Saavedra
- Statistician, Professor. Department of Mathematics, University of Las Palmas de Gran Canaria, The Canary Islands, Spain
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Bui TNT, Hotham E, Loughhead M, McMillan SS, Procter N, Poole K, Suppiah V. Exploring mental health clients' current medication knowledge, beliefs and experience with healthcare providers in the community in South Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5968-e5978. [PMID: 36148522 PMCID: PMC10086827 DOI: 10.1111/hsc.14029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 07/25/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
In Australia, mental illness has been recognised as a National Health Priority area, with the coronavirus pandemic adding a layer of urgency to the need to address the multiple health problems faced by clients with mental illnesses. Whilst much has been done in efforts to support these clients, little is known about their medication knowledge and experience with health professionals. The aim of the study was to explore the knowledge and beliefs of clients on the use of psychotropic medications and study their experiences with healthcare providers. Adult participants at a not-for-profit community-managed specialist mental health service provider in Adelaide, South Australia were recruited. Four focus group sessions were conducted between February 2020 and March 2021. All sessions were co-facilitated by a peer practitioner with lived experience. Sessions were audio recorded and transcribed verbatim. Participants (n = 27) reported that provision of medication education was inadequate and, in some cases, non-existent. There was an apparent lack of support for monitoring and managing common side effects, such as weight gain. Participants described not being involved in any decision-making processes and that establishing and maintaining a therapeutic relationship with their healthcare providers was challenging. Perceived stigma remains a barrier in accessing healthcare. Despite participants regularly interacting with a range of healthcare providers, findings highlight key gaps in care, particularly medication education and establishing a therapeutic relationship with their healthcare providers. Future mental health reforms should consider the provision of additional medication education in community settings, such as at not-for-profit organisations. Moreover, healthcare providers should take a proactive approach in establishing therapeutic relationships.
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Affiliation(s)
- Tien Ngoc Thi Bui
- UniSA Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Elizabeth Hotham
- UniSA Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Mark Loughhead
- UniSA Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Mental Health and Suicide Prevention Research GroupUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Sara S. McMillan
- Quality Use of Medicines Network, Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Nicholas Procter
- UniSA Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Mental Health and Suicide Prevention Research GroupUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Kessie Poole
- Sub‐Acute ServicesMind Australia LimitedAdelaideSouth AustraliaAustralia
| | - Vijayaprakash Suppiah
- UniSA Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Australian Centre for Precision HealthUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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7
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Sun Y, Tong J, Feng Y, Fang H, Jiang T, Zhao L, Wang Q, Yang Y. Attitude and influencing factors of patients with schizophrenia toward long-acting injections: A community-based cross-sectional investigation in China. Front Public Health 2022; 10:951544. [PMID: 36299738 PMCID: PMC9589343 DOI: 10.3389/fpubh.2022.951544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/22/2022] [Indexed: 01/24/2023] Open
Abstract
Background Low prescription rates of antipsychotic long-acting injections (LAIs) may be a major challenge in the prevention and treatment of schizophrenia. However, there are few studies on the usage and attitude toward LAIs among community-based patients with schizophrenia. Methods A large community-based cross-sectional investigation was conducted among 6,336 patients with schizophrenia from Shanghai, China from March 1 to June 30, 2021. The structured Attitude and Status toward Treatment of Community Patients with Schizophrenia Questionnaire (AST-CSQ) was used to investigate the attitude and influencing factors of community-dwelling patients with schizophrenia toward LAIs. Results Among the 6,336 participants, the average age was 49.28 ± 11.23. The rate of agreement to LAI antipsychotics among participants was 3.16% (n = 200). The family financial resources, care ability, and disease course of the LAIs group were less than those of the non-LAIs group. However, the LAIs group had higher immediate family guardianship, social activity, previous hospitalization, number of hospitalization, outpatient adherence, previous antipsychotic use, antipsychotic adherence, and attitude toward oral antipsychotics than the non-LAIs group, with significant differences between the two groups (p < 0.05). Furthermore, age (β = -0.036, OR 0.964, 95% CI 0.947-0.982), marital status (β = 0.237, OR 1.267, 95% CI 1.002-1.602), care ability (β = 0.709, OR 2.032, 95% CI 1.437-2.875), outpatient adherence (β = -0.674, OR 0.510, 95% CI 0.358-0.725), antipsychotic adherence (β = 0.920, OR 2.509, 95% CI 1.092-5.764), and attitude toward oral antipsychotics (β = -1.357, OR 0.258, 95% CI 0.103-0.646) were significant predictors of attitude toward LAI antipsychotics (p < 0.05). Conclusions The community-dwelling patients with schizophrenia in China had a low willingness to use LAIs. Patients of a younger age, more hospitalizations, and a shorter course of disease were prone to be more willing to accept LAIs. The patients' age, marital status, care ability, outpatient adherence, antipsychotic adherence, and attitude toward oral antipsychotics were important predictor of patients' attitudes toward LAIs. Under the global deinstitutionalized management model of mental disorders, these results highlight an urgent problems for public mental health service providers and policy-makers and provide more solutions for them.
