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Bener A, Saldı MH, Bhugra D, Ventriglio A. Factors contributing to treatment non-compliance in a large sample of psychiatric patients in Turkey. Asian J Psychiatr 2025; 109:104528. [PMID: 40403677 DOI: 10.1016/j.ajp.2025.104528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2025] [Revised: 04/23/2025] [Accepted: 05/14/2025] [Indexed: 05/24/2025]
Abstract
OBJECTIVE This study aims to investigate the determinants of treatment non-compliance among psychiatric patients by exploring related factors. METHODS This is a cross-sectional study including patients hospitalized for psychiatric disorders and aged between 25 and 70 years in Istanbul, Turkey. 1648 patients were approached and 1310 (79.5 %) agreed to participate. A set of sociodemographic and clinical variables were collected as well as the Turkish Version of the 9-item Patient-Doctor Relationship Questionnaire (PDRQ-9) was administered. Statistical analyses included t-tests, chi-square tests, factor analysis, Confirmatory Factor Analysis, and computation of the Lorenz curve and Gini index. RESULTS Of 1310 patients, 761 (58.1 %) were compliant with treatments while 549 (41.9 %) were considered as non-compliant. Patients aged above 60 years were significantly less represented in the compliant group of patients (p = 0.008). Non-compliant patients were more like to be obese (p = 0.046), cigarette smokers (p = 0.019), nargileh-hookah users (p = 0.037), and perform less physical exercise (p = 0.044). Patients diagnosed with schizophrenia (p = 0.034), bipolar disorder (p = 0.016), depression (p = 0.008), obsessive-compulsive disorder (p = 0.015) and dementia/Alzheimer's disease (p = 0.003) were more likely to be compliant with treatments whereas patients affected by stress or post-traumatic stress disorder were significantly less complaint (p = 0.015 and p = 0.006, respectively). The main factors contributing to non-compliance included lack of social supervision and family support (p < 0.001), not regular attendance of the mental health services (p = 0.016), lack of insight towards treatments (p = 0.0124), lack of satisfaction with the doctor (p = 0.021), lack of education regarding medications side effects (p < 0.001), and poor perceived improvement with treatment (p = 0.005). Concurrently, the exploratory and confirmatory factor analyses confirmed validity and psychometric characteristics of the Turkish version of the 9-item Patient-Doctor Relationship Questionnaire (PDRQ-9). CONCLUSION This study reported a high prevalence rate of non-compliance among psychiatric patients. An empathetic patient-doctor approach, shared decision making as well as socially supportive and psychoeducational interventions are potentially useful for improving patients' attitudes toward treatments and their compliance.
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Affiliation(s)
- Abdulbari Bener
- Depts. of Biostatistics and Public Health, School of Medicine, Istanbul Medipol University, İstanbul, Turkey; Dept. of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The University of Manchester, Manchester, UK.
| | - Mustafa Hakan Saldı
- Depts. of Logistic Management, School of Medicine, Istanbul Medipol University, İstanbul, Turkey.
| | - Dinesh Bhugra
- Centre for Affective Disorders, Institute of Psychiatry, King's College London, UK,.
| | - Antonio Ventriglio
- Dept of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy.
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Oneib B, Mansour A, Bouazzaoui MA. The effect of psychoeducation on clinical symptoms, adherence, insight and autonomy in patients with schizophrenia. DISCOVER MENTAL HEALTH 2025; 5:26. [PMID: 40019728 PMCID: PMC11871247 DOI: 10.1007/s44192-025-00152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 02/21/2025] [Indexed: 03/01/2025]
Abstract
OBJECTIVE The aim of this study is to assess the impact of psychoeducation on patients with schizophrenia, focusing on clinical symptoms, insight, self-esteem, treatment adherence, and social autonomy. METHODS This prospective study evaluates the effects of a 6-month psychoeducation program, the P.A.C.T. (Psychosis Aider Comprendre Traiter) program, on stabilized outpatients with schizophrenia, without the use of a control group. The program is designed to help patients understand their illness and treatment, improving adherence to care. Topics covered include the symptoms of schizophrenia, available treatment options, and coping strategies. The program also emphasizes peer support and individualized care, addressing challenges such as cognitive deficits and low motivation. Data were collected both prior to and following the psychoeducation program using a standardized questionnaire and assessment scales to evaluate the following: clinical symptoms (Positive and Negative Syndrome Scale, PANSS), therapeutic adherence (Medication Adherence Report Scale, MARS), insight (Birchwood Insight Scale), self-esteem (Rosenberg Self-Esteem Scale), and social autonomy (Social Autonomy Scale, SAS). RESULTS A total of 100 patients participated in the psychoeducational sessions, with a mean age of 37.73 ± 10.51 years and a male predominance. Following the psychoeducation program, significant improvements were observed across all assessment scales: - PANSS: Clinical symptoms improved markedly, with the mean score decreasing from 83.17 ± 23.09 before psychoeducation to 43.67 ± 16.11 after psychoeducation (p < 0.0001). - MARS-5: The rate of good adherence to treatment increased from 9% to 63.7%, with a significant change (p < 0.0001). - Birchwood Insight Scale and Rosenberg Self-Esteem Scale: Insight and self-esteem scores improved significantly (p < 0.0001). - SAS Social autonomy showed substantial improvement, with the mean SAS score decreasing from 58.81 to 20.21 (p < 0.0001). CONCLUSION The P.A.C.T. psychoeducation program has been shown to significantly improve clinical outcomes, treatment adherence, insight, self-esteem, and social autonomy in patients with schizophrenia. However, the absence of a control group prevents the generalization of these data. Subsequent comparative studies would be desirable to demonstrate the positive effect of psychoeducation in the early stages of the disease within the framework of a comprehensive approach to recovery.
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Affiliation(s)
- Bouchra Oneib
- Department of Psychiatry, CHU Mohammed VI, Faculty of Medicine, University Mohammed I, Oujda, Morocco.
| | - Atif Mansour
- Department of Psychiatry, CHU Mohammed VI, Faculty of Medicine, University Mohammed I, Oujda, Morocco
| | - Mohammed Amine Bouazzaoui
- Department of Epidemiology, CHU Mohammed VI, Faculty of Medicine, University Mohammed I, Oujda, Morocco
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Jakobsen MI, Schaug JP, Storebø OJ, Austin SF, Nielsen J, Simonsen E. What is the current scope of research assessing patients' and clinicians' perspectives on clozapine treatment? A comprehensive scoping review. BMJ Open 2025; 15:e085956. [PMID: 39819922 PMCID: PMC11751990 DOI: 10.1136/bmjopen-2024-085956] [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: 03/18/2024] [Accepted: 12/09/2024] [Indexed: 01/19/2025] Open
Abstract
OBJECTIVES Clozapine is continuously underused. The existing systematic reviews addressing barriers to clozapine prescribing primarily focus on clinical staff's attitudes and perceived barriers to prescribing. However, a preliminary literature search revealed additional literature on the subject not previously included in systematic reviews, including literature on patient perspectives. A scoping review is warranted to map the scope of primary studies on patients' and/or clinicians' perspectives on clozapine treatment and to identify gaps in research. DESIGN A scoping review was designed and reported in accordance with established guidelines for scoping reviews. DATA SOURCES The electronic databases Cochrane Library, CINAHL, Web of Science, PsycINFO, MEDLINE, EMBASE, Google Scholar and two grey literature databases were searched. Furthermore, citation tracking of selected studies was undertaken. ELIGIBILITY CRITERIA We included primary, empirical studies reporting clinicians' and/or patients' perspectives on clozapine treatment. No limitation was set for the year of publication or type of primary study. DATA EXTRACTION AND SYNTHESIS Two researchers independently screened for studies, extracted the data and coded the content. Findings were summarised visually and narratively. RESULTS 146 studies were included. Most studies reported on patients' or clinicians' perspectives on active clozapine treatment or on clinicians' perspectives on barriers to clozapine initiation in general. Three gaps in research were identified: (1) clozapine-eligible, yet clozapine-naïve, patients' attitudes towards clozapine commencement, (2) clinicians' reasons for clozapine withholding and perceived facilitators of clozapine treatment in specific patient-cases and (3) patient and clinician perspectives on clozapine discontinuation, continuation and rechallenge in specific patient cases. CONCLUSIONS Research on clozapine perspectives tends to repeat itself. Future studies addressing the identified gaps in evidence could provide the insights needed to optimise clozapine utilisation.
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Affiliation(s)
- Michelle Iris Jakobsen
- Psychiatric Services Region Zealand East, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn N, Denmark
| | - Julie Perrine Schaug
- Psychiatric Services Region Zealand Psychiatric Research Unit, Slagelse, Denmark
| | - Ole Jakob Storebø
- Psychiatric Services Region Zealand Psychiatric Research Unit, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Stephen F Austin
- Psychiatric Services Region Zealand East, Roskilde, Denmark
- Department of Psychology, University of Copenhagen Faculty of Social Sciences, Copenhagen, Denmark
| | - Jimmi Nielsen
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
- Psychiatric Centre Glostrup, Unit for Complicated Schizophrenia, Capital Region of Denmark Mental Health Services, Kobenhavn, Denmark
| | - Erik Simonsen
- Psychiatric Services Region Zealand East, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
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Kim EY, Kim J, Jeong JH, Jang J, Kang N, Seo J, Park YE, Park J, Jeong H, Ahn YM, Kim YS, Lee D, Kim SH. Machine learning prediction model of the treatment response in schizophrenia reveals the importance of metabolic and subjective characteristics. Schizophr Res 2025; 275:146-155. [PMID: 39731846 DOI: 10.1016/j.schres.2024.12.018] [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: 05/28/2024] [Revised: 12/09/2024] [Accepted: 12/22/2024] [Indexed: 12/30/2024]
Abstract
Predicting early treatment response in schizophrenia is pivotal for selecting the best therapeutic approach. Utilizing machine learning (ML) technique, we aimed to formulate a model predicting antipsychotic treatment outcomes. Data were obtained from 299 patients with schizophrenia from three multicenter, open-label, non-comparative clinical trials. For prediction of treatment response at weeks 4, 8, and 24, psychopathology (both objective and subjective symptoms), sociodemographic and clinical factors, functional outcomes, attitude toward medication, and metabolic characteristics were evaluated. Various ML techniques were applied. The highest area under the curve (AUC) at weeks 4, 8 and 24 was 0.711, 0.664 and 0.678 with extreme gradient boosting, respectively. Notably, our findings indicate that BMI and attitude toward medication play a pivotal role in predicting treatment responses at all-time points. Other salient features for weeks 4 and 8 included psychosocial functioning, negative symptoms, subjective symptoms like psychoticism and hostility, and the level of prolactin. For week 24, positive symptoms, depression, education level and duration of illness were also important. This study introduced a precise clinical model for predicting schizophrenia treatment outcomes using multiple readily accessible predictors. The findings underscore the significance of metabolic parameters and subjective traits.
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Affiliation(s)
- Eun Young Kim
- Department of Psychiatry, Seoul National University Health Service Center, Seoul, Republic of Korea; Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jayoun Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Jeong
- Department of Psychiatry, Nowon Eulji University Hospital, Seoul, Republic of Korea
| | - Jinhyeok Jang
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Nuree Kang
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jieun Seo
- Department of Statistics, Ewha Womans University, Seoul, Republic of Korea
| | - Young Eun Park
- Department of Statistics, Ewha Womans University, Seoul, Republic of Korea
| | - Jiae Park
- Department of Statistics, Ewha Womans University, Seoul, Republic of Korea
| | - Hyunsu Jeong
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Sik Kim
- Department of Psychiatry, Nowon Eulji University Hospital, Seoul, Republic of Korea
| | - Donghwan Lee
- Department of Statistics, Ewha Womans University, Seoul, Republic of Korea.
| | - Se Hyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Nebhinani N, Pareek V, Choudhary S, Tripathi S, Singh P, Kumar M. Pathways of care and attitudes toward psychotropics in patients with depressive disorders and psychotic disorders. J Neurosci Rural Pract 2022; 13:785-790. [PMID: 36743762 PMCID: PMC9893934 DOI: 10.25259/jnrp-2021-11-39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Delay in institution of appropriate mental healthcare is closely linked with attitudes, stigma, and availability of services, which further directs the help seeking pathways. This study was aimed to assess the pathway of care and attitudes toward psychotropic medications among patients with depressive disorder and psychotic disorders. Materials and Methods Eighty outpatients with depressive disorder and 40 patients with psychotic disorder were assessed in a tertiary care center for pathways to care and attitude toward psychotropics through Attitude toward Psychotropic Medications Questionnaire and Drug attitude inventory-10. Results The psychiatrist remained the most common first treatment contact (46% in depression and 62% in psychosis). Greater number of patients in psychotic disorder group had first treatment contact with faith healers or exorcist (17.5%), compared to depressive disorder (6.2%). Patients in depressive group had more favorable attitude toward psychotropics compared to psychosis group. Majority of patients had favorable attitude toward psychotropic medications, but they also had substantial misconceptions about side effects, utility, and need of taking lesser than prescribed doses. Conclusions Although majority of patients had favorable attitude, they also had substantial misconceptions about medications. These issues need to be addressed for better delivery of comprehensive mental healthcare.
