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Jiang N, Jin W, Fu Z, Cao H, Zheng H, Wang Q, Zhang Q, Ju K, Wang J. Effects of Social Support on Medication Adherence Among Patients with Schizophrenia: Serial Multiple Mediation Model. Patient Prefer Adherence 2024; 18:947-955. [PMID: 38737488 PMCID: PMC11086644 DOI: 10.2147/ppa.s460210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose This study aims to explore the serial mediating effect of stigma and depression on the association between social support and medication adherence. Patients and Methods A cross-sectional survey was undertaken in the Changning District of Shanghai using a five-part questionnaire from August to December 2023. A convenient sampling method was employed, and 35 patients with schizophrenia were invited from each of the 9 streets in Changning District to participate in the survey, resulting in a total of 305 valid questionnaires collected. The questionnaire measured social support, stigma, depression, medication adherence, and demographic characteristics. Data analysis involved descriptive statistics, independent samples t-tests, ANOVA, Pearson correlation analysis, and the bootstrap method. Results There was a direct and significantly positive association between social support and medication adherence (β = 0.69, p < 0.001). Moreover, increased levels of stigma (β = - 0.45, p = 0.013) and depression (β = - 0.09, p = 0.017) were both associated with a decline in medication adherence. Bootstrapping analysis revealed that the association between social support and medication adherence operated indirectly through stigma (β = 0.11, 95% CI: 0.03, 0.18). Additionally, social support was indirectly associated with medication adherence through depression (β = 0.15, 95% CI: 0.04, 0.30). Further analysis indicated that social support had an indirect association with medication adherence through both stigma and depression (β = 0.04, 95% CI: 0.01, 0.07). Conclusion Stigma and depression serially mediate the association between social support and medication adherence among patients with schizophrenia. This serial multiple mediation model underscores the importance of integrating social support interventions with psychological interventions aimed at reducing stigma and depression, thereby effectively enhancing medication adherence in patients with schizophrenia.
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Affiliation(s)
- Nan Jiang
- Key Laboratory of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Wei Jin
- Department of Patriotic Public Health and Health Promotion instruction, Shanghai Municipal Center for Health Promotion, Shanghai, People’s Republic of China
| | - Zhenghui Fu
- Shanghai Changning Mental Health Center (Affiliated to East China Normal University), Shanghai, People’s Republic of China
| | - He Cao
- Key Laboratory of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Hong Zheng
- Shanghai Changning Mental Health Center (Affiliated to East China Normal University), Shanghai, People’s Republic of China
| | - Quqing Wang
- Key Laboratory of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Qiongting Zhang
- Shanghai Changning Mental Health Center (Affiliated to East China Normal University), Shanghai, People’s Republic of China
| | - Kang Ju
- Shanghai Changning Mental Health Center (Affiliated to East China Normal University), Shanghai, People’s Republic of China
| | - Jiwei Wang
- Key Laboratory of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, People’s Republic of China
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Sampogna G, Di Vincenzo M, Giuliani L, Menculini G, Mancuso E, Arsenio E, Cipolla S, Della Rocca B, Martiadis V, Signorelli MS, Fiorillo A. A Systematic Review on the Effectiveness of Antipsychotic Drugs on the Quality of Life of Patients with Schizophrenia. Brain Sci 2023; 13:1577. [PMID: 38002537 PMCID: PMC10669728 DOI: 10.3390/brainsci13111577] [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: 10/14/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Pharmacological antipsychotic drug interventions represent the cornerstone of the management of patients with schizophrenia and other psychotic spectrum disorders. The choice of the "best" treatment should be made on the basis of several clinical domains. However, despite available treatments, the quality of life reported by patients with schizophrenia taking antipsychotics is still very poor, and this outcome is rarely taken into account in trials assessing the efficacy and effectiveness of antipsychotic treatments. Therefore, we performed a systematic review in order to assess the impact of antipsychotic treatment on patients' quality of life. In particular, we aimed to identify any differences in the improvement in quality of life according to the (a) type of formulation of antipsychotic drugs (i.e., oral vs. depot vs. long-acting injectable); (b) type of the drug (first vs. second vs. third generation); and (c) patients' clinical characteristics. One hundred and eleven papers were included in the review. The main findings were as follows: (1) quality of life is usually considered a secondary outcome in trials on the efficacy and effectiveness of drugs; (2) second-generation antipsychotics have a more positive effect on quality of life; and (3) long-acting injectable antipsychotics are associated with a more stable improvement in quality of life and with a good safety and tolerability profile. Our systematic review confirms that quality of life represents a central element for selecting the appropriate treatment for people with schizophrenia. In particular, the availability of new treatments with a better tolerability profile, a proven effectiveness on patients' cognitive and social functioning, and with a more stable blood concentration might represent the appropriate strategy for improving the quality of life of people with schizophrenia.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Giulia Menculini
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy
| | - Emiliana Mancuso
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Eleonora Arsenio
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Salvatore Cipolla
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Bianca Della Rocca
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | | | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
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Zubiaur P, Soria-Chacartegui P, Villapalos-García G, Gordillo-Perdomo JJ, Abad-Santos F. The pharmacogenetics of treatment with olanzapine. Pharmacogenomics 2021; 22:939-958. [PMID: 34528455 DOI: 10.2217/pgs-2021-0051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Genetic polymorphism in olanzapine-metabolizing enzymes, transporters and drug targets is associated with alterations in safety and efficacy. The aim of this systematic review is to describe all clinically relevant pharmacogenetic information on olanzapine and to propose clinically actionable variants. Two hundred and eighty-four studies were screened; 76 complied with the inclusion criteria and presented significant associations. DRD2 Taq1A (rs1800497) *A1, LEP -2548 (rs7799039) G and CYP1A2*1F alleles were related to olanzapine effectiveness and safety variability in several studies, with a high level of evidence. DRD2 -141 (rs1799732) Ins, A-241G (rs1799978) G, DRD3 Ser9Gly (rs6280) Gly, HTR2A rs7997012 A, ABCB1 C3435T (rs1045642) T and G2677T/A (rs2032582) T and UGT1A4*3 alleles were related to safety, effectiveness and/or pharmacokinetic variability with moderated level of evidence.