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Affiliation(s)
- Yiying Sun
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Jie Tong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Ying Feng
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Haiping Fang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Tao Jiang
- Shanghai Yangjing Community Health Service Center, Shanghai, China
| | - Liping Zhao
- Shanghai Sanlin Community Health Service Center, Shanghai, China
| | - Qiang Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China,Qiang Wang
| | - Yi Yang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China,Mental Health Subcentre of Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China,*Correspondence: Yi Yang
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8
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Zhang Y, Ren M, Zou S. Effect of Physical Exercise on College Students' Life Satisfaction: Mediating Role of Competence and Relatedness Needs. Front Psychol 2022; 13:930253. [PMID: 35967665 PMCID: PMC9372330 DOI: 10.3389/fpsyg.2022.930253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
This study examined the effect of physical exercise on the life satisfaction among college students. On the basis of the Basic Psychological Need Theory, the mediating roles of competence and relatedness needs satisfaction and their differences among college students in physical education (PE) majors and non-PE majors were explored. The sample included 1,012 college students who were selected to participate in an online survey. Major findings were as follows: (1) The total effect of physical exercise commitment on college students' life satisfaction was marginally significant while that of physical exercise adherence was not significant; (2) The effect of physical exercise commitment was observed exclusively through the mediating role of relatedness need satisfaction, while that of physical exercise adherence was through both competence and relatedness needs satisfaction; (3) In terms of differences caused by major, only one mediation path, that was, physical exercise → competence need satisfaction → college students's life satisfaction was significant among PE majors. This study thus enriched the empirical research on the benefits of physical exercise to individual mental health, highlighted the particularity of college students majoring in PE, and provided targeted and sensible suggestions for the design of physical exercise intervention programs.
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Affiliation(s)
- Yunqi Zhang
- Faculty of Education, Southwest University, Chongqing, China
- School of Education and Psychology, Southwest Minzu University, Chengdu, China
| | - Menghao Ren
- Department of Psychology, Center for Mind and Brain Science, Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, China
| | - Shengqi Zou
- Department of Psychology, Center for Mind and Brain Science, Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, China
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Nebhinani N, Tripathi S, Suthar N, Pareek V, Purohit P, Sharma P. Correlates of Metabolic Syndrome in Patients with Schizophrenia: An Exploratory Study. Indian J Clin Biochem 2022; 37:232-237. [PMID: 35463100 PMCID: PMC8993960 DOI: 10.1007/s12291-020-00912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/27/2020] [Indexed: 11/28/2022]
Abstract
Metabolic syndrome (MS) is commonly reported in patients with severe mental illness including schizophrenia, but data is sparse from north-western India. The study was aimed to assess the metabolic profile in patients with schizophrenia. Patients with schizophrenia and healthy controls (N = 55 in each group) were recruited from psychiatric outpatient clinic and evaluated for the presence of metabolic syndrome using the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria. Prevalence of MS was significantly greater in patient group (34.5%), compared to healthy controls (14.5%). Other 31 patients (56.4%) had one or two metabolic abnormalities. Most common metabolic abnormality was higher waist circumference in both the groups. Nearly half of the patients (56%) were obese. Greater age, weight, body mass index, and obesity were significantly associated with MS and similar variables were significant predictors of MS. MS was not associated with duration and severity of schizophrenia (PANSS score), attitude towards psychotropics (DAI-10 score), functionality (GAF score) and demographic variables. Metabolic abnormalities were significantly greater in patients with schizophrenia. It calls for comprehensive evaluation of the patients with schizophrenia, with timely management and effective prevention of metabolic problems.