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Affiliation(s)
- Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Vrinda Pareek
- Department of Psychiatry, Government Medical College, Vadodara, Gujarat, India
| | - Swati Choudhary
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Swapnil Tripathi
- Department of Medicine, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Prerna Singh
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Manish Kumar
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
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Barlati S, Morena D, Nibbio G, Cacciani P, Corsini P, Mosca A, Deste G, Accardo V, Turrina C, Valsecchi P, Vita A. Internalized stigma among people with schizophrenia: Relationship with socio-demographic, clinical and medication-related features. Schizophr Res 2022; 243:364-371. [PMID: 34183209 DOI: 10.1016/j.schres.2021.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/11/2021] [Accepted: 06/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND People with schizophrenia are at high risk of suffering from stigma and internalizing it. Recently, a better understanding of the stigma process has shifted the attention from public stigma to self-stigma, which is deeply debilitating. This study aimed to assess factors associated to self-stigma by evaluating socio-demographic, clinical and treatment-related variables in a group of subjects diagnosed with schizophrenia and to identify predictors of high internalized stigma. METHODS Ninety-four inpatients accessing rehabilitative centers with a diagnosis of schizophrenia were included in this cross-sectional study. Measures included both patient-rated scales, assessing internalized stigma, attitude toward medications, side effects experience and subjective well-being, and clinician-rated scales, assessing schizophrenia symptoms and global clinical severity and antipsychotic-related side effects. RESULTS Twenty-one patients (22.3%) showed high internalized stigma while 73 (77.7%) did not. Patients experiencing more medication adverse effects and worse subjective well-being were more likely to suffer from internalized stigma according to a logistic regression analysis. Extrapyramidal, psychic and some autonomic reactions also emerged as individual predictors of self-stigma in a separate regression analysis. CONCLUSIONS Self-stigma and subjective medication side effects perception represent a relevant issue in patients' life and should be carefully taken into account in clinical practice.
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Affiliation(s)
- Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | | | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Cacciani
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Paola Corsini
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alessandra Mosca
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Vivian Accardo
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Cesare Turrina
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Valsecchi
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Verdoux H, Quiles C, Bon L, Chéreau-Boudet I, Dubreucq J, Legros-Lafarge E, Guillard-Bouhet N, Massoubre C, Plasse J, Franck N. Characteristics associated with self-reported medication adherence in persons with psychosis referred to psychosocial rehabilitation centers. Eur Arch Psychiatry Clin Neurosci 2021; 271:1415-1424. [PMID: 33169212 DOI: 10.1007/s00406-020-01207-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023]
Abstract
The aim of the present study was to explore the characteristics of psychotropic treatment and of psychosocial functioning associated with self-reported medication adherence in persons with psychosis engaged in rehabilitation. The study was performed in the REHABase cohort including persons referred to a French network of psychosocial rehabilitation centers. Treatment adherence was assessed using the Medication Adherence Rating Scale (MARS). The associations between MARS score (categorized as "low" < 7 vs. "high" ≥ 7) and functioning or psychotropic treatment characteristics were explored using multivariate analyses in 326 participants with schizophrenia spectrum disorders. Regarding psychotropic treatment, high anticholinergic load was the only characteristic associated with poor medication adherence (adjusted OR, aOR 1.98, 95% CI 1.07-3.66). Regarding functioning measures, participants with poor medication adherence were more likely to present with lower stage of recovery (aOR 2.38, 95% CI 1.31-4.32), poor quality of life (aOR 2.17, 95% CI 1.27-3.71), mental well-being (aOR 1.68, 95% CI 1.03-2.72) and self-esteem (aOR 1.74, 95% CI 1.05-2.87), and higher internalized stigma (aOR 1.88, 95% CI 1.09-3.23). Self-reported poor medication adherence is a marker of poor functioning in persons with psychosis. The MARS is a quick and simple measure of adherence that may be helpful in clinical and rehabilitation settings to identify persons with specific rehabilitation needs.
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Affiliation(s)
- Hélène Verdoux
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, 33000, Bordeaux, France. .,Centre Référent de Réhabilitation Psychosociale (C2RP), Centre Hospitalier Charles Perrens, 33000, Bordeaux, France. .,Hôpital Charles Perrens, 121 rue de la Bechade, 33076, Bordeaux Cedex, France.
| | - Clélia Quiles
- Centre Référent de Réhabilitation Psychosociale (C2RP), Centre Hospitalier Charles Perrens, 33000, Bordeaux, France
| | - Laura Bon
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), Hôpital Le Vinatier, Centre National de la Recherche Scientifique (CNRS) et Université Claude Bernard, Lyon 1, Lyon, France
| | - Isabelle Chéreau-Boudet
- Centre Référent Conjoint de Réhabilitation (CRCR), Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Julien Dubreucq
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère/Réseau Handicap Psychique, St Martin d'Hères, France.,ReHPSY, Centre Hospitalier Alpes Isère, Grenoble, France
| | | | | | - Catherine Massoubre
- REHALise, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Julien Plasse
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), Hôpital Le Vinatier, Centre National de la Recherche Scientifique (CNRS) et Université Claude Bernard, Lyon 1, Lyon, France
| | - Nicolas Franck
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), Hôpital Le Vinatier, Centre National de la Recherche Scientifique (CNRS) et Université Claude Bernard, Lyon 1, Lyon, France.,Pôle Centre rive gauche, Centre Hospitalier Le Vinatier, Lyon, France
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Bitar Z, Haddad C, Obeid S, Hallit S. Treatment satisfaction and its association with anxiety, depression and fear of COVID-19 among Lebanese inpatients with schizophrenia. Pharm Pract (Granada) 2021; 19:2364. [PMID: 34621448 PMCID: PMC8455125 DOI: 10.18549/pharmpract.2021.3.2364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/12/2021] [Indexed: 12/21/2022] Open
Abstract
Background: The patient’s evaluation of treatment and its associated outcomes
define the treatment satisfaction. The quality of treatment satisfaction and
healthcare service has been affected by depression, anxiety and fear of the
current coronavirus disease 2019 (COVID-19) pandemic. Objective: Therefore, this study aimed to assess factors associated with treatment
satisfaction among Lebanese inpatients with schizophrenia, namely
depression, anxiety and fear of COVID-19. Methods: A cross-sectional study was conducted between September and November 2020,
enrolled 118 patients with chronic schizophrenia consecutively admitted to
Psychiatric Hospital of the Cross, Lebanon. The Functional Assessment of
Chronic Illness Therapy-Treatment Satisfaction-Patient Satisfaction Scale
(FACIT-TS-PS) was used to assess treatment satisfaction, the Lebanese
Anxiety Scale -10 (LAS-10) was used to assess anxiety, Montgomery-Asberg
Depression Rating Scale (MADRS) to assess depression and the Fear of
COVID-19 Scale to assess the level of fear of the COVID-19 pandemic. Results: The mean scores of the scales were as follows: treatment satisfaction (65.20;
SD 16.11; median=71), LAS-10 (13.65; SD 6.02), MADRS (9.09; SD 6.69) and
fear of COVID-19 (18.59; SD 6.78). Higher depression (r= -0.46,
p<0.001) was significantly associated with lower treatment
satisfaction. Female gender (beta=7.51, p=0.029) was significantly
associated with higher treatment satisfaction score. Fear of COVID-19 did
not show any significant association with the treatment satisfaction
score. Conclusions: Results of this study found that depression and gender were associated with
treatment satisfaction among inpatients with schizophrenia. No association
has been found between fear of COVID-19 and treatment satisfaction among
those patients. More research is warranted to evaluate treatment
satisfaction and associated factors among chronic inpatients with
schizophrenia, specifically during the COVID-19 pandemic, in order to
improve treatment satisfaction and subjective well-being of patients.
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Affiliation(s)
- Zeinab Bitar
- Faculty of Science, Lebanese University. Beirut (Lebanon).
| | - Chadia Haddad
- Research Department, Psychiatric Hospital of the Cross. Jal Eddib (Lebanon).
| | - Sahar Obeid
- Faculty of Arts and Science, Holy Spirit University of Kaslik (USEK). Jounieh (Lebanon).
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK). Jounieh (Lebanon).
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Abdisa E, Fekadu G, Girma S, Shibiru T, Tilahun T, Mohamed H, Wakgari A, Takele A, Abebe M, Tsegaye R. Self-stigma and medication adherence among patients with mental illness treated at Jimma University Medical Center, Southwest Ethiopia. Int J Ment Health Syst 2020; 14:56. [PMID: 32760443 PMCID: PMC7391813 DOI: 10.1186/s13033-020-00391-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/23/2020] [Indexed: 02/01/2023] Open
Abstract
Background Self-stigma associated with mental illness has remained a global public health issue affecting social interactions, health care, productivity and acceptance among others. It is one of important factors contributing to non-adherence to medication that leads to increased hospitalization and higher healthcare costs. Hence, the study aimed to assess self-stigma and medication adherence among patients with mental illness treated at the psychiatric clinic of Jimma University Medical Center (JUMC). Methods A cross-sectional, community-level study was conducted at Jimma town. The patient’s data was collected from records between April and June 2017 and the collected data was analyzed using SPSS version 21. The Internalized Stigma of Mental Illness (ISMI) tool was utilized to measure internalized stigma. Linear regression analysis was performed to get the final model. Statistical significance association was considered at p-values less than 0.05 and 95% confidence interval was used. Results Males comprised more than half (61%) of the total sample of 300 respondents and with a mean age of 34.99 (SD ± 11.51) years. About one-third (32%) of patients had a working diagnosis of schizophrenia followed by major depressive disorder (24.3%). More than half of them, 182 (60.7%) were adherent to their psychotropic medication. The overall mean value of self-stigma was 2.16 (SD = 0.867) and 84 (28%) of the respondents had moderate to high self-stigma. Using ISMI the mean score of alienation was 2.26 (SD = 0.95), stereotype endorsement 2.14 (SD = 0.784), perceived discrimination 2.18 (SD = 0.90), social withdrawal 2.10 (SD = 0.857) and stigma resistance 2.11 (SD = 0.844). Increasing age of the patients (std. β = − 0.091, p = 0.009) and living with kids and spouse (std. β = − 0.099, p = 0.038) were negatively associated with self-stigma whereas increased world health organization disability assessment schedule (WHODAS) score (β = 0.501, p < 0.001), number of relapses (std. β = 0.183, p < 0.01) and medication non-adherence (std. β = 0.084, p = 0.021) were positively associated with self-stigma. Conclusion The study revealed that there was high self-stigma among patients with mental illness and a significant association between overall ISMI score and level of medication adherence. These require mental health professionals and policy-makers should give attention to ways to overcome self-stigma and increase medication adherence among patients with mental illness.
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Affiliation(s)
- Eba Abdisa
- Department of Psychiatry, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ginenus Fekadu
- Clinical Pharmacy Department, School of Pharmacy, Institute of Health Sciences, Wollega University, P.O Box 395, Nekemte, Ethiopia
| | - Shimelis Girma
- Department of Psychiatry, College of Health Science, Jimma University, Jimma, Ethiopia
| | - Tesfaye Shibiru
- Department of Pediatrics and Child Health, Wollega University Referral Hospital, Nekemte, Ethiopia
| | - Temesgen Tilahun
- Department of Obstetrics and Gynecology, School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Habib Mohamed
- Department of Obstetrics and Gynecology, School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Aaga Wakgari
- Department of Obstetrics and Gynecology, School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Amsalu Takele
- Department of Surgery, School of Medicine, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Milkias Abebe
- Medical Microbiology Unit, Department of Medical Laboratory Science, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Reta Tsegaye
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Abstract
OBJECTIVE Clozapine is the only approved strategy for treatment-resistant schizophrenia, although it is highly underutilized. We aim to generate practical and actionable evidence-based recommendations for the use of this drug considering prescription barriers. METHOD Narrative review. RESULTS A consistent body of evidence supports the efficacy of clozapine reducing morbidity and mortality in schizophrenia. The main obstacles to its use are the lack of experience by prescribers and perceived treatment burden. Systematic screening of eligibility, utilization of available resources for consultation, developing a professional network with other stakeholders, as well as optimizing how clozapine is presented to patients is discussed. Furthermore, specific evidence-based recommendations for initiation, maintenance, and safety monitoring with clozapine are provided. CONCLUSION Clozapine prescription is one of the areas in psychiatry with the greatest mismatch between efficacy and utilization in clinical practice. Although multiple barriers to the use of clozapine exist, some of these may be overcome by updates of routine clinical practice.