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Affiliation(s)
- Pablo Zubiaur
- Department of Clinical Pharmacology, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain.,UICEC Hospital Universitario de La Princesa, Plataforma SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain
| | - Paula Soria-Chacartegui
- Department of Clinical Pharmacology, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain
| | - Gonzalo Villapalos-García
- Department of Clinical Pharmacology, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain
| | - Juan J Gordillo-Perdomo
- Department of Clinical Analysis, Hospital Universitario de La Princesa, Madrid, 28006, Spain
| | - Francisco Abad-Santos
- Department of Clinical Pharmacology, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain.,UICEC Hospital Universitario de La Princesa, Plataforma SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, 28006, Spain
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Thériault RK, St-Denis M, Hewitt T, Khokhar JY, Lalonde J, Perreault ML. Sex-Specific Cannabidiol- and Iloperidone-Induced Neuronal Activity Changes in an In Vitro MAM Model System of Schizophrenia. Int J Mol Sci 2021; 22:ijms22115511. [PMID: 34073710 PMCID: PMC8197248 DOI: 10.3390/ijms22115511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/20/2022] Open
Abstract
Cortical circuit dysfunction is thought to be an underlying mechanism of schizophrenia (SZ) pathophysiology with normalization of aberrant circuit activity proposed as a biomarker for antipsychotic efficacy. Cannabidiol (CBD) shows potential as an adjunctive antipsychotic therapy; however, potential sex effects in these drug interactions remain unknown. In the present study, we sought to elucidate sex effects of CBD coadministration with the atypical antipsychotic iloperidone (ILO) on the activity of primary cortical neuron cultures derived from the rat methylazoxymethanol acetate (MAM) model used for the study of SZ. Spontaneous network activity measurements were obtained using a multielectrode array at baseline and following administration of CBD or ILO alone, or combined. At baseline, MAM male neurons displayed increased bursting activity whereas MAM female neurons exhibited no difference in bursting activity compared to sex-matched controls. CBD administered alone showed a rapid but transient increase in neuronal activity in the MAM networks, an effect more pronounced in females. Furthermore, ILO had an additive effect on CBD-induced elevations in activity in the MAM male neurons. In the MAM female neurons, CBD or ILO administration resulted in time-dependent elevations in neuronal activity, but the short-term CBD-induced increases in activity were lost when CBD and ILO were combined. Our findings indicate that CBD induces rapid increases in cortical neuronal activity, with sex-specific drug interactions upon ILO coadministration. This suggests that sex should be a consideration when implementing adjunct therapy for treatment of SZ.
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Affiliation(s)
- Rachel-Karson Thériault
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada; (R.-K.T.); (M.S.-D.); (T.H.); (J.L.)
- Collaborative Program in Neuroscience, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Myles St-Denis
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada; (R.-K.T.); (M.S.-D.); (T.H.); (J.L.)
| | - Tristen Hewitt
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada; (R.-K.T.); (M.S.-D.); (T.H.); (J.L.)
- Collaborative Program in Neuroscience, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Jibran Y. Khokhar
- Collaborative Program in Neuroscience, University of Guelph, Guelph, ON N1G 2W1, Canada;
- Department of Biomedical Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Jasmin Lalonde
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada; (R.-K.T.); (M.S.-D.); (T.H.); (J.L.)