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Affiliation(s)
- Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan 342005 India
| | - Swapnil Tripathi
- Department of Medicine, All India Institute of Medical Science, Jodhpur, Rajasthan India
| | - Navratan Suthar
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan 342005 India
| | - Vrinda Pareek
- Department of Psychiatry, Government Medical College, Vadodara, Gujarat India
| | - Priyanka Purohit
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan 342005 India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Science, Jodhpur, Rajasthan India
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Kashiwagi H, Matsumoto J, Miura K, Takeda K, Yamada Y, Fujimoto M, Yasuda Y, Yamamori H, Ikeda M, Hirabayashi N, Hashimoto R. Neurocognitive features, personality traits, and social function in patients with schizophrenia with a history of violence. J Psychiatr Res 2022; 147:50-58. [PMID: 35021134 DOI: 10.1016/j.jpsychires.2022.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/28/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
Recent literature examining associations between cognitive function, clinical features, and violence in patients with schizophrenia has been growing; however, the results are inconsistent. Reports on social function and personality are limited. These studies are yet to be reflected in risk assessment tools and management plans. The aim of this study is to provide a resource for risk assessment and intervention studies by conducting multifaceted well-established assessments in a large population. Data from 355 patients with schizophrenia (112 patients with a history of violence; 243 patients without a history of violence) and 1265 healthy subjects were extracted from a large database of individuals with mental disorders in a general psychiatric population in Japan. The associations between violence in patients with schizophrenia and intellectual function, cognitive function (memory function, executive function, attentional function, verbal learning, processing speed, social cognition), clinical variables, personality traits, social function, and quality of life (QOL) were analyzed. Compared with healthy subjects, the schizophrenia group had broadly impaired cognitive function and social cognition, and their personality traits showed similar differences as those reported previously. Patients with schizophrenia with a history of violence showed significantly more impaired visual memory function (P = 1.9 × 10-5, Cohen's d = 0.34), longer hospitalization (P = 5.9 × 10-4, Cohen's d = 0.38), more severe excited factor on Positive and Negative Syndrome Scale (P = 1.6 × 10-4, Cohen's d = 0.47), higher self-transcendence personality construct on the Temperament and Character Inventory (P = 1.8 × 10-4, Cohen's d = 0.46), and shorter total working hours per week (P = 4.8 × 10-4, Cohen's d = 0.53) than those with schizophrenia without a history of violence. New findings, including impaired visual memory, a high self-transcendence personality trait, and shorter total working hours, could be focused on in future interventional research.
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Affiliation(s)
- Hiroko Kashiwagi
- Department of Forensic Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan; Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan
| | - Koji Takeda
- Department of Forensic Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan; Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan
| | - Yuji Yamada
- Department of Forensic Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan
| | - Michiko Fujimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan; Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Yuka Yasuda
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan; Medical Corporation Foster, Osaka, 531-0075, Japan
| | - Hidenaga Yamamori
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan; Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan; Japan Community Healthcare Organization Osaka Hospital, Osaka, 553-0003, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Naotsugu Hirabayashi
- Department of Forensic Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan.