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Affiliation(s)
- J M Rubio
- Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Glen Oaks, NY, USA.,Feinstein Institute for Medical Research, Northwell Health, Glen Oaks, NY, USA.,The Zucker Hillside Hospital - Northwell Health, Glen Oaks, NY, USA
| | - J M Kane
- Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Glen Oaks, NY, USA.,Feinstein Institute for Medical Research, Northwell Health, Glen Oaks, NY, USA.,The Zucker Hillside Hospital - Northwell Health, Glen Oaks, NY, USA
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11
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Chauhan N, Chakrabarti S, Grover S. Attitudes to Medication-Treatment Among Patients and Caregivers: A Longitudinal Comparison of Bipolar Disorder and Schizophrenia From India. J Clin Psychopharmacol 2020; 40:18-29. [PMID: 31804452 DOI: 10.1097/jcp.0000000000001144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Attitudes toward medication treatment are thought to significantly influence adherence in bipolar disorder (BD) and schizophrenia. However, the actual impact of patients' treatment attitudes on adherence and determinants of attitudes is still uncertain. METHODS A longitudinal examination of treatment attitudes and their correlates was conducted among patients with BD and their caregivers compared with those with schizophrenia. Structured assessments of symptom severity, functioning, insight, medication side effects, knowledge of illness, medication adherence, treatment attitudes, and treatment satisfaction were performed among 176 selected patients (106 with BD and 70 with schizophrenia) and their caregivers. Participants were reassessed on these parameters at 3 and 6 months. RESULTS Rates of nonadherence at baseline varied widely between self-reports, clinician ratings, and serum levels. Though symptoms and functioning improved with treatment, overall rates of nonadherence increased in the first 3 months because of early dropouts and remained stable thereafter. However, treatment attitudes and treatment satisfaction remained largely unchanged among patients and caregivers. Both positive and negative attitudes were commonly held and patients' attitudes did not differ between BD and schizophrenia. Patients' attitudes were significantly associated with adherence, insight, knowledge about illness, treatment satisfaction, symptom severity, social disadvantage, and side effects together with caregivers' knowledge, attitudes, and satisfaction. Caregivers of patients with schizophrenia were more knowledgeable and had more positive attitudes than patients. CONCLUSIONS Patients' attitudes to medication treatment are associated with adherence over time. They are relatively enduring and mainly associated with insight, knowledge of illness, and treatment satisfaction among patients and their caregivers. These findings could inform psychosocial interventions aiming to improve treatment attitudes and adherence in BD and schizophrenia.
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Affiliation(s)
- Nidhi Chauhan
- From the Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institution of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institution of Medical Education and Research (PGIMER), Chandigarh, India
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12
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Alzahrani A. Assessing the attitudes of medical students towards psychiatry: A new paradigm. Asian J Psychiatr 2019; 43:17-23. [PMID: 31075651 DOI: 10.1016/j.ajp.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Gauging the probability that medical students will select psychiatry as a career is a challenge, especially in Saudi Arabia, where the profession of psychiatry has still to gain ground. Thus, the aim of the current study was to investigate the attitudes of Saudi medical students towards psychiatry. METHOD A total of 317 medical students were recruited in a cross-sectional study. An ATP-30 questionnaire was used. In addition to the suggested cut-off point of 90 in previous studies, the data were also categorized using the visual binning procedure. To enhance the number of significant predictors and obtain more realistic results, an Ordinal Logistic Regression model was applied. RESULT The attitudes of medical students towards the three outcomes (dependent) variables; "Overall attitudes towards psychiatry, I want to be a psychiatrist, and Attitudes towards psychiatric treatment" varied across the five explanatory (predictor) variables, when assessed using Ordinal Logistic Regression. Age and gender proved significant with the three outcome variables, whereas Exposure to Psychiatric Clerkship identified "Overall attitudes towards psychiatry" and "Attitudes towards psychiatric treatment". Significant effects from a "Psychiatrist Relative" was found in "Overall attitudes towards psychiatry"and "I want to be a psychiatrist". The predictor variable; "Having a relative who is a psychiatric patient" was found to be significant only with, "I want to be a psychiatrist". CONCLUSION The attitudes of medical students towards psychiatry can be predicted in the presence of specific factors. This is discussed in more detail in the relevant part of the study.
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Lee Y, Lee MS, Jeong HG, Youn HC, Kim SH. Medication Adherence Using Electronic Monitoring in Severe Psychiatric Illness: 4 and 24 Weeks after Discharge. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:288-296. [PMID: 30905129 PMCID: PMC6478086 DOI: 10.9758/cpn.2019.17.2.288] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/09/2018] [Accepted: 09/10/2018] [Indexed: 12/13/2022]
Abstract
Objective The purpose of this study was to examine post-hospitalization outpatient drug adherence in patients with severe psychiatric illness, including bipolar disorder and schizophrenia, and to investigate factors associated with drug adherence. Methods Eighty-one patients diagnosed with schizophrenia or bipolar disorder who were hospitalized due to aggravation of psychiatric symptoms were monitored. At hospitalization, we conducted clinical assessments such as the Clinical Global Impression-Severity, Drug Attitude Inventory, Contour Drawing Rating Scale, Multidimensional Scale of Perceived Social Support scale, and patients’ demographic factors. We measured drug adherence using the Medication Event Monitoring System (MEMS), pill count, and patients’ self-report upon out-patients visits, 4 and 24 weeks after discharge. Results The mean values of the various measures of adherence were as follows: MEMS (4 weeks) 84.8%, pill count (4 weeks) 94.6%, self-report (4 weeks) 92.6%, MEMS (24 weeks) 81.6%, pill count (24 weeks) 90.6%, and self-report (24 weeks) 93.6%. The adherence agreement between MEMS, pill count, and self-report was moderate (4 weeks intra-class correlation [ICC]=0.54, 24 weeks ICC=0.52). Non-adherence (MEMS ≤0.08) was observed in 26.4% of the patients at 4 weeks and 37.7% at 24 weeks. There was a negative correlation between drug adherence assessed 4 weeks after discharge and Contour Drawing Rating Scale difference score (r=−0.282, p<0.05). A positive correlation was found between drug adherence assessed 24 weeks after discharge and Drug Attitude Inventory (r=0.383, p<0.01). Conclusion Patients’ attitude towards their medication and their degree of physical dissatisfaction influenced post-hospitalization drug adherence in severe psychiatric patients.
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Affiliation(s)
- Yujin Lee
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine
| | - Moon-Soo Lee
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine
| | - Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine
| | - Hyun-Chul Youn
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine
| | - Seung-Hyun Kim
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine
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Grover S, Mehra A, Chakrabarti S, Avasthi A. Attitude toward psychotropic medications: A comparison of the elderly and adult patients with affective and psychotic disorders. JOURNAL OF GERIATRIC MENTAL HEALTH 2019. [DOI: 10.4103/jgmh.jgmh_36_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Attitude towards Antipsychotic Medications in Patients Diagnosed with Schizophrenia: A Cross-Sectional Study at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. SCHIZOPHRENIA RESEARCH AND TREATMENT 2019; 2019:5094017. [PMID: 31263597 PMCID: PMC6556305 DOI: 10.1155/2019/5094017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/06/2019] [Accepted: 05/15/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Poor attitude towards antipsychotic drugs is high, and it is a factor for non-adherence to treatment. This increases the risk of relapse, associated healthcare utilization, and costs. This study aimed to assess attitude towards antipsychotic medication among patients with schizophrenia. OBJECTIVES The aim of this institution based cross-sectional study was to assess attitude towards antipsychotic medications and associated factors among patients with schizophrenia who attend the outpatient clinics at Amanuel Mental Specialized Hospital, 2018. METHODS In a cross-sectional study, 393 schizophrenic patients from Amanuel Mental Specialized Hospital were recruited by a systematic random sampling technique. Drug Attitude Inventory (DAI-10) was used to assess attitude, experience, and belief about antipsychotics. Glasgow antipsychotic side effect scale modified version, positive and negative syndrome scale, and Birch wood's insight scale for psychosis were the instruments used to assess the associated factors. Simple and multiple linear regression analysis models were fitted, and the adjusted unstandardized beta (β) coefficient at 95% confidence interval was used. RESULTS The mean score of attitude towards antipsychotic medications was 6.51 with standard deviation (SD) of 2.22. In multiple linear regression, positive symptoms (β= -0.07, 95% CI: (-0.09, -0.05)), negative symptoms (β= -0.04, 95% CI: (-0.06,-0.02)), shorter (≤5 years) duration of illness (β= -0.39, 95% CI: (-0.63, -0.15)), first generation antipsychotics (β = -0.35, 95% CI: (-0.55,-0.14)), having sedation (β= -0.28, 95% CI: (-0.52, -0.02)), and extra-pyramidal side effects (β= -0.34, 95% CI: (-0.59,-0.09)) were factors negatively associated with attitude towards antipsychotic medication treatment. Insight to illness (β= 0.24, 95% CI: (0.20, 0.27) was a factor positively associated with attitude towards antipsychotic medications. CONCLUSION The result suggests that the mean score of participants' attitude towards antipsychotic medications was good. Prevention of side effects particularly due to first generation antipsychotics is necessary.
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Predicting Unsuccessful Clozapine Treatment After First Use in Adult Patients With Psychotic Disorders. J Clin Psychopharmacol 2018; 38:604-608. [PMID: 30371636 DOI: 10.1097/jcp.0000000000000977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND Cessation of clozapine therapy and insufficient response may result in relapse of psychotic symptoms and in clinical admissions. However, discontinuation rates are high. Identifying patients at risk for unsuccessful clozapine use might enable clinicians to direct specific attention to them. METHODS/PROCEDURES Routinely collected data from a large insurance company were used to develop a simple prediction model for unsuccessful clozapine treatment in psychiatric patients 1 year after clozapine was first dispensed by a community pharmacy in the Netherlands. Multivariate logistic regression analyses were performed with the Nagelkerke R statistic as a measure of the predictive value of the model. FINDINGS/RESULTS A total of 937 patients were dispensed clozapine for the first time by their community pharmacy between January 1, 2011, and December 31, 2015 (index date). Of these, 741 patients had started their clozapine treatment in hospital before the index date (inpatient starters); the remaining 196 patients started clozapine as outpatients on the index date (outpatient starters). In 191 patients (20.4%), clozapine treatment was unsuccessful 1 year after the index date. Unsuccessful treatment was more common among outpatient starters than among inpatient starters (32.1% vs 17.3%). Using backward selection of the variables, a model consisting of 61 variables had the best predictive value overall (Nagelkerke R = 0.301), whereas a model consisting of 52 variables had the best predictive value in outpatient starters (Nagelkerke R = 0.676). IMPLICATIONS/CONCLUSIONS The likelihood of unsuccessful clozapine treatment after 1 year was higher among patients who started clozapine as outpatients. Despite the use of a diversity of variables and different statistical approaches, it was not possible to make a simple prediction model for unsuccessful clozapine treatment using relatively easily accessible data.
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Widschwendter CG, Kemmler G, Rettenbacher MA, Yalcin-Siedentopf N, Hofer A. Subjective well-being, drug attitude, and changes in symptomatology in chronic schizophrenia patients starting treatment with new-generation antipsychotic medication. BMC Psychiatry 2018; 18:212. [PMID: 29954366 PMCID: PMC6022409 DOI: 10.1186/s12888-018-1791-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/12/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Non-adherence to medication remains a major challenge in the long-term management of patients with schizophrenia. Next to lack of insight into the illness, adverse effects of antipsychotic drugs, cognitive deficits, poor therapeutic alliance, reduced quality of life, missing social support, and negative attitudes toward medication are predictors of non-adherence. This study examined potential correlations between attitudes toward antipsychotic drug therapy, subjective well-being, and symptom change in patients with chronic schizophrenia. METHODS 30 patients with schizophrenia starting monotherapy with a new-generation antipsychotic were included into the study. The Drug Attitude Inventory (DAI) and the Subjective Well-being under Neuroleptic Treatment Scale, short form (SWN-K), were administered after 2, 4, and 12 weeks of treatment. At the same points in time and at baseline, psychopathological symptoms were rated by means of the Positive and Negative Syndrome Scale (PANSS), and functioning was assessed by means of the Global Assessment of Functioning Scale (GAF). Antipsychotic induced side effects were evaluated by using the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale. RESULTS Study participants had a mean age of 37.5 ± 9.7 years, baseline symptoms were mild. The PANSS total score improved significantly from baseline to weeks 4 (p = .003) and 12 (p = .001), respectively. Neither the DAI total score nor the SWN-K total score changed significantly over the course of time. The severity of symptoms was not correlated with drug attitude at any time point but was negatively correlated with wellbeing at weeks 2 (r = -.419, p = .021) and 4 (r = -.441, p = .015). There was no significant correlation between DAI and SWN-K total scores at any time point. CONCLUSIONS Next to showing that the DAI and the SWN-K measure different aspects of subjective experiences during antipsychotic treatment these findings emphasize the use of both instruments to optimize adherence to medication.