- Collaborative Program in Neuroscience, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Melissa L. Perreault
- Collaborative Program in Neuroscience, University of Guelph, Guelph, ON N1G 2W1, Canada;
- Department of Biomedical Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
- Correspondence: ; Tel.: +1-(519)-824-4120 (ext. 52013)
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Marder SR, Meehan SR, Weiss C, Chen D, Hobart M, Hefting N. Effects of Brexpiprazole Across Symptom Domains in Patients With Schizophrenia: Post Hoc Analysis of Short- and Long-Term Studies. SCHIZOPHRENIA BULLETIN OPEN 2021; 2:sgab014. [PMID: 34901863 PMCID: PMC8650077 DOI: 10.1093/schizbullopen/sgab014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The successful treatment of schizophrenia entails improvement across a spectrum of symptoms. The aim of this post hoc analysis was to characterize the short- and long-term effects of brexpiprazole on Positive and Negative Syndrome Scale (PANSS) ‘Marder factors.’ Data were included from three 6-week, randomized, double-blind, placebo-controlled studies; a 52-week, randomized, double-blind, placebo-controlled maintenance treatment study; and two 52-week open-label extension (OLEx) studies—all in schizophrenia (DSM-IV-TR criteria). Patients receiving oral brexpiprazole were dosed at 2–4 mg/day (short-term studies) or 1–4 mg/day (long-term studies). At Week 6, least squares mean differences (LSMDs, with 95% confidence limits [CLs]) for brexpiprazole (n = 868) vs placebo (n = 517) were: Positive symptoms: −1.55 (−2.30, −0.80), P < .0001, Cohen’s d effect size (ES) = 0.27; Negative symptoms: −1.12 (−1.63, −0.61), P < .0001, ES = 0.29; Disorganized thought: −1.26 (−1.78, −0.74), P < .0001, ES = 0.32; Uncontrolled hostility/excitement: −0.76 (−1.15, −0.37), P = .0002, ES = 0.26; Anxiety/ depression: −0.56 (−0.91, −0.22), P = .0014, ES = 0.22. At last visit of the maintenance study, LSMDs (95% CLs) for brexpiprazole (n = 96) vs placebo (n = 104) were: Positive symptoms: −3.44 (−4.99, −1.89), P < .0001, ES = 0.62; Negative symptoms: −1.23 (−2.52, 0.07), P = .063, ES = 0.27; Disorganized thought: −1.69 (−2.81, −0.56), P = .0035, ES = 0.42; Uncontrolled hostility/excitement: −1.26 (−2.12, −0.39), P = .0046, ES = 0.41; Anxiety/depression: −0.72 (−1.47, 0.03), P = .061, ES = 0.27. In the OLEx studies, improvements were maintained over 58 (6 + 52) weeks of brexpiprazole treatment. In conclusion, these data suggest that brexpiprazole treats the continuum of schizophrenia symptoms, in the short- and long-term. Trial Registration: Data used in this post hoc analysis came from ClinicalTrials.gov identifiers: NCT01396421, NCT01393613, NCT01810380, NCT01668797, NCT01397786, NCT01810783.
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Affiliation(s)
- Stephen R Marder
- Department of Psychiatry, Semel Institute for Neuroscience at UCLA and the VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA
| | | | - Catherine Weiss
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ
| | - Dalei Chen
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ
| | - Mary Hobart
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ
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Assessment of Real-Life Outcomes in Schizophrenia Patients according to Compliance. PSYCHIATRY JOURNAL 2020; 2020:5848601. [PMID: 32934955 PMCID: PMC7479455 DOI: 10.1155/2020/5848601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/13/2020] [Accepted: 08/01/2020] [Indexed: 11/18/2022]
Abstract
Objective To describe and compare demographics, outcomes and comorbidities in schizophrenia patients by treatment compliance. Methods This was a cross-sectional survey of hospital- or office-based psychiatrists who saw ≥6 schizophrenia patients per week and were responsible for treatment decisions. Recruited physicians completed a patient record form (PRF) for their first 10 consulted schizophrenia patients aged ≥18. These patients voluntarily completed a patient self-completion form (PSC). Compliance was measured by subjective physician assessment. Drivers of and outcomes associated with compliance were identified by regression analyses. Results A total of 150 physicians completed PRFs for 1489 patients (706 sometimes compliant (SC), 636 always compliant (AC)). A total of 680 patients completed a PSC (327 SC, 295 AC). AC patients were less likely to be male (52.2% vs. 58.6%; P = 0.021) and unemployed (odds ratio (OR) 0.91, 95% confidence interval (CI) 0.82-1.00; P < 0.001) or to have had a treatment regimen change (OR 0.56, 95% CI 0.40-0.80; P = 0.001) than SC patients. AC patients were less likely to have had more comorbidities (OR 0.91, 95% CI 0.82-1.00; P = 0.045) and hospitalizations in the past 12 months (OR 0.59, 95% CI 0.43-0.80; P = 0.001) than SC patients. Overall, AC patients had better clinical and humanistic outcomes. Weight gain was a common side effect for all patients; SC patients with weight gain had poorer outcomes than those without weight gain. Conclusion Schizophrenia patients that were SC experienced poorer clinical outcomes and quality of life. Weight gain may exacerbate these poorer outcomes.