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Nyanyiwa S, Peters K, Murphy G. A scoping review: Treatment attitudes and adherence for adults with schizophrenia. J Clin Nurs 2022; 31:3060-3075. [PMID: 35043496 DOI: 10.1111/jocn.16219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/22/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
AIM AND OBJECTIVES This scoping review presents an exploration of literature on the relationship between treatment attitudes and adherence in adults experiencing schizophrenia. BACKGROUND Strategies to address adherence and improve treatment outcomes are described in literature. However, adherence remains a challenge for people experiencing mental illness in practice. Transformational frameworks, evidence-based practice and patient-centred approaches have been established and implemented but non-adherence incidence rates continue to rise among people with schizophrenia. Moreover, the relationship between treatment attitudes and adherence in adults diagnosed with schizophrenia remains unclear. DESIGN A scoping review using the framework offered by Implementation Science, 5, 2010, 1. The PRISMA-ScR checklist was used to ensure integrity of the review. METHODS Four databases PsychINFO, Medline, Cochrane and CINAHL databases were searched for literature along with the reference lists of eligible sources. Original research, peer-reviewed articles published between 2010 and 2020 in English language were included. Articles were included if study participants were adults with a diagnosis of schizophrenia or related psychosis. Methodological quality was evaluated using a quality assessment checklist, the Critical Appraisal Skills Programme tool. RESULTS Ten articles were included in the study. Five main themes about treatment adherence emerged from the literature: (i) severity of symptoms, (ii) side effects, (iii) beliefs and attitudes, (iv) insight and (v) support and relationships. CONCLUSIONS This scoping review concluded that attitude influenced adherence to medication in people with schizophrenia. The five main themes reported directly influenced attitude, impacting on treatment adherence in people experiencing schizophrenia. This review makes recommendations for a person-centred and recovery framework that aims to improve adherence. RELEVANCE TO CLINICAL PRACTICE Nurses in all healthcare settings could use evidence-based strategies to enhance treatment adherence in people with a range of physical and mental health conditions.
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Affiliation(s)
- Simehlani Nyanyiwa
- School of Nursing & Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kath Peters
- School of Nursing & Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Gillian Murphy
- School of Nursing & Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
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Paulus FW, Möhler E, Festag L, Joas J. Preschool Temperament as a Factor of Risk and Protection for Later Childhood Psychopathology. Front Psychiatry 2022; 13:803959. [PMID: 35722569 PMCID: PMC9198218 DOI: 10.3389/fpsyt.2022.803959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Temperament might be considered as a risk factor as well as a resilience factor for later externalizing and internalizing disorders. Therefore, this study examines different dimensions of temperament in preschool age with regard to their predictive value for psychopathology later in childhood. METHODS A total of 76 patients (63.2% male) were assessed in a special psychiatric consultation for preschool age at measuring point time t1 (x = 4.2) and measuring point time t2 (x = 9.2). At t1, the Integrative Child Temperament Inventory (ICTI) was used for assessment. At t2, parents completed the Strengths and Difficulties Questionnaire SDQ. Multiple regression analyses were used to test if the temperament factors of the ICTI predicted clinical abnormalities in the SDQ subscales or total difficulties score. RESULTS SDQ total difficulties score as an indicator of total psychiatric disturbance in childhood appears to be good predicted by the temperament factor frustration/anger. Sensory sensitivity in preschoolers serves as a risk factor for later emotional symptoms, whereas high activity levels appear to prevent later emotional symptoms. Behavioral inhibition appears to protect against hyperactivity/inattention. CONCLUSION Our data suggests that preschool temperament contributes differently to the development of externalizing and internalizing problems in childhood. The temperament factor frustration/anger in preschool children might be a strong predictor of the general mental condition in childhood at nine years of age and can therefore be used as a target for prevention of psychopathology in children. On one hand, high sensory sensitivity can be a predictor to identify preschool children at risk for later emotional symptoms, on the other hand, activity level acts as a protective factor against later emotional symptoms. An increased level of behavioral inhibition might be protective against the development of hyperactivity/inattention symptoms. Overall, this study illustrates the complexity and ambiguity of temperament in child development.