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Affiliation(s)
- Christian G. Widschwendter
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Georg Kemmler
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Maria A. Rettenbacher
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Nursen Yalcin-Siedentopf
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Alex Hofer
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
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Chaudhari B, Saldanha D, Kadiani A, Shahani R. Evaluation of treatment adherence in outpatients with schizophrenia. Ind Psychiatry J 2017; 26:215-222. [PMID: 30089972 PMCID: PMC6058450 DOI: 10.4103/ipj.ipj_24_17] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Treatment nonadherence is a major obstacle in the successful management of schizophrenia. Finding out factors associated with nonadherence and the reasons for nonadherence are important to improve treatment adherence in patients with schizophrenia. This study was conceived to evaluate treatment adherence in patients with schizophrenia and the factors associated with it. MATERIALS AND METHODS A cross-sectional study was conducted in 50 consecutive patients with schizophrenia with the help of semi-structured pro forma consisting of sociodemographic details, information regarding illness and treatment history, (PANSS), and Morisky Medication Adherence Scale-8 to assess medication adherence. Nonadherent patients were further assessed for their reasons for nonadherence. RESULTS Among the patients, 52% were low adherers (nonadherers). Factors associated with nonadherence were younger age of patients, male gender, low household income, higher PANSS score (positive, negative, and total score), lower grades of insight, lack of family history of psychiatric illness, responsibility of taking self-medications, first-generation antipsychotics, and number of drugs in prescription. Major reason for nonadherence given by patients were adverse effects of medications, treatment perceived as ineffective, financial problems, shame and stigma about illness and treatment, regarding treatment unnecessary and difficulty to access health-care facility. CONCLUSION Our study established high proportion of nonadherence in patients with schizophrenia and also brought out factors associated and reasons for nonadherence. Adequate psychoeducation of patients and their caretakers as well as psychosocial interventions, strengthening mental health infrastructure, and community mental health services will significantly improve treatment adherence.
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Affiliation(s)
- Bhushan Chaudhari
- Department of Psychiatry, Dr DY Patil Medical College, Pune, Maharashtra, India
| | - Daniel Saldanha
- Department of Psychiatry, Dr DY Patil Medical College, Pune, Maharashtra, India
| | - Adnan Kadiani
- Department of Psychiatry, Dr DY Patil Medical College, Pune, Maharashtra, India
| | - Roma Shahani
- Dr DY Patil Medical College, Pune, Maharashtra, India
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Ren Z, Wang H, Feng B, Gu C, Ma Y, Chen H, Li B, Liu L. An exploratory cross-sectional study on the impact of education on perception of stigma by Chinese patients with schizophrenia. BMC Health Serv Res 2016; 16:210. [PMID: 28340611 PMCID: PMC5366160 DOI: 10.1186/s12913-016-1424-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 05/04/2016] [Indexed: 11/22/2022] Open
Abstract
Background Stigma is a major issue across various society and cultures, and few studies focus on the perception of stigma by Chinese patients with schizophrenia. In the current cross-sectional study, we sought to assess the extent of internalized stigma among outpatients with schizophrenia in China and to investigate whether education level correlated with the experience of stigma. Methods Outpatients with schizophrenia were evaluated using the brief psychosis rating scale (BPRS), the positive and negative syndrome scale (PANSS), the clinical global impression-severity of illness (CGI-SI) scale and the Stigma Scale for Mental Illness (SSMI 2C). Patients were categorized into the high education and low education group according to their educational levels. Results One hundred thirty-three subjects were included in the study. Their mean course of illness was 4.32 ± 6.14 years (range, 1 month to 15 years). Their mean BPRS score was 19.87 ± 5.46, their mean PANSS score was 44.11 ± 13.1, and their mean CGI-SI score was 2.22 ± 0.81. In addition, the mean SSMI 2C score of the high education group (7.15 ± 0.98) was markedly higher than that of the low education group (5.75 ± 0.79, P < 0.05). The mean domain I score of the high education group (2.30 ± 0.76) was comparable to that of the low education group (2.07 ± 0.78, P > 0.05). The mean domain II score of the high education group (2.42 ± 0.96) was markedly higher than that of the low education group (2.01 ± 0.79, P < 0.05). Moreover, the mean domain III score of the high education group (2.43 ± 0.79) was significantly higher than that of the low education group (1.67 ± 0.77, P < 0.05). Conclusions Education level impacts on the perception of stigma by patients with schizophrenia and more psycho-education should be done to improve patients’ knowledge about schizophrenia.
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Affiliation(s)
- Zhibin Ren
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, 234 Gucui Road, Hangzhou, Zhejiang, 310012, China
| | - Heqiu Wang
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, 234 Gucui Road, Hangzhou, Zhejiang, 310012, China.
| | - Bin Feng
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, 234 Gucui Road, Hangzhou, Zhejiang, 310012, China
| | - Chenyu Gu
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, 234 Gucui Road, Hangzhou, Zhejiang, 310012, China
| | - Yongchun Ma
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, 234 Gucui Road, Hangzhou, Zhejiang, 310012, China
| | - Hong Chen
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, 234 Gucui Road, Hangzhou, Zhejiang, 310012, China
| | - Bingling Li
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, 234 Gucui Road, Hangzhou, Zhejiang, 310012, China
| | - Lanying Liu
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, 234 Gucui Road, Hangzhou, Zhejiang, 310012, China
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Singh AC, Massey AJ, Thompson MD, Rappa LR, Honeywell MS. Addressing Nonadherence in the Schizophrenic Population. J Pharm Pract 2016. [DOI: 10.1177/0897190007300726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nonadherence within the schizophrenic population is a challenge for both the patient and the clinician. This problem not only causes an increase in health care use and cost but also places the patient at risk of relapse and dissatisfaction with medical care. Nonadherence is influenced by several factors including disease, treatment, and psychological and social factors. All of these factors must be addressed if the clinician hopes to reduce nonadherence within this patient population. This article will attempt to identify factors that contribute to nonadherence and review strategies that can be implemented to address each of these factors.
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Affiliation(s)
- Angela C. Singh
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences, 1415 S. Martin Luther King Blvd, Tallahassee, FL 32307,
| | - Angela J. Massey
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences
| | - Michael D. Thompson
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Tallahassee
| | - Leonard R. Rappa
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Miami
| | - Marlon S. Honeywell
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Tallahassee
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Awad G, Ng-Mak D, Rajagopalan K, Hsu J, Pikalov A, Loebel A. Long-term health-related quality of life improvements among patients treated with lurasidone: results from the open-label extension of a switch trial in schizophrenia. BMC Psychiatry 2016; 16:176. [PMID: 27245981 PMCID: PMC4888300 DOI: 10.1186/s12888-016-0879-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 05/19/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Long-term improvement of health-related quality of life (HRQoL) in schizophrenia may improve adherence and reduce relapse and rehospitalization. This analysis examines long-term changes in HRQoL among patients with schizophrenia switched to lurasidone from other antipsychotics. METHODS Patients who completed an open-label 6-week switch study continued on lurasidone for an additional 24-weeks. HRQoL was measured using the self-reported Personal Evaluation of Transitions in Treatment (PETiT) scale and Short-Form 12 (SF-12) questionnaire. The PETiT assessed HRQoL via total and domain scores (adherence-related attitude and psychosocial functioning). The SF-12 assessed patients' mental and physical component summary scores (MCS and PCS). Mean changes from the initial baseline were calculated at extension baseline and extension endpoint using analysis of covariance models. Analyses were further stratified by prior antipsychotic medication and responder status; responders were defined as having a ≥20 % improvement in Positive and Negative Syndrome Scale during the first 6-weeks of treatment. RESULTS The analysis included 144 patients with PETIT or SF-12 data who received ≥1 dose of lurasidone. Mean (standard deviation) PETiT total score improved significantly from 34.9 (9.3) at baseline to 39.5 (8.9) at extension baseline and 39.1 (9.0) at extension endpoint, representing improvements of 4.5 (7.9) and 5.1 (7.2) points, respectively (both p < 0.001). Significant improvements in adherence-related attitude and psychosocial functioning were observed at extension baseline and extension endpoint (all p < 0.001). Improvement in SF-12 MCS score was observed at extension baseline and endpoint, and PCS score at extension endpoint (all p < 0.01). Patients who switched from quetiapine and aripiprazole showed significant improvement of PETiT total score and adherence-related attitude at extension baseline and extension endpoint. In addition, patients who switched from quetiapine, risperidone, aripiprazole, or ziprasidone showed significant improvement in MCS scores from baseline to extension endpoint. Responders to lurasidone demonstrated greater improvement in PETiT total, psychosocial functioning, and MCS scores at extension baseline than nonresponders. CONCLUSIONS After switching to lurasidone, patients with schizophrenia experienced HRQoL improvements that were sustained for an additional 24 weeks of treatment. Further study is warranted to understand the implications of these improvements in terms of employment, adherence, relapse, and rehospitalization. TRIAL REGISTRATION Clinical trials.gov identifier NCT01143090 (June 10th, 2010).
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Affiliation(s)
- George Awad
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada. .,Department of Psychiatry and Mental Health, Humber River Hospital, 1235 Wilson Avenue, 5th Floor, Toronto, M3M 0B2, ON, Canada.
| | - Daisy Ng-Mak
| | | | - Jay Hsu
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Fitzgerald S, Deiches J, Umucu E, Brooks J, Muller V, Wu JR, Chan F. Psychometric Properties of the Vocational Rehabilitation Engagement Scale When Used With People With Mental Illness in Clubhouse Settings. REHABILITATION RESEARCH, POLICY, AND EDUCATION 2016. [DOI: 10.1891/2168-6653.30.3.276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose:The purpose of this study was to validate the Vocational Rehabilitation Engagement Scale (VRES) for use in the Clubhouse Model of Psychosocial Rehabilitation.Method:There were 124 individuals with serious mental illness recruited from 8 Clubhouse programs in Hawaii. Measurement structure of the VRES was evaluated using exploratory factor analysis.Results:Exploratory factor analysis of the Clubhouse version of the VRES yielded 2 reliable factors (cognitive-affective engagement and behavioral engagement). Both the cognitive-affective engagement and behavioral engagement factors were found to correlate with other self-determination theory constructs including autonomy support, relatedness, and outcome expectancy.Conclusions:The Clubhouse version of the VRES is a brief, reliable, and valid instrument for assessing vocational rehabilitation (VR) engagement and contributes to the use of self-determination as a paradigm for improving recovery outcomes in psychiatric rehabilitation.
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Cultural translation and Tunisian validation of the Drug Attitude Inventory (DAI-30) in outpatients with schizophrenia. Compr Psychiatry 2015; 56:69-74. [PMID: 25270281 DOI: 10.1016/j.comppsych.2014.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/22/2014] [Accepted: 09/03/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Non-adherence to treatment in patients with schizophrenia is associated with increased hospitalization, higher health care costs, and poorer long-term outcomes in terms of relapse rates. It is established that a negative drug attitude was a risk factor for non-adherence in long-term schizophrenia. The scale "Drug Attitude Inventory" is one of the scales designed to assess this concept. It has been translated and validated in different languages. However, its psychometric properties have not yet been studied in our sociocultural context. OBJECTIVES The aims of this study were to translate into Tunisian Arabic dialect the scale "Drug Attitude Inventory" with 30 dichotomous items (DAI-30) and validate it in Tunisian sociocultural context in patients with schizophrenia. MATERIALS AND METHODS This study was performed in 234 outpatients with schizophrenia, recruited through a random drawing. These patients are in remission and meet remission criteria proposed by "The Remission in schizophrenia Working Group". We recruited 30 patients for pretest and 204 patients for linguistic validation. Forward and backward translation of the DAI-30 was performed according to the protocol of the "MAPI Research Institute". This final version was submitted to 24 experts and followed by a pretest. Construct validity has been established by performing a principal component analysis factor on a sample of 204 patients. Internal consistency was assessed by Cronbach alpha coefficient and inter-rater reliability was assessed by the use of Intra-Class Correlation coefficient (ICC). For the test-retest reliability evaluation, the "r" Pearson's coefficient was used between the DAI scores obtained in the initial evaluation and those obtained at 15 days. RESULTS Regarding construct validity, factor analysis revealed seven factors that were responsible for 59.9% of the variance. The study of internal consistency between the 30 items was rated good (α=0.88). The test-retest reliability was satisfactory (r=0.99, p<10(-3)), as well as inter-rater reliability (ICC=0.99). CONCLUSION In the Tunisian cultural context, the DAI-30 presented seven factors with good consistency and an inter-rater reliability.