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Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, Gregory CJ, Haddad PM, Howes OD, Jones I, Joyce EM, Lewis S, Lingford-Hughes A, MacCabe JH, Owens DC, Patel MX, Sinclair JM, Stone JM, Talbot PS, Upthegrove R, Wieck A, Yung AR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2020; 34:3-78. [PMID: 31829775 DOI: 10.1177/0269881119889296] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
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Affiliation(s)
- Thomas Re Barnes
- Emeritus Professor of Clinical Psychiatry, Division of Psychiatry, Imperial College London, and Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Richard Drake
- Clinical Lead for Mental Health in Working Age Adults, Health Innovation Manchester, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Carol Paton
- Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Emeritus Professor of Psychiatry, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bill Deakin
- Professor of Psychiatry, Neuroscience & Psychiatry Unit, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - I Nicol Ferrier
- Emeritus Professor of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine J Gregory
- Honorary Clinical Research Fellow, University of Manchester and Higher Trainee in Child and Adolescent Psychiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Honorary Professor of Psychiatry, Division of Psychology and Mental Health, University of Manchester, UK and Senior Consultant Psychiatrist, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Oliver D Howes
- Professor of Molecular Psychiatry, Imperial College London and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Jones
- Professor of Psychiatry and Director, National Centre of Mental Health, Cardiff University, Cardiff, UK
| | - Eileen M Joyce
- Professor of Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Shôn Lewis
- Professor of Adult Psychiatry, Faculty of Biology, Medicine and Health, The University of Manchester, UK, and Mental Health Academic Lead, Health Innovation Manchester, Manchester, UK
| | - Anne Lingford-Hughes
- Professor of Addiction Biology and Honorary Consultant Psychiatrist, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - James H MacCabe
- Professor of Epidemiology and Therapeutics, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Honorary Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - David Cunningham Owens
- Professor of Clinical Psychiatry, University of Edinburgh. Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK
| | - Maxine X Patel
- Honorary Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience and Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
| | - Julia Ma Sinclair
- Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Stone
- Clinical Senior Lecturer and Honorary Consultant Psychiatrist, King's College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Trust, London, UK
| | - Peter S Talbot
- Senior Lecturer and Honorary Consultant Psychiatrist, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, University of Birmingham and Consultant Psychiatrist, Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angelika Wieck
- Honorary Consultant in Perinatal Psychiatry, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Professor of Psychiatry, University of Manchester, School of Health Sciences, Manchester, UK and Centre for Youth Mental Health, University of Melbourne, Australia, and Honorary Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Iasevoli F, Fagiolini A, Formato MV, Prinzivalli E, Giordano S, Balletta R, De Luca V, de Bartolomeis A. Assessing patient-rated vs. clinician-rated adherence to the therapy in treatment resistant schizophrenia, schizophrenia responders, and non-schizophrenia patients. Psychiatry Res 2017; 249:159-166. [PMID: 28104562 DOI: 10.1016/j.psychres.2017.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/27/2016] [Accepted: 01/03/2017] [Indexed: 01/23/2023]
Abstract
The present study evaluated consistency, reliability, and determinants of two real-world measures of adherence to prescription in 57 schizophrenia and 61 non-schizophrenia patients. Treatment resistant schizophrenia (TRS) was additionally diagnosed in 28 of the schizophrenia patients. Patients were screened for clinical severity, cognitive functioning, and adherence by 10-item Drug Attitude Inventory (DAI-10) or Adherence-to-Therapy (AtT), a clinician-rated tool developed by our group. DAI-10 and AtT scores showed a significant correlation (p=0.039; ρ=0.21; df=103). Compared to the DAI-10 scale, a higher number of variables were associated with AtT. In schizophrenia and TRS patients, substance abuse was the only significant predictor of lower DAI-10 score (p=0.027, F=5.2, R2=0.07, and p=0.06, F=8.9, R2=0.23, respectively). Lower AtT score was significantly associated with first-generation antipsychotic use (p=0.001, RR: 2.00 [1.40-2.87]), positive symptoms (p=0.02, RR: 1.63 [1.05-2.53]), impaired verbal fluency (p=0.01, RR: 1.88 [0.81-4.32]) or problem solving (p=0.01, RR: 2.14 [0.92-4.98]). AtT, but not DAI-10, score correlated with the score on the Personal and Social Performance scale (p=0.02, F=5.86, R2=0.08). Overall, AtT score was predicted by pharmacological, psychopathological, and cognitive factors, and predictive of psychosocial functioning. Therefore, AtT measure may represent a convenient and practical tool to evaluate schizophrenia patients' adherence.
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Affiliation(s)
- Felice Iasevoli
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | | | - Maria Vittoria Formato
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Emiliano Prinzivalli
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Sara Giordano
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Raffaele Balletta
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Vincenzo De Luca
- Centre for Addiction and Mental Health; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Andrea de Bartolomeis
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
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Abdel Aziz K, Elamin MH, El-Saadouni NM, El-Gabry DA, Barakat M, Alhayyas F, Moselhy HF. Schizophrenia: Impact of psychopathology, faith healers and psycho-education on adherence to medications. Int J Soc Psychiatry 2016; 62:719-725. [PMID: 27815512 DOI: 10.1177/0020764016676215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Many patients suffering from psychosis are nonadherent to their medications. Nonadherence can range from treatment refusal to irregular use or partial change in daily medication doses. AIM To investigate whether symptom dimensions, post-discharge care plans and being involved with faith healer affect the adherence to treatment in patients with schizophrenia. METHOD A total of 121 patients with schizophrenia were examined 6 weeks post-discharge from the inpatient unit and assessed for full, partial or nonadherence to medication. RESULTS There was a significant association between family involvement and partial adherence and between community team involvement post-discharge and full adherence to medications. Psycho-education was a predictor for adherence to medications, persecutory delusions and lack of insight predicted partial adherence, while being involved with faith healers predicted nonadherence. CONCLUSION Adherence to medications and socio-demographic variables are independent. This study demonstrated that nonadherence or partial adherence to medications is associated with lack of insight and persecutory delusions. Psycho-education could improve the adherence to medication compliances.