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Affiliation(s)
- Frank W Paulus
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Lisa Festag
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Jens Joas
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
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Elowe J, Ramain J, Solida A, Conus P, Golay P. Dynamics between insight and medication adherence in first-episode psychosis: Study of 3-year trajectories. Eur Psychiatry 2022; 65:e49. [PMID: 35968709 PMCID: PMC9486827 DOI: 10.1192/j.eurpsy.2022.2305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background While specialized early intervention programs represent the gold standard in terms of optimal management of first-episode psychosis (FEP), poor medication adherence remains a predominant unmet need in the treatment of psychosis. In this regard, an interaction between insight and adherence in FEP patients has been hypothesized but has been challenged by multiple pitfalls. Methods Latent profile analysis and trajectory modeling techniques were used to evaluate insight and adherence of 331 FEP patients engaged at the beginning, middle, and end of a 3-year specialized early psychosis program. A Bayesian model comparison approach was used to compare scores of clinical, functional, and socioeconomic outcomes at the end point of the study. Results Nearly one-third of the patients maintain a high level of insight and adherence during the entire program. At the end of the 3-year follow-up, more than three-quarters of patients are considered adherent to their medication. Patients with low levels of insight and adherence at the beginning of the program improve first in terms of adherence and then of insight. Furthermore, patients with high levels of insight and adherence are most likely to reach functional recovery and to experience an increase in environmental quality of life. Conclusions Latent FEP subpopulations can be identified based on insight and adherence. Medication adherence was the first variable to improve, but a gain in insight possibly plays a role in the reinforcement of adherence.
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The Effect of Therapeutic Alliance on Attitudes Toward Psychiatric Medications in Schizophrenia. J Clin Psychopharmacol 2021; 41:551-560. [PMID: 34411007 DOI: 10.1097/jcp.0000000000001449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE/BACKGROUND The differential influence of therapeutic alliance with different health care professionals on patients' medication adherence has never been examined. METHODS/PROCEDURES Ninety-five stable outpatients (91 patients with schizophrenia and 4 patients with schizoaffective disorder) were recruited. Individual, clinical, and medication factors were assessed, along with drug attitude (10-item Drug Attitude Inventory). Comparison on these factors was made between outpatients who identified psychiatrists as the health care professional most involved in their care, as compared with other health care professionals. FINDINGS/RESULTS Older age, longer duration of illness, presence of medical comorbidities, lower levels of internalized stigma, higher levels of insight, higher levels of functioning, lesser severity of depressive symptoms, and positive symptoms were found to be significantly associated with greater levels of drug attitude (small to moderate associations). Only therapeutic alliance had a large correlation with drug attitude (ρ = 0.503, P < 0.001). The therapeutic alliance scores between the 2 health care professionals groups are not significantly different. However, participants who have identified psychiatrists as the health care professional that contributed the most to their recovery reported a significantly more positive attitude (μ = 6.18, SD = 3.42) toward psychiatric medication as compared with the other health care professionals group (μ = 3.11, SD = 5.32, P = 0.004). Only 2 factors, the Revised Helping Alliance Questionnaire (β = 0.424, P < 0.001) and Personal and Social Performance scale (β = 0.272, P = 0.006), were statistically significant predictors of drug attitude. IMPLICATIONS/CONCLUSIONS Therapeutic alliance is found to be the lead factor associated with drug attitude in patients with schizophrenia. Identifying psychiatrists as the health care professional most involved in the patients' recovery can greatly increase patients' drug attitudes. Maintaining individuals' functioning also contributes to drug attitude.
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