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Brain C, Sameby B, Allerby K, Quinlan P, Joas E, Lindström E, Burns T, Waern M. Stigma, discrimination and medication adherence in schizophrenia: results from the Swedish COAST study. Psychiatry Res 2014; 220:811-7. [PMID: 25457284 DOI: 10.1016/j.psychres.2014.10.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/22/2014] [Accepted: 10/12/2014] [Indexed: 11/29/2022]
Abstract
The aims of this naturalistic non-interventional study were to quantify the level of stigma and discrimination in persons with schizophrenia and to test for potential associations between different types of stigma and adherence to antipsychotics. Antipsychotic medication use was electronically monitored with a Medication Event Monitoring System (MEMS®) for 12 months in 111 outpatients with schizophrenia and schizophrenia-like psychosis (DSM-IV). Stigma was assessed at endpoint using the Discrimination and Stigma Scale (DISC). Single DISC items that were most frequently reported included social relationships in making/keeping friends (71%) and in the neighborhood (69%). About half of the patients experienced discrimination by their families, in intimate relationships, regarding employment and by mental health staff. Most patients (88%) wanted to conceal their mental health problems from others; 70% stated that anticipated discrimination resulted in avoidance of close personal relationships. Non-adherence (MEMS® adherence≤0.80) was observed in 30 (27.3%). When DISC subscale scores (SD) were entered in separate regression models, neither experienced nor anticipated stigma was associated with adherence. Our data do not support an association between stigma and non-adherence. Further studies in other settings are needed as experiences of stigma and levels of adherence and their potential associations might vary by a healthcare system or cultural and sociodemographic contexts.
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Grover S, Chakrabarti S, Sharma A, Tyagi S. Attitudes toward psychotropic medications among patients with chronic psychiatric disorders and their family caregivers. J Neurosci Rural Pract 2014; 5:374-383. [PMID: 25288840 PMCID: PMC4173235 DOI: 10.4103/0976-3147.139989] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM To examine attitudes towards psychotropic medications among patients with chronic psychiatric disorders as well as their family caregivers by using factor analysis. MATERIALS AND METHODS The study included 200 patients and their family caregivers with chronic psychiatric disorders who are attending the psychiatry outpatient services. A self-designed 18-item self-rated questionnaire was used to evaluate the attitude toward psychotropics and factor analysis was done to study the different models of attitudes. RESULTS In general both patients and caregivers had positive attitude toward the psychotropic medications and there was no significant difference between the patients and caregivers on the various items of the questionnaire assessing the attitude. Factor analysis of the questionnaire indicated that either two-factor or four-factor models explained the attitude of the patients and caregivers. In the two-factor model there was one positive and one negative attitude factor, whereas the four-factor model comprised of two positive and two negative attitude factors. The four-factor model of attitudes provided a more comprehensive solution to how attitudes might be formed among patients and their family caregivers. Factors one and four in the four-factor solution still reflected positive attitudes, but appeared to portray a risk-benefit approach, in which benefits such as the efficacy of psychotropic medications in treating mental illnesses and preventing relapse, and medications being better than other options were being contrasted with the risks of side effects and permanent damage or harm. CONCLUSION Attitudes of patients with chronic psychiatric disorders and their caregivers toward psychotropic medications appear to be shaped by factors such as perceived efficacy or benefit from medicines, the necessity for taking treatment and concerns such as side effects, harm or expense.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aarti Sharma
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shikha Tyagi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Karthik MS, Warikoo N, Chakrabarti S, Grover S, Kulhara P. Attitudes towards antipsychotics among patients with schizophrenia on first- or second-generation medications. Indian J Psychol Med 2014; 36:288-293. [PMID: 25035553 PMCID: PMC4100415 DOI: 10.4103/0253-7176.135382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Given the paucity of research in this area, this study attempted to assess attitudes toward antipsychotic medications and its correlates among patients with schizophrenia, either on first-generation antipsychotics (FGAs) or second-generation antipsychotics (SGAs) medications. MATERIALS AND METHODS Structured assessments of attitudes to antipsychotics, psychopathology, insight and side-effects were carried out in 120 patients with DSM-IV schizophrenia; 89 of these were on SGAs and 31 on FGAs. RESULTS Patients had predominantly positive attitudes toward antipsychotics. Severity of side-effects was the principal correlate of attitudes, explaining 19.5% of the variance, followed by greater insight (4.2% of the variance). Other factors such as younger age, male gender, employment, higher family income, urban residence and lower symptom-severity explained only a negligible proportion of the variance (0.2%) in attitudes. Patients on SGAs had more positive views of their medications than those on FGAs. They felt more normal on their medications, believed that their thoughts were clearer on medications, felt that good things about their medications outweighed the bad and believed that their medications helped them from falling ill again. In addition, they did not feel as tired and sluggish on their medications and did not believe that medications were unnatural or controlled their bodies. CONCLUSIONS Positive attitudes toward antipsychotics were common among patients with schizophrenia. Attitudes were principally determined by severity of side-effects and insight levels. Patients on SGAs had better attitudes, possibly because of less severe side-effects and greater insight among them. The importance of exploring patients' attitudes toward their antipsychotics is highlighted by this study.
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Affiliation(s)
- M. S. Karthik
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nisha Warikoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parmanand Kulhara
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Chandra IS, Kumar KL, Reddy MP, Reddy CMPK. Attitudes toward Medication and Reasons for Non-Compliance in Patients with Schizophrenia. Indian J Psychol Med 2014; 36:294-8. [PMID: 25035554 PMCID: PMC4100416 DOI: 10.4103/0253-7176.135383] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Non-compliance for the medication is an important area of concern in schizophrenia as it contributes to relapse and re-hospitalization of the patients. One of the ways to improve the drug compliance is to know crucial factors responsible for poor drug compliance and hence that proper strategies may be planned to improve patient's drug compliance. AIM The aim of the following study is to find out the attitudes of patients toward medication and reasons for drug non-compliance in schizophrenia and its association with clinical and socio-demographic variables. MATERIALS AND METHODS The study was conducted on follow-up patients with schizophrenia for the duration of 5 months. Their socio-demographic details were noted and illness related variables were evaluated using Positive and Negative Syndrome scale (PANSS). Patient's attitudes toward medication and the reasons for treatment non-compliance were assessed using the standardized tools, which consist of Drug Attitude Inventory-10 scale and Rating of Medication Influences scale respectively. RESULTS Nearly 41.9% of our study sample were non-compliant to medication. A significant association has been found between non-compliance and younger age group, unemployment, early age of onset, high positive PANSS score and poorer insight into the illness. The significant reasons for non-compliance in our study were Denial of illness, financial burden, less access to treatment facilities, Side-effects of the medication, Feeling that the medication was unnecessary and Substance abuse. CONCLUSIONS Findings suggest that there is a need to provide adequate information about mental illness and medications prescribed, to enhance medication compliance and to develop community mental health care facilities.
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Ren Z, Wang H, Feng B, Gu C, Ma Y, Chen H, Li B, Liu L. A cross-sectional study on perception of stigma by Chinese schizophrenia patients. Neuropsychiatr Dis Treat 2014; 10:535-40. [PMID: 24707179 PMCID: PMC3971935 DOI: 10.2147/ndt.s54115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE In this cross-sectional study, we sought to assess the extent of internalized stigma among inpatients and outpatients with schizophrenia in the People's Republic of China and to investigate whether education level correlated with the experience of stigma. METHODS Schizophrenia patients were evaluated using the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions-Severity of Illness (CGI-S) scale and the Stigma Scale for Mental Illness (SSMI-C). Patients were categorized into high education and low education groups, according to their educational levels. RESULTS One hundred thirty-three subjects were included in the study. Their mean course of illness was 4.32±6.14 years (range: 1 month to 15 years). Their mean BPRS score was 19.87±5.46, their mean PANSS score was 44.11±13.1, and their mean CGI-S score was 2.22±0.81. In addition, their mean SSMI-C score was 6.49±0.9. The mean SSMI-C score of patients who have received high school education or above was 7.15±0.98, which was markedly higher than that of patients who have received middle school education or below, which was 5.75±0.79 (P<0.05). Before the study most patients (92.5%, 123/133) took atypical drugs. CONCLUSION Education level impacts on the perception of stigma by schizophrenia patients, and more psychoeducation should be undertaken to improve patients' knowledge about schizophrenia.
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Affiliation(s)
- Zhibin Ren
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Heqiu Wang
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Bin Feng
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Chenyu Gu
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Yongchun Ma
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Hong Chen
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Bingling Li
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Lanying Liu
- Department of Psychiatry, Tongde Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
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Awad G, Hassan M, Loebel A, Hsu J, Pikalov A, Rajagopalan K. Health-related quality of life among patients treated with lurasidone: results from a switch trial in patients with schizophrenia. BMC Psychiatry 2014; 14:53. [PMID: 24559217 PMCID: PMC3936838 DOI: 10.1186/1471-244x-14-53] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 02/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with schizophrenia frequently switch between antipsychotics, underscoring the need to achieve and maintain important treatment outcomes such as health-related quality of life (HRQoL) following the switch. This analysis evaluated HRQoL changes among patients with schizophrenia switched from their current antipsychotic to lurasidone. METHODS Stable but symptomatic outpatients with schizophrenia were switched from their current antipsychotic to lurasidone in a six-week, open-label trial. HRQoL was assessed using two validated patient-reported measures, the Personal Evaluation of Transitions in Treatment (PETiT) scale and the Short-Form 12 (SF-12). Total and domain scores (psychosocial function and adherence-related attitude) were assessed using the PETiT scale; patients' mental and physical component summary scores (MCS and PCS) were assessed using the SF-12. Changes in HRQoL from baseline to study endpoint were compared using ANCOVA, with baseline score, treatment, and pooled site as covariates. Changes were assessed among all patients and those switched from specific antipsychotics to lurasidone. RESULTS The analysis included 235 patients with data on the PETiT and SF-12 who had received ≥ 1 dose of lurasidone. Statistically significant improvements were observed from baseline to study endpoint on the PETiT total (mean change [SD]: 3.2 [8.5]) and psychosocial functioning (2.5 [6.9]) and adherence-related attitude (0.7 [2.6]) domain scores (all p ≤ 0.002). When examined by preswitch antipsychotic, significant improvements in PETiT total scores were observed in patients switched from quetiapine, risperidone, aripiprazole, and ziprasidone (all p < 0.03) but not olanzapine (p = 0.893). Improvements on the SF-12 MCS score were observed for all patients (mean change [SD]: 3.7 [11.5], p < 0.001) and for those switched from quetiapine or aripiprazole (both p < 0.03). The SF-12 PCS scores remained comparable to those at baseline in all patient groups. CONCLUSIONS These findings indicate that patients switching from other antipsychotics to lurasidone experienced statistically significant improvement of HRQoL, based on PETiT scores, within six weeks of treatment. Patient health status remained stable with respect to the SF-12 physical component and showed improvement on the mental component. Changes in HRQoL varied based on the antipsychotic used before switching to lurasidone. TRIAL REGISTRATION NCT01143077.
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Affiliation(s)
- George Awad
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry and Mental Health, Humber River Regional Hospital, Toronto, ON, Canada
| | | | | | - Jay Hsu
- Sunovion Pharmaceuticals, Inc, Fort Lee, NJ, USA
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Kako Y, Ito K, Hashimoto N, Toyoshima K, Shimizu Y, Mitsui N, Fujii Y, Tanaka T, Kusumi I. The relationship between insight and subjective experience in schizophrenia. Neuropsychiatr Dis Treat 2014; 10:1415-22. [PMID: 25114533 PMCID: PMC4122548 DOI: 10.2147/ndt.s66121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To examine the relationship between level of insight and various subjective experiences for patients with schizophrenia. MATERIALS AND METHODS Seventy-four patients with schizophrenia who were discharged from our hospital were evaluated. The level of insight into their illness and various subjective experiences were evaluated at discharge. We used the Scale to Assess Unawareness of Mental Disorder (SUMD) for evaluation of insight. In addition, five different rating scales were used to evaluate subjective experiences: Subjective Experience of Deficits in Schizophrenia (SEDS), Subjective Well-being under Neuroleptic drug treatment Short form (SWNS), Schizophrenia Quality of Life Scale (SQLS), Beck Depression Inventory (BDI), and the Drug Attitude Inventory (DAI)-30. RESULTS The SWNS and the scores for awareness of mental disorder and awareness of the social consequences of mental disorder on SUMD showed a weak positive correlation. The DAI-30 showed a significant negative correlation with most general items on SUMD and a negative correlation between the subscale scores for the awareness and attribution of past symptoms. SEDS, SWNS, SQLS, and the BDI significantly correlated with the subscale scores for awareness of current symptoms on SUMD, and weakly correlated with the subscale scores for attribution of current negative symptoms. CONCLUSION Awareness of subjective distress was related to awareness of having a mental disorder. Feeling subjective distress was related to awareness of current symptoms, as well as to the ability to attribute current negative symptoms to a mental disorder. Positive attitudes toward medication correlated with better general insight into the illness.