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Affiliation(s)
- Karim Abdel Aziz
- College of Medicine, United Arab Emirates University, Al Ain, UAE
| | | | - Nisrin M El-Saadouni
- Psychiatry Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Dina Aly El-Gabry
- Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | - Hamdy F Moselhy
- College of Medicine, United Arab Emirates University, Al Ain, UAE
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Andrisano-Ruggieri R, Crescenzo P, Ambrosio R, Pinto G, Grieco F. Building therapeutic relationship in schizophrenic and alcohol-related disorder cases. PSYCHODYNAMIC PRACTICE 2016. [DOI: 10.1080/14753634.2016.1198717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
This study aimed to evaluate the effects of aripiprazole lauroxil on hostility and aggressive behavior in patients with schizophrenia. Patients aged 18-70 years with a diagnosis of schizophrenia and currently experiencing an acute exacerbation or relapse were randomized to intramuscular (IM) aripiprazole lauroxil 441 mg (n=207), 882 mg (n=208), or placebo (n=207) for 12 weeks. In post-hoc analyses, hostility and aggression were assessed by the Positive and Negative Syndrome Scale (PANSS) Hostility item (P7) and a specific antihostility effect was assessed by adjusting for positive symptoms of schizophrenia, somnolence, and akathisia. The PANSS excited component score [P4 (Excitement), P7 (Hostility), G4 (Tension), G8 (Uncooperativeness), and G14 (Poor impulse control)], and the Personal and Social Performance scale disturbing and aggressive behavior domain were also assessed. Of the 147 patients who received aripiprazole lauroxil 882 mg and with a baseline PANSS Hostility item P7 more than 1, there was a significant (P<0.05) improvement versus placebo on the PANSS Hostility item P7 score by mixed-model repeated-measures at the end of the study, which remained significant when PANSS-positive symptoms and somnolence or akathisia were included as additional covariates. The proportion with PANSS Hostility item P7 more than 1 at endpoint was significantly (P<0.05) lower with aripiprazole lauroxil versus placebo (53.6, 46.1, and 66.3% for 441, 882 mg, and placebo). A significant (P<0.05) improvement was found with aripiprazole lauroxil versus placebo for change from baseline in the PANSS excited component score. The proportion of patients with aggressive behavior on the Personal and Social Performance scale was significantly (P<0.05) lower for aripiprazole lauroxil: 30.0% for 441 mg versus 44.1% for placebo (P=0.006) and 22.2% for 881 mg (P<0.001 versus placebo). Treatment with aripiprazole lauroxil resulted in decreases in agitation and hostility in patients with schizophrenia and this antihostility effect appears to be independent of a general antipsychotic effect.
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Pothimas N, Tungpunkom P, Kanungpiarn T. Experiences of medication adherence among people with schizophrenia: a systematic review protocol of qualitative evidence. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:51-57. [PMID: 27532139 DOI: 10.11124/jbisrir-2016-2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The objective of this qualitative review is to synthesize the lived experiences of medication adherence among people with schizophrenia. The specific review question is: what are the experiences of taking prescribed medication among people with schizophrenia?
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Affiliation(s)
- Nisakorn Pothimas
- 1Faculty of Nursing, Chiang Mai University, Thailand 2Faculty of Nursing, Chiang Mai University, The Thailand Centre for Evidence-based Nursing, Midwifery and Health Science (TCEBNMHS): a Collaborating Centre of the Joanna Briggs Institute
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El-Missiry A, Elbatrawy A, El Missiry M, Moneim DA, Ali R, Essawy H. Comparing cognitive functions in medication adherent and non-adherent patients with schizophrenia. J Psychiatr Res 2015; 70:106-12. [PMID: 26424429 DOI: 10.1016/j.jpsychires.2015.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/19/2015] [Accepted: 09/11/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Medication non-adherence presents a considerable problem in patients with schizophrenia. Cognitive and executive functions can affect adherence. The association between medication non-adherence and cognitive impairment in schizophrenia is under investigated with limited and conflicting research data. PURPOSE OF THE STUDY To prospectively assess the rate of drug adherence among a sample of patients with schizophrenia and to compare the cognitive and executive functions between adherent and non-adherent patients. SUBJECTS AND METHODS 109 patients with schizophrenia diagnosed according to the DSM-IV classification were initially assessed by the Wechsler Adult Intelligence Scale (WAIS), Wechsler Memory Scale-Revised (WMS-R) and Wisconsin Card Sorting Test (WCST) and six months later by the Brief Adherence Rating Scale (BARS). RESULTS 68.8% were non-adherent to their antipsychotic medication. Adherent patients (31.2%) had significantly higher mean scores for the total, verbal and performance IQ. They had significantly higher mean scores in most of WMS subtests (orientation, information, verbal paired association, digit span, visual memory span), and higher mean scores for; total correct, conceptual level response, percentage and categories completed on the WSCT subscales (P < 0.0001). Whereas the non-adherent group had higher mean scores in; trials administered, total errors, perseverative responses, and perseverative errors (P < 0.0001). In a step regression analysis, digit span, conceptualization, total and percentage of errors were putative predictors of non-adherence. CONCLUSION Cognitive deficits, especially verbal memory and executive functions were the strongest patients' related factors associated with non adherence to medication. Psychiatrists ought to consider possible cognitive factors influencing adherence to enable offering proper interventions.
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Affiliation(s)
- Ahmed El-Missiry
- Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt.
| | - Amira Elbatrawy
- Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt
| | - Marwa El Missiry
- Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt
| | - Dalia Abdel Moneim
- Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt
| | - Ramy Ali
- Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt
| | - Heba Essawy
- Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt
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Na E, Yim SJ, Lee JN, Kim JM, Hong K, Hong MH, Han H. Relationships among medication adherence, insight, and neurocognition in chronic schizophrenia. Psychiatry Clin Neurosci 2015; 69:298-304. [PMID: 25600955 DOI: 10.1111/pcn.12272] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/14/2014] [Accepted: 01/10/2015] [Indexed: 12/21/2022]
Abstract
AIMS In order to improve long-term prognosis in schizophrenia, enhancing medication adherence is essential. The aim of this study was thus to identify the association between medication non-adherence and possible risk factors in a large sample of patients with chronic schizophrenia. METHODS One hundred and four patients with schizophrenia with a disease duration of over 10 years were enrolled in this cross-sectional study. The subjects were assessed with the Scale to Assess Unawareness of Mental Disease-Korean version, the Korean version of the Medication Adherence Rating Scale, a neurocognition battery designed for this study, and the Positive and Negative Symptoms Scale. An anova and multiple regression models were conducted to identify the correlations among variables and the factors that contribute to medication adherence. RESULTS The adherence score measured on the Korean version of the Medication Adherence Rating Scale was 7.60 ± 2.12; 88 (84.62%) patients were categorized as well-adherent and 16 (15.38%) as poorly adherent to their medication. Patients with good insight were more likely to maintain their medication (P = 0.0005), and better executive function was associated with increased medication adherence (P = 0.0008). Furthermore, fewer depressive symptoms were associated with good medication adherence (P = 0.0304). CONCLUSIONS This study is the first in the Republic of Korea to identify the relationship between medication adherence, insight, and neurocognition in a large sample of patients with chronic schizophrenia. These results could be used to establish a strategy for improving the prognosis of chronic schizophrenia.
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Affiliation(s)
- Euihyeon Na
- Department of General Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
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El-Mallakh P, Findlay J. Strategies to improve medication adherence in patients with schizophrenia: the role of support services. Neuropsychiatr Dis Treat 2015; 11:1077-90. [PMID: 25931823 PMCID: PMC4404876 DOI: 10.2147/ndt.s56107] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The purpose of this review is to describe research over the past 10 years on the role of support services in promoting medication adherence in mental health consumers diagnosed with schizophrenia. A literature search was conducted using the terms "medication adherence," "schizophrenia," and "support services," using Medline, PubMed, and CINAHL. Reference lists from published studies were also reviewed to identify additional research studies. Twenty-two articles focused on support-service intervention studies, and these were selected for review. Available support-service interventions include adherence therapy, electronic reminders via text messages and telephones, cognitive-behavioral and motivational strategies, and financial incentives. Support-service intervention strategies need to be tailored to the specific needs of mental health consumers with schizophrenia. More research is needed to investigate effective support services to enhance long-term adherence and adherence to medications for medical illnesses in this population.