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Affiliation(s)
- Yuki Kako
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Koki Ito
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kuniyoshi Toyoshima
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yusuke Shimizu
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuyuki Mitsui
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yutaka Fujii
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Teruaki Tanaka
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Karthik MS, Kulhara P, Chakrabarti S. Attitude towards second-generation antipsychotics among patients with schizophrenia and their relatives. Hum Psychopharmacol 2013; 28:457-465. [PMID: 23784674 DOI: 10.1002/hup.2332] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 05/13/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Given the paucity of research in this area, this study attempted to assess attitudes towards second-generation antipsychotic medications and their correlates among the patients with schizophrenia and their relatives. METHODS Structured assessments of attitudes to medications, psychopathology, insight/knowledge, side effects, functioning and treatment satisfaction were carried out in a random sample of 50 patients with DSM-IV schizophrenia and their relatives. All, except one of the patients, were on second-generation antipsychotics. RESULTS Most patients had positive attitudes towards second-generation antipsychotics. Severity of positive symptoms and higher burden of side effects (e.g. sexual dysfunction, weight gain and sedation) emerged as the principal correlates of negative attitudes among patients. Greater awareness of illness, being employed, better social functioning and greater treatment satisfaction were all associated with positive attitudes among patients. Relatives had significantly more positive attitudes towards antipsychotics than patients and were more satisfied with the treatment. They were well informed about the illness, and their level of knowledge had a significant association with positive attitudes. CONCLUSIONS Effective antipsychotic treatment, which improves functioning and minimises side effects could lead to more favourable attitudes towards antipsychotics among patients. Increasing awareness of illness, enhancing treatment satisfaction and involving relatives in treatment could also be of help.
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Affiliation(s)
- M S Karthik
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Lako IM, Bruggeman R, Liemburg EJ, van den Heuvel ER, Knegtering H, Slooff CJ, Wiersma D, Taxis K. A brief version of the Subjects' Response to Antipsychotics questionnaire to evaluate treatment effects. Schizophr Res 2013; 147:175-180. [PMID: 23561295 DOI: 10.1016/j.schres.2013.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/31/2013] [Accepted: 02/20/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Monitoring patients' experiences with antipsychotics may help to improve medication adherence and outcome. We aimed to develop a shorter version of a comprehensive 74-item self-report questionnaire suitable for routine monitoring of desired and undesired effects of antipsychotics. METHODS Included were patients with psychotic disorders from seven mental health care organizations in The Netherlands, using antipsychotic medication, who completed the Subjects' Response to Antipsychotics (SRA-74). Exploratory factor analysis (EFA) and similarity analysis based on mutual information were used to identify the latent factor structure of the SRA. Items were reduced according to their metric properties and clinical relevance upon consensus by an expert panel, using a Delphi procedure of three rounds. We determined the internal consistency of the shorter version using Cronbach's alpha. RESULTS SRA data of N=1478 patients (mean age of 40 years, 31% females) were eligible for analysis. EFA extracted thirteen factors from the SRA-74, including four factors for desired effects (e.g. recovery of psychosis, cognition and social functioning) and nine factors for undesired effects (e.g. weight gain, flattened affect and increased sleep). Based on this solution 12 items were eliminated for statistical reasons. The expert panel eliminated another 28 items with redundant content, resulting in a 34-item version. The SRA-34 includes 10 desired and 24 clinically relevant undesired effects. Both the subscales for desired and undesired effects have a Cronbach's alpha coefficient of 0.82. CONCLUSIONS The SRA-34 can be used to evaluate desired and undesired effects of antipsychotics in routine clinical practice and research.
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Affiliation(s)
- Irene M Lako
- Rob Giel Research Center (RGOc), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen, The Netherlands.
| | - Richard Bruggeman
- Rob Giel Research Center (RGOc), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; University Center of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Edith J Liemburg
- Rob Giel Research Center (RGOc), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Neuroimaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Edwin R van den Heuvel
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Henderikus Knegtering
- Rob Giel Research Center (RGOc), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Neuroimaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Lentis Center for Mental Health Care, Groningen, The Netherlands.
| | - Cees J Slooff
- Rob Giel Research Center (RGOc), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Psychotic Disorders, Mental Health Centre Assen (GGZ Drenthe), Assen, The Netherlands.
| | - Durk Wiersma
- Rob Giel Research Center (RGOc), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Katja Taxis
- Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen, The Netherlands.
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Bener A, Dafeeah EE, Salem MO. A study of reasons of non-compliance of psychiatric treatment and patients' attitudes towards illness and treatment in Qatar. Issues Ment Health Nurs 2013; 34:273-80. [PMID: 23566190 DOI: 10.3109/01612840.2012.745039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to examine the extent of psychiatric patients' compliance and non-compliance with treatment and examine the factors that affect compliance. Patients were recruited who were between 16 and 60 years of age and who were hospitalized with a psychiatric disorder and treated in the outpatient clinics of the psychiatry department. A total of 689 patients were approached and 564 patients agreed to participate in the study, a response rate of 81.8%. Participants were asked to complete a questionnaire that asked about socio-demographic characteristics (e.g., age, gender, nationality, level of education, occupation, marital status, and life style habits); medication(s) prescribed and the participant's response; the degree of social supervision (rated subjectively by the patient as "poor," "good," or "very good"); data also were obtained from clinical records. Data analyses explored significant associations between compliance and non-compliance and a group of relevant variables. Of the 564 patients studied, 328 (58.2%) were compliant with treatment and 236 (41.8%) were non-compliant. There was no significant difference between compliance and non-compliance in terms of gender (p = 0.471). Patients between 21-30 years of age were significantly more compliant with drug treatment than not. Non-compliance was more common among patients diagnosed with schizophrenia (28.4%), followed by depression (14.4%), and bipolar affective disorder (12.7%) (p = 0.001). Only 25% of compliant patients and 26.3% of non-compliant patients used non-psychotropic medication. Social supervision (40%) was very poor in non-compliant patients whereas 49.4% of compliant patients had very good family support. Notable reasons for non-compliance were irregular attendance to clinic (55.5%), ignorance about side effects of medication (61%), free medicine (45.8%), and a lack of education about medication (58.1%). This study revealed that non-compliance rates among psychiatry patients were comparable to the rates reported in other studies. The findings suggest that there is a need to provide community-level mental health education and proper counseling to psychiatry patients.
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Affiliation(s)
- Abdulbari Bener
- Department of Medical Statistics and Epidemiology, Hamad Medical Corporation, Doha, Qatar.
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Bensasson G. Comportement d’observance et autonomie des patients en psychiatrie. EVOLUTION PSYCHIATRIQUE 2013. [DOI: 10.1016/j.evopsy.2013.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Boyer L, Cermolacce M, Dassa D, Fernandez J, Boucekine M, Richieri R, Vaillant F, Dumas R, Auquier P, Lancon C. Neurocognition, insight and medication nonadherence in schizophrenia: a structural equation modeling approach. PLoS One 2012; 7:e47655. [PMID: 23144705 PMCID: PMC3483287 DOI: 10.1371/journal.pone.0047655] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/14/2012] [Indexed: 01/29/2023] Open
Abstract
Objective The aim of this study was to examine the complex relationships among neurocognition, insight and nonadherence in patients with schizophrenia. Methods Design: Cross-sectional study. Inclusion criteria: Diagnosis of schizophrenia according to the DSM-IV-TR criteria. Data collection: Neurocognition was assessed using a global approach that addressed memory, attention, and executive functions; insight was analyzed using the multidimensional ‘Scale to assess Unawareness of Mental Disorder;’ and nonadherence was measured using the multidimensional ‘Medication Adherence Rating Scale.’ Analysis: Structural equation modeling (SEM) was applied to examine the non-straightforward relationships among the following latent variables: neurocognition, ‘awareness of positive symptoms’ and ‘negative symptoms’, ‘awareness of mental disorder’ and nonadherence. Results One hundred and sixty-nine patients were enrolled. The final testing model showed good fit, with normed χ2 = 1.67, RMSEA = 0.063, CFI = 0.94, and SRMR = 0.092. The SEM revealed significant associations between (1) neurocognition and ‘awareness of symptoms,’ (2) ‘awareness of symptoms’ and ‘awareness of mental disorder’ and (3) ‘awareness of mental disorder’ and nonadherence, mainly in the ‘attitude toward taking medication’ dimension. In contrast, there were no significant links between neurocognition and nonadherence, neurocognition and ‘awareness of mental disorder,’ and ‘awareness of symptoms’ and nonadherence. Conclusions Our findings support the hypothesis that neurocognition influences ‘awareness of symptoms,’ which must be integrated into a higher level of insight (i.e., the ‘awareness of mental disorder’) to have an impact on nonadherence. These findings have important implications for the development of effective strategies to enhance medication adherence.
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Affiliation(s)
- Laurent Boyer
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Marseille, France.
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Acosta FJ, Hernández JL, Pereira J, Herrera J, Rodríguez CJ. Medication adherence in schizophrenia. World J Psychiatry 2012; 2:74-82. [PMID: 24175171 PMCID: PMC3782179 DOI: 10.5498/wjp.v2.i5.74] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 07/12/2012] [Accepted: 09/18/2012] [Indexed: 02/05/2023] Open
Abstract
Non-adherence is a major problem in the treatment of schizophrenia. Its high prevalence, potentially severe consequences and associated costs make the study of this phenomenon a priority issue. In this article, basic non-adherence concepts of prevalence, consequences, evaluation methods, methodological restrictions of available studies, risk factors and intervention strategies, are reviewed. Studying non-adherence risk factors is a necessary step toward designing adequately oriented intervention strategies. An operative definition of adherence and good knowledge of its evaluation methods are essential to study this phenomenon. Unfortunately, most available studies contain methodological restrictions, especially concerning the evaluation methods, and an agreed operative definition of adherence has only very recently been reached. Knowing non-adherence risk factors, intervention strategies and available evidence on their effectiveness is essential in making treatment decisions in daily clinical practice.
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Affiliation(s)
- Francisco Javier Acosta
- Francisco Javier Acosta, José Luis Hernández, José Pereira, Service of Mental Health, General Health Care Programs Direction, Canary Health Service, Las Palmas de Gran Canaria 35004, Spain
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Välimäki M, Hätönen H, Lahti M, Kuosmanen L, Adams CE. Information and communication technology in patient education and support for people with schizophrenia. Cochrane Database Syst Rev 2012; 10:CD007198. [PMID: 23076932 PMCID: PMC11186738 DOI: 10.1002/14651858.cd007198.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Poor compliance with treatment often means that many people with schizophrenia or other severe mental illness relapse and may need frequent and repeated hospitalisation. Information and communication technology (ICT) is increasingly being used to deliver information, treatment or both for people with severe mental disorders. OBJECTIVES To evaluate the effects of psychoeducational interventions using ICT as a means of educating and supporting people with schizophrenia or related psychosis. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (2008, 2009 and September 2010), inspected references of identified studies for further trials and contacted authors of trials for additional information. SELECTION CRITERIA All clinical randomised controlled trials (RCTs) comparing ICT as a psychoeducational and supportive tool with any other type of psychoeducation and supportive intervention or standard care. DATA COLLECTION AND ANALYSIS We selected trials and extracted data independently. For homogenous dichotomous data we calculated fixed-effect risk ratios (RR) with 95% confidence intervals (CI). For continuous data, we calculated mean differences (MD). We assessed risk of bias using the criteria described in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included six trials with a total of 1063 participants. We found no significant differences in the primary outcomes (patient compliance and global state) between psychoeducational interventions using ICT and standard care.Technology-mediated psychoeducation improved mental state in the short term (n = 84, 1 RCT, RR 0.75, 95% CI 0.56 to 1.00; n = 30, 1 RCT, MD -0.51, 95% CI -0.90 to -0.12) but not global state (n = 84, 1 RCT, RR 1.07, 95% CI 0.82 to 1.42). Knowledge and insight were not effected (n = 84, 1 RCT, RR 0.89, 95% CI 0.68 to 1.15; n = 84, 1 RCT, RR 0.77, 95% CI 0.58 to 1.03). People allocated to technology-mediated psychoeducation perceived that they received more social support than people allocated to the standard care group (n = 30, 1 RCT, MD 0.42, 95% CI 0.04 to 0.80).When technology-mediated psychoeducation was used as an adjunct to standard care it did not improve general compliance in the short term (n = 291, 3 RCTs, RR for leaving the study early 0.81, 95% CI 0.55 to 1.19) or in the long term (n = 434, 2 RCTs, RR for leaving the study early 0.70, 95% CI 0.39 to 1.25). However, it did improve compliance with medication in the long term (n = 71, 1 RCT, RR 0.45, 95% CI 0.27 to 0.77). Adding technology-mediated psychoeducation on top of standard care did not clearly improve either general mental state, negative or positive symptoms, global state, level of knowledge or quality of life. However, the results were not consistent regarding level of knowledge and satisfaction with treatment.When technology-mediated psychoeducation plus standard care was compared with patient education not using technology the only outcome reported was satisfaction with treatment. There were no differences between groups. AUTHORS' CONCLUSIONS Using ICT to deliver psychoeducational interventions has no clear effects compared with standard care, other methods of delivering psychoeducation and support, or both. Researchers used a variety of methods of delivery and outcomes, and studies were few and underpowered. ICT remains a promising method of delivering psychoeducation; the equivocal findings of this review should not postpone high-quality research in this area.