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Affiliation(s)
| | - Jan Findlay
- College of Nursing, University of Kentucky, Lexington, KY, USA
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de Araújo AA, de Araújo Dantas D, do Nascimento GG, Ribeiro SB, Chaves KM, de Lima Silva V, de Araújo RF, de Souza DLB, de Medeiros CACX. Quality of life in patients with schizophrenia: the impact of socio-economic factors and adverse effects of atypical antipsychotics drugs. Psychiatr Q 2014; 85:357-67. [PMID: 24789610 DOI: 10.1007/s11126-014-9290-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This cross-sectional study compared the effects of treatment with atypical antipsychotic drugs on quality of life (QoL) and side effects in 218 patients with schizophrenia attending the ambulatory services of psychiatric in Rio Grande do Norte, Brazil. Socio-economic variables were compared. The five-dimension EuroQoL (EQ-5D) was used to evaluate QoL, and side effects were assessed using the Udvalg for Kliniske Undersøgelser (UKU) Side Effect Rating Scale and the Simpson-Angus Scale. Data were analysed using the χ (2) test and Student's t test, with a significance level of 5 %. Average monthly household incomes in the medication groups were 1.1-2.1 minimum wages ($339-$678). UKU Scale scores showed significant differences in side effects, mainly, clozapine, quetiapine and ziprasidone (p < 0.05). EQ-5D scores showed that all drugs except olanzapine significantly impacted mobility (p < 0.05), and proportions of individuals reporting problems in other dimensions were high: 63.6 % of clozapine users reported mobility problems, 63.7 and 56.3 % of clozapine and ziprasidone users, respectively, had difficulties with usual activities, 68.8 and 54.5 % of ziprasidone and clozapine users, respectively, experienced pain and/or discomfort, and 72.8 % of clozapine users reported anxiety and/or depression. Psychiatric, neurological, and autonomous adverse effects, as well as other side effects, were prevalent in users of atypical antipsychotic drugs, especially clozapine and ziprasidone. Olanzapine had the least side effects. QoL was impacted by side effects and economic conditions in all groups. Thus, the effects of these antipsychotic agents appear to have been masked by aggravating social and economic situations.
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Affiliation(s)
- Aurigena Antunes de Araújo
- Department of Biophysical and Pharmacology, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil,
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Einarson TR, Vicente C, Zilbershtein R, Piwko C, Bø CN, Pudas H, Jensen R, Hemels MEH. Pharmacoeconomics of depot antipsychotics for treating chronic schizophrenia in Sweden. Nord J Psychiatry 2014; 68:416-27. [PMID: 24274837 DOI: 10.3109/08039488.2013.852243] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To determine the cost-effectiveness of long-acting injectable (LAI) antipsychotics for chronic schizophrenia in Sweden. METHODS A 1-year decision tree was developed for Sweden using published data and expert opinion. Five treatment strategies lasting 1 year were compared: paliperidone palmitate (PP-LAI), olanzapine pamoate (OLZ-LAI), risperidone (RIS-LAI), haloperidol decanoate (HAL-LAI) and olanzapine tablets (oral-OLZ). Patients intolerant/failing drugs switched to another depot; subsequent failures received clozapine. Resources and employment time lost (indirect costs) were costed in 2011 Swedish kroner (SEK), from standard government lists. The model calculated the average cost/patient and quality-adjusted life-years (QALYs), which were combined into incremental cost-effectiveness ratios. Multivariate and 1-way sensitivity analyses tested model stability. RESULTS PP-LAI followed by OLZ-LAI had the lowest cost/patient (189,696 SEK) and highest QALYs (0.817), dominating in the base case. OLZ-LAI followed by PP-LAI cost 229,775 SEK (0.812 QALY), RIS-LAI followed by HAL-LAI cost 221,062 SEK (0.804 QALY), HAL-LAI followed by oral-OLZ cost 243,411 SEK (0.776 QALY), and oral-OLZ followed by HAL-LAI cost 249,422 SEK (0.773 QALY). The greatest proportions of costs (52.5-83.8%) were for institutional care; indirect costs were minor (2.4-3.8%). RESULTS were sensitive to adherence and hospitalization rates, but not drug cost. PP-LAI followed by OLZ-LAI dominated OLZ-LAI followed by PP-LAI in 59.4% of simulations, RIS-LAI followed by HAL-LAI in 65.8%, HAL-LAI followed by oral-OLZ in 94.0% and oral-OLZ followed by HAL-LAI in 95.9%; PP-LAI followed by OLZ-LAI was dominated in 1.1% of the 40,000 iterations. CONCLUSION PP-LAI followed by OLZ-LAI was cost-effective in Sweden for chronic schizophrenia and cost-saving overall to the healthcare system.
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Haddad PM, Brain C, Scott J. Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies. Patient Relat Outcome Meas 2014; 5:43-62. [PMID: 25061342 PMCID: PMC4085309 DOI: 10.2147/prom.s42735] [Citation(s) in RCA: 337] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Nonadherence with medication occurs in all chronic medical disorders. It is a particular challenge in schizophrenia due to the illness's association with social isolation, stigma, and comorbid substance misuse, plus the effect of symptom domains on adherence, including positive and negative symptoms, lack of insight, depression, and cognitive impairment. Nonadherence lies on a spectrum, is often covert, and is underestimated by clinicians, but affects more than one third of patients with schizophrenia per annum. It increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life. It results from multiple patient, clinician, illness, medication, and service factors, but a useful distinction is between intentional and unintentional nonadherence. There is no gold standard approach to the measurement of adherence as all methods have pros and cons. Interventions to improve adherence include psychoeducation and other psychosocial interventions, antipsychotic long-acting injections, electronic reminders, service-based interventions, and financial incentives. These overlap, all have some evidence of effectiveness, and the intervention adopted should be tailored to the individual. Psychosocial interventions that utilize combined approaches seem more effective than unidimensional approaches. There is increasing interest in electronic reminders and monitoring systems to enhance adherence, eg, Short Message Service text messaging and real-time medication monitoring linked to smart pill containers or an electronic ingestible event marker. Financial incentives to enhance antipsychotic adherence raise ethical issues, and their place in practice remains unclear. Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive therapeutic alliance and good communication between the clinician and patient. These elements remain essential for all patients, not least for the small minority where vulnerability and risk issue dictate that compulsory treatment is necessary to ensure adherence.