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Lysaker PH, Tunze C, Yanos PT, Roe D, Ringer J, Rand K. Relationships between stereotyped beliefs about mental illness, discrimination experiences, and distressed mood over 1 year among persons with schizophrenia enrolled in rehabilitation. Soc Psychiatry Psychiatr Epidemiol 2012; 47:849-55. [PMID: 21603968 PMCID: PMC3263418 DOI: 10.1007/s00127-011-0396-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 05/10/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Research suggests stereotype endorsement or self-stigma serves as a barrier to functioning and well-being among persons with schizophrenia. Little is known about how stable self-stigma is and whether it is linked over time with related constructs such as discrimination experiences and psychological distress. METHODS Stereotype endorsement and discrimination experiences were assessed using the Internalized Stigma of Mental Illness Scale and psychological distress was assessed using the Emotional Discomfort component of the Positive and Negative Syndrome Scale, at three points in time across 1 year. RESULTS Path analyses indicated that the constructs of stereotype endorsement and discrimination experiences are stable over periods of 5-7 months and may fluctuate over 12 months. Further, the constructs of stereotype endorsement and discrimination experiences were related to one another concurrently, but analyses failed to detect a relationship over time. Neither construct was related to psychological distress over time. CONCLUSIONS Self-stigma is a stable construct in the short term, and is distinct from related constructs such as discrimination experiences and psychological distress.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Indianapolis, IN 46202, USA.
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Psychometric properties of the Taiwanese version of the Illness Concept Scale: relation of health beliefs to psychopathology and medication compliance. Soc Psychiatry Psychiatr Epidemiol 2012; 47:597-606. [PMID: 21373925 DOI: 10.1007/s00127-011-0363-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 02/21/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE This paper describes the development of a Taiwanese version of the Illness Concept Scale (ICS) and assesses the psychometric properties of this instrument. The ICS is one of the few tools available to measure a global level of illness concepts or health beliefs and has been widely used in a range of clinical and research settings. The ICS has already been translated into several languages, but there is no validated Taiwanese version. METHODS The English version of the ICS was translated into Taiwanese (ICS-T) and applied in this study. A total of 192 participants with and without psychoses completed the ICS-T and additional evaluations to assess psychopathology and medication compliance. Psychometric properties (factor structures and various types of reliability and validity) were assessed for this translated questionnaire. RESULTS Overall, the ICS-T showed good reliability and stability over time. Its scale is comprised of a seven-factor solution, as in the original ICS. Following the validation of the internal structure of this scale, we obtained the total ICS-T score, representing the measurement of an individual's illness concepts by subtracting the scores of the guilt, idiosyncratic assumption, and negative expectation subscales from those of the trust in medication, trust in physician, susceptibility, and chance control subscales. In comparison analyses, the differences in mean total scores between individuals with and without psychoses were not significant. No significant association was found between the ICS and psychopathology. However, both the total and six out of seven subscales of the ICS-T showed a significant connection with compliance. CONCLUSIONS In light of these findings, we believe that the ICS-T is a valid and reliable instrument for the assessment of illness concepts in research and clinical settings.
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Medina E, Salvà J, Ampudia R, Maurino J, Larumbe J. Short-term clinical stability and lack of insight are associated with a negative attitude towards antipsychotic treatment at discharge in patients with schizophrenia and bipolar disorder. Patient Prefer Adherence 2012; 6:623-9. [PMID: 22969293 PMCID: PMC3437911 DOI: 10.2147/ppa.s34345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The primary aim of this study was to assess the range of attitudes towards antipsychotic treatment at hospital discharge in patients with schizophrenia and bipolar disorder. The secondary aim was to analyze the relationship between patients' attitudes and sociodemographic and clinical parameters. PATIENTS AND METHODS A cross-sectional study with a sample of patients admitted due to acute exacerbation of schizophrenia or a manic episode was conducted. Attitude towards pharmacological treatment at discharge was assessed with the 10-item Drug Attitude Inventory (DAI-10). Logistic regression was used to determine significant variables associated with attitude to medication. RESULTS Eighty-six patients were included in the study. The mean age was 43.1 years (standard deviation [SD] 12.1), and 55.8% were males. Twenty-six percent of the patients presented a negative attitude towards antipsychotic treatment (mean DAI-10 score of -4.7, SD 2.7). Most of them had a diagnosis of schizophrenia. Multivariate analysis showed that poor insight into illness and a greater number of previous acute episodes was significantly associated with a negative attitude towards medication at discharge (odds ratio 1.68 and 1.18, respectively). CONCLUSION Insight and clinical stability prior to admission were related to patients' attitude towards antipsychotic treatment at hospital discharge among patients with schizophrenia and bipolar disorder. The identification of factors related to the attitude towards medication would offer an improved opportunity for clinicians to select patients eligible for prophylactic adherence-focused interventions.
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Affiliation(s)
| | - Joan Salvà
- Department of Psychiatry, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - Jorge Maurino
- AstraZeneca Medical Department, Madrid, Spain
- Correspondence: Jorge Maurino, AstraZeneca Medical Department, Serrano Galvache 56 (28033), Madrid, Spain, Fax +34 91 301 9084, Email
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Tsai JK, Lin WK, Lung FW. Social interaction and drug attitude effectiveness in patients with schizophrenia. Psychiatr Q 2011; 82:343-51. [PMID: 21499787 DOI: 10.1007/s11126-011-9177-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study aimed to explore the relationship between dosage of paliperidone and drug attitude, and also clarify the factors associated with drug attitude, using Intention-to-Treat (ITT) analysis. Three hundred thirty-one patients diagnosed with schizophrenia, who prescribed paliperidone between April 2008 and April 2009, from 10 hospitals in Taiwan were enrolled. By structural equation modeling, inpatient/outpatient status associated with occupation status, sex, and score on the Clinical Global Impression-Severity (CGIS) Scale. The score on the Personal and Social Performance (PSP) Scale associated with occupation status, inpatient/outpatient status, and the score on the CGIS Scale. The scores on the DAI-10 associated with the score on the PSP Scale and age. Good drug attitude and medication adherence significantly related to good social interaction. We should enhance the drug attitude and medication adherence of patients with schizophrenia who have poor social interaction to improve the outcome of schizophrenia.
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Affiliation(s)
- Jui-Kang Tsai
- Department of Psychiatry, Kaohsiung Armed Forces General Hospital, No. 2 Chung Cheng 1st Road, Kaohsiung, Taiwan
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Beck EM, Cavelti M, Kvrgic S, Kleim B, Vauth R. Are we addressing the 'right stuff' to enhance adherence in schizophrenia? Understanding the role of insight and attitudes towards medication. Schizophr Res 2011; 132:42-9. [PMID: 21820875 DOI: 10.1016/j.schres.2011.07.019] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 07/12/2011] [Accepted: 07/15/2011] [Indexed: 01/18/2023]
Abstract
BACKGROUND Despite the fact that medication adherence is among the most important health related behaviors in relapse prevention and recovery in schizophrenia, it is often not sufficiently endorsed by patients. Poor insight and negative attitudes towards medication are risk factors for non-adherence. Their relationship and the influence of more general attitudes towards pharmacotherapy besides attitudes towards antipsychotics have not been fully understood. The present study investigated whether these factors independently influence adherence or whether they mediate one another. METHODS A cross-sectional sample of 150 outpatients completed the Beliefs about Medication Questionnaire. It assesses patients' beliefs about antipsychotic medication in terms of necessity and concerns and more general beliefs about pharmacotherapy in terms of distrust. Additionally, the patients' global awareness of illness (Scale to assess Unawareness of Mental Disorder), and medication adherence (Brief Adherence Rating Scale, Service Engagement Scale) were assessed. RESULTS Using structural equation modeling, the study found evidence for a mediational model. Awareness of illness contributed to medication adherence via patients' perceived necessity of antipsychotics. The model further revealed a direct negative relationship between concerns regarding antipsychotics and adherence and an indirect negative effect of a general distrust regarding pharmacotherapy and adherence via antipsychotic specific attitudes. CONCLUSION Interventions to enhance medication adherence may be more effective if they focus on treatment related attitudes rather than on global insight into illness. Clinicians may not only enhance the patients' perceived necessity of antipsychotic treatment but also explore and address concerns and the patients' distrust in pharmacotherapy in a more personalized way.
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Affiliation(s)
- Eva-Marina Beck
- Department of Psychiatric Outpatient Treatment (Psychiatrische Universitätspoliklinik), Psychiatric University Hospital of Basel, Claragraben 95, CH-4057 Basel, Switzerland
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Beck EM, Cavelti M, Wirtz M, Kossowsky J, Vauth R. How do socio-demographic and clinical factors interact with adherence attitude profiles in schizophrenia? A cluster-analytical approach. Psychiatry Res 2011; 187:55-61. [PMID: 21074860 DOI: 10.1016/j.psychres.2010.10.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 08/12/2010] [Accepted: 10/14/2010] [Indexed: 10/18/2022]
Abstract
Knowledge regarding socio-demographic and clinical risk factors of medication nonadherence does not always help in addressing adherence in individual patients. Classifying patients according to subjective adherence influencing factors may aid practitioners in choosing adequate strategies for improving medication adherence. A total of 171 outpatients with schizophrenia and schizoaffective disorder were classified according to factors influencing their medication adherence assessed using the Rating of Medication Influences Scale. Additionally, psychotic symptoms, depression, and insight, also known to influence pharmacological treatment motivation, were assessed. A cluster analysis yielded 3 groups that were distinguished both by the relative ranking of adherence influences and by specific associations with risk factors of nonadherence. For the "Interpersonal, Future-oriented Group" (n=59, 35% of the sample), interpersonal factors (positive therapeutic relationship, positive attitudes of significant others towards medication), immediate positive consequences of the medication intake (daily benefits, no perceived pressure to take medication), and avoiding future negative consequences of non-compliance, such as relapse and re-hospitalization, were essential for adherence. The "Autonomous, Future-oriented Group" (n=69, 40% of the sample) appraised interpersonal factors as being less important as compared to the other groups. This group exhibited significantly fewer depressive symptoms than the first group and had significantly more stable partnerships as compared to the other groups. The "Autonomous, Present-oriented Group" (n=43, 25% of the sample) was mainly motivated by immediate positive consequences and displayed higher levels of cognitive disorganization and negative symptoms than the second group, as well as the lowest level of insight of all groups. Treatment strategies addressing adherence enhancement in schizophrenia may profit by considering both the patient's subjective adherence attitude profile as well as the specific pattern of risk factors for nonadherence including depression, lack of insight, negative syndrome, cognitive disorganization and socio-demographic factors, which are differentially associated with each adherence attitude profile.
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Affiliation(s)
- Eva-Marina Beck
- Department of Psychiatric Outpatient Treatment, Psychiatric University Hospital of Basel, Claragraben 95, CH-4057 Basel, Switzerland
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Chiang YL, Klainin-Yobas P, Ignacio J, Chng CML. The impact of antipsychotic side effects on attitudes towards medication in people with schizophrenia and related disorders. J Clin Nurs 2011; 20:2172-82. [PMID: 21539628 DOI: 10.1111/j.1365-2702.2010.03659.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This research aimed to: (i) investigate the prevalence and perceived severity of antipsychotic side effects in people with schizophrenia and related disorders living in communities in Singapore; (ii) examine the relationship between antipsychotic variables (type, dose, route, prescription duration) and side effects; and (iii) examine the relationship between side effects and attitudes towards medication. BACKGROUND Antipsychotics are the mainstay treatment in schizophrenia and other psychotic disorders. However, antipsychotics are associated with a wide range of side effects, which potentially have adverse effects on patients' functioning. A lack of studies comparing the frequency of side effects and their associated levels of distress across multiple antipsychotics and different medication variables has been noted. Additionally, it is essential to assess patients' attitudes towards antipsychotics in relation to their experience of side effects. DESIGN A cross-sectional, non-experimental research design was used. METHOD A convenience sample of 96 adults with schizophrenia and related disorders on antipsychotic treatment and attending the hospital's outpatient clinic was recruited. Variables collected included antipsychotic type, dose, route, prescription duration and side effects, attitudes towards medication and demographic and clinical variables. They were analysed with descriptive statistics and correlational analyses. RESULTS Many participants experienced psychic (80·2%), extrapyramidal (69·8%) and miscellaneous side effects (61·5%). Side effects positively correlated with dose (p = 0·016) and negatively correlated with prescription duration (p = 0·014). Negative attitudes towards medication were positively correlated with side effects in general (p = 0·023), along with hormonal (p = 0·013) and psychic side effects (p = 0·008). CONCLUSION Findings revealed that majority of the participants experienced and were distressed over psychic, extrapyramidal and weight gain, which may be related to high doses and treatment duration. Additionally, patients experiencing psychic and hormonal side effects are at risk of developing negative attitudes towards medication. RELEVANCE TO CLINICAL PRACTICE Findings guide the development of appropriate nursing interventions that aim to alleviate side effects, reduce negative attitudes towards medication and prevent compliance problems.
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Affiliation(s)
- Yan Ling Chiang
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore.
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Drug attitude and subjective well-being in antipsychotic treatment monotherapy in real-world settings. ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s1121189x00000993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SummaryAims– To assess using two well-know scales (DAI-30 and SWN) the drug attitude and subjective well-being of patients treated with haloperidol or second-generation antipsychotics (SGA) in four different Italian communities.Methods– The sample included 145 patients taking five different antipsychotics (APs) in mono-therapy: haloperidol, clozapine, olanzapine, risperidone, quetiapine. A stepwise multiple regression analysis (SMRA) was used to analyse the contribution of different AP treatments and of other predictors to SWN and DAI-30 scores. Results – Univariate analyses showed no differences in DAI-30 and SWN scores across treatments. The SMRA showed that SWN scores were negatively correlated with the severity of the psychoses (BPRS scores), while the DAI-30 scores were negatively correlated with the severity of the psychoses and positively correlated both with the length of drug treatment and with the use of olanzapine. Conclusions – Our study does not confirm a better drug attitude in patients treated with SGA with respect to haloperidol. The only partial exception is the better performance of olanzapine over haloperidol on DAI-30, which could be due to the lower use of anticholinergic drugs during olanzapine treatment. The differences between the SWN and DAI-30 may give good reason for the use of both instruments during AP treatments.Declarationof Interest: No grants have been received for this study. In the last two years: Matteo Balestrieri has received grants from AstraZeneca, Eli Lilly, BMS, Janssen-Cilag, Boehringer-Ingelheim, Innova-Pharma, Pfizer, Bristol, Abbott, Lundbeck; Guido Di Sciascio has received grants from AstraZeneca, Eli Lilly, BMS, Janssen-Cilag, Sanofi-Aventis, Wyeth, Boehringer- Ingelheim; Elisa Maso has received grants from Pfizer; Cesario Bellantuono has received grants from Eli Lilly, BMS, Boehringer- Ingelheim, Innova-Pharma, Italfarmaco; The other authors have not received any grants in the last two years.
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Ling CY, Klainin-Yobas P, Ignacio J. The impact of antipsychotic side-effects on attitudes toward medication in patients with schizophrenia and related disorders: a systematic review. JBI LIBRARY OF SYSTEMATIC REVIEWS 2011; 9:791-832. [PMID: 27820504 DOI: 10.11124/01938924-201109220-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Antipsychotics are associated with a wide range of side-effects. Many patients experience antipsychotics as unpleasant and something they would rather avoid, leading some of them to discontinue taking their medication. The importance of evaluating the patients' perspective, especially their attitudes toward medication in the presence of side-effects, has long been emphasized. However, no definite conclusion has been made to date on the relationship between antipsychotic side-effects and attitudes toward medication. OBJECTIVES The objective of this systematic review was to determine the best available evidence regarding the impact of antipsychotic side-effects on attitudes toward medication in patients with schizophrenia and related disorders, which include schizoaffective and schizophreniform disorders. INCLUSION CRITERIA Types of studies - This review considered quantitative studies that examined the magnitude of the effect of antipsychotic side-effects on attitudes toward medication in patients with schizophrenia.Types of participants - This review considered studies that included adults aged 18 to 70 years old, with a confirmed diagnosis of schizophrenia or related disorders, and receiving antipsychotic treatment in any healthcare setting.Types of intervention - This review included studies that investigated the impact of antipsychotic side-effects using standardised scales.Types of outcomes - This review included studies that quantitatively measure attitudes toward medication using standardised scales. Attitudes toward medication refer to the patients' perception towards different aspects of medication including, but not limited to, medication-taking, medication effects, and/or medication side-effects. SEARCH STRATEGY The search aimed to find published studies using a range of databases. A search strategy was developed using all identified keywords, and it was extended to the following databases: MEDLINE, CINAHL, PsycINFO, Scopus, ScienceDirect, and Web of Science. The search was limited to studies in English language and those published between the years 1990 to 2009. METHODOLOGICAL QUALITY Selected studies were assessed by two reviewers for methodological quality using the appropriate JBI critical appraisal instrument. DATA COLLECTION Data was extracted from the included studies using the appropriate JBI data extraction instrument. DATA ANALYSIS The heterogenous nature of the studies prevented statistical pooling of the data, thus the findings were presented in a narrative summary. RESULTS A total of 13 studies were included in the review. Two studies found a positive relationship between attitudes toward medication and antipsychotic side-effects, while another five studies found a positive relationship between attitudes toward medication and specific side-effects such as sedation, concentration difficulties, increased sleep, diminished sexual desire, and extrapyramidal side-effects, specifically dyskinesia and parkinsonism. The remaining six studies found no positive relationship between attitudes and side-effects. CONCLUSIONS This review provides some support to the notion that patients experiencing antipsychotic side-effects are at risk of developing more negative attitudes toward medication. Implications for practice - Regular attitude assessments should be conducted for patients with side-effects, and prompt clinical interventions and patient education can be carried out to manage side-effects. Implications for research - There is a need for more quantitative studies to further understand the relationship between the two variables.
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Affiliation(s)
- Chiang Yan Ling
- 1. Student, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, & Singapore National University Hospital Centre for Evidence-based Nursing: Collaborating Centre of the Joanna Briggs Institute. . 2. Assistant Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, & Singapore National University Hospital Centre for Evidence-based Nursing: Collaborating Centre of the Joanna Briggs Institute. . 3. Lecturer, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, & Singapore National University Hospital Centre for Evidence-based Nursing: Collaborating Centre of the Joanna Briggs Institute.
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Abstract
OBJECTIVE The purpose of the present study was to investigate and describe from the participants' perspectives the factors and processes influencing their choice as to whether to use prescribed psychiatric medication. METHODS Thematic content analysis of data was obtained from semi-structured interviews with 19 individuals diagnosed with mental illnesses. RESULTS Central themes related to using psychiatric medication were negative side effects, feeling like a "guinea pig," stigma, and struggling with the decision to continue or not to continue to take medication. The consequences of this decision were also considered. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Our findings support the notion that "non-adherence" related to psychiatric medication is not simply a "problem" but rather a complex issue requiring personalized attention. To further examine the potential usefulness of psychiatric medication, it is important that medication be perceived as personally relevant and that medication issues be discussed within the context of an ongoing authentic dialogue between medication prescriber and user.
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Barraco A, Rossi A, Nicolò G. Description of study population and analysis of factors influencing adherence in the observational Italian study "Evaluation of Pharmacotherapy Adherence in Bipolar Disorder" (EPHAR). CNS Neurosci Ther 2010; 18:110-8. [PMID: 21199448 DOI: 10.1111/j.1755-5949.2010.00225.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In patients with bipolar disorder, medication is effective in preventing relapses. Unfortunately, adherence to treatment in bipolar disorder, as in other chronic or recurrent conditions, is not optimal. Estimates of nonadherence to prescribed treatment range from 30% to 60% in epidemiological studies, and are at around 30% in clinical trials. Adherence to treatment is a potent predictor of effectiveness, both in clinical trials and cohort studies, therefore is a very relevant area of investigation. This study will try to show a picture of the real life care where adherence is influenced by a wide range of variables. METHODS Prospective, observational, multicenter study in 650 adult patients with bipolar disorder, who had to initiate or change their treatment regimen, observed for 1 year. Adherence was measured by the Simplified Medication Adherence Questionnaire (SMAQ). Additional variables: Symptom severity, Montgomery-Åsberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Clinical Global Impression-Bipolar Disorder (CGI-BD), the Drug Attitude Inventory score (DAI-30), and quality of life (EuroQoL 5 Dimensions). The variables were recorded every 3 months for the next year. RESULTS Most subjects were out-patients (77.1%), female (58.8%), aged 31-50 years (50.1%) and overweight (41.8%) or obese (28.7%); 67.4% had type I bipolar disorder and 66.8% had depressive or mixed symptoms. Adherence was 39.9% at baseline (and increased up to 67.0% at completion. The main predictors of nonadherence were alcohol consumption, severe bipolar symptoms, young age at time of first treatment, negative attitude towards treatment. CONCLUSIONS The patient population of this observational trial was representative of the patients changing their therapy for bipolar disorder seen in clinical practice in Italy. Lack of adherence to pharmacotherapy for bipolar disorder is a serious issue, which is more likely to arise in alcohol users and patients with severe symptoms, negative attitude towards medication and/or initiation of treatment early in life. The findings could lead to a more adequate approach of adherence in patients with bipolar disorders.
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Affiliation(s)
- Alessandra Barraco
- Medical Department, Eli Lilly Italia S.p.A., Sesto Fiorentino, Florence, Rome, Italy
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Carswell C, Wheeler A, Vanderpyl J, Robinson E. Comparative effectiveness of long-acting risperidone in New Zealand: a report of resource utilization and costs in a 12-month mirror-image analysis. Clin Drug Investig 2010; 30:777-87. [PMID: 20712387 DOI: 10.2165/11537680-000000000-00000] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Schizophrenia affects approximately 1% of the population and is associated with a considerable economic burden to society. The healthcare costs of the disorder are high and are compounded by substantial productivity losses. Failure to adhere to medication regimens, with subsequent relapse and hospitalization, is a key driver of these costs. A long-acting injectable formulation of the second generation antipsychotic risperidone (risperidone long-acting injection [risperidone LAI]) was licensed in New Zealand and received full government funding in October 2005. Second generation antipsychotics may have some efficacy advantages, be associated with fewer adverse effects and could improve adherence. However, the acquisition cost of risperidone LAI is higher than that of first generation antipsychotics and healthcare decision makers need information that allows them to determine whether risperidone LAI represents a cost-effective investment in terms of improved outcomes. OBJECTIVES To explore real-world outcomes and costs of patients treated with risperidone LAI within New Zealand. METHODS A mirror-image retrospective study was conducted comparing outcomes and costs 12 months post- versus 12 months pre-initiation of risperidone LAI in all adults receiving approval for risperidone LAI between 1 October 2005 and 31 October 2006 in five health services. Continuation rates, compulsory treatment status, psychiatric hospitalization (admission number, bed-stay and cost) and treatment data were collected from clinical files and patient information systems for the 12 months on either side of the first risperidone LAI prescription. Hospitalization costs were valued using estimates for cost per admission and cost per hospital day ($NZ, year 2009 values). RESULTS 58.3% of patients remained on risperidone LAI 12 months after initiation. Compared with the pre-risperidone LAI treatment period the mean number of admissions for the total study population was significantly lower in the post-risperidone LAI treatment period (1.38 vs 0.61, p<0.001) but the mean length of bed-stay increased (37.2 vs 53.3 days, p<0.001), as did compulsory treatment use. Overall hospital bed-nights (hospitalization days) increased by 6877 in the post-index period, driven mostly by those who discontinued treatment. Patients who continued risperidone LAI had fewer admissions and days in hospital post-risperidone LAI than patients who discontinued risperidone LAI use in the first year. The reduction in total hospital admission rates between the two treatment periods was significantly greater in the continuation group and mean difference in bed-days between the two treatment periods was significantly less for continuers (5.4 vs 31.1 days, p<0.001). Applying a cost per admission, hospitalization costs reduced by approximately $NZ1.7 million in the post risperidone LAI-period. Applying a daily hospitalization cost resulted in an increase of approximately $NZ3.5 million in the post-risperidone LAI period. CONCLUSION This study suggests that patients have reduced hospital admissions but longer bed-stay after starting risperidone LAI. Longer admissions were driven by those that discontinued treatment and continuation was associated with improved resource and cost outcomes compared with those who discontinued. These findings have potential implications for payers, providers and patients that require further investigation over a longer time frame.
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