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Affiliation(s)
- Peter M Haddad
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
- Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK
| | - Cecilia Brain
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden
- Nå Ut-teamet, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, London, UK
- Centre for Affective Disorders, Institute of Psychiatry, London, UK
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Lyseng-Williamson KA. Oral olanzapine: a guide to its use in adults with schizophrenia or bipolar I disorder. DRUGS & THERAPY PERSPECTIVES 2013. [DOI: 10.1007/s40267-013-0074-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cullen BA, McGinty EE, Zhang Y, dosReis SC, Steinwachs DM, Guallar E, Daumit GL. Guideline-concordant antipsychotic use and mortality in schizophrenia. Schizophr Bull 2013; 39:1159-68. [PMID: 23112292 PMCID: PMC3756776 DOI: 10.1093/schbul/sbs097] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine if care concordant with 2009 Schizophrenia Patient Outcomes Research Team (PORT) pharmacological recommendations for schizophrenia is associated with decreased mortality. METHODS We conducted a retrospective cohort study of adult Maryland Medicaid beneficiaries with schizophrenia and any antipsychotic use from 1994 to 2004 (N = 2132). We used Medicaid pharmacy data to measure annual and average antipsychotic continuity, to calculate chlorpromazine (CPZ) dosing equivalents, and to examine anti-Parkinson medication use. Cox proportional hazards regression models were used to examine the relationship between antipsychotic continuity, antipsychotic dosing, and anti-Parkinson medication use and mortality. RESULTS Annual antipsychotic continuity was associated with decreased mortality. Among patients with annual continuity greater than or equal to 90%, the hazard ratio [HR] for mortality was 0.75 (95% confidence interval [CI] 0.57-0.99) compared with patients with annual medication possession ratios (MPRs) of less than 10%. The HRs for mortality associated with continuous annual and average antipsychotic continuity were 0.75 (95% CI 0.58-0.98) and 0.84 (95% CI 0.58-1.21), respectively. Among users of first-generation antipsychotics, doses greater than or equal to 1500 CPZ dosing equivalents were associated with increased risk of mortality (HR 1.88, 95% CI 1.10-3.21), and use of anti-Parkinson medication was associated with decreased risk of mortality (HR 0.72, 95% CI 0.55-0.95). Mental health visits were also associated with decreased mortality (HR 0.96, 95% CI 0.93-0.98). CONCLUSIONS Adherence to PORT pharmacological guidelines is associated with reduced mortality among patients with schizophrenia. Adoption of outcomes monitoring systems and innovative service delivery programs to improve adherence to the PORT guidelines should be considered.
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Affiliation(s)
- Bernadette A. Cullen
- Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, Baltimore, MD
| | - Emma E. McGinty
- Department of Health Policy and Management and Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, Baltimore, MD
| | - Yiyi Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan C. dosReis
- Departments of Epidemiology and Psychiatry and Behavioral Sciences
| | - Donald M. Steinwachs
- Department of Health Policy and Management and Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, Baltimore, MD
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gail L. Daumit
- To whom correspondence should be addressed; 2024 East Monument Street, Room 2-513, Baltimore 21205, MD, USA; tel: 410-614-6460, fax: 410-614-0588, e-mail:
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Higashi K, Medic G, Littlewood KJ, Diez T, Granström O, De Hert M. Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Ther Adv Psychopharmacol 2013; 3:200-18. [PMID: 24167693 PMCID: PMC3805432 DOI: 10.1177/2045125312474019] [Citation(s) in RCA: 346] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nonadherence to medication is a recognized problem and may be the most challenging aspect of treatment. METHODS We performed a systematic review of factors that influence adherence and the consequences of nonadherence to the patient, healthcare system and society, in patients with schizophrenia. Particular attention was given to the effect of nonadherence on hospitalization rates, as a key driver of increased costs of care. A qualitative systematic literature review was conducted using a broad search strategy using disease and adherence terms. Due to the large number of abstracts identified, article selection was based on studies with larger sample sizes published after 2001. Thirty-seven full papers were included: 15 studies on drivers and 22 on consequences, of which 12 assessed the link between nonadherence and hospitalization. RESULTS Key drivers of nonadherence included lack of insight, medication beliefs and substance abuse. Key consequences of nonadherence included greater risk of relapse, hospitalization and suicide. Factors positively related to adherence were a good therapeutic relationship with physician and perception of benefits of medication. The most frequently reported driver and consequence were lack of insight and greater risk of hospitalization respectively. CONCLUSIONS Improving adherence in schizophrenia may have a considerable positive impact on patients and society. This can be achieved by focusing on the identified multitude of factors driving nonadherence.
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Affiliation(s)
- Kyoko Higashi
- Mapi Consultancy, De Molen 84, 3995 AX, Houten, The Netherlands
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San L, Bernardo M, Gómez A, Peña M. Factors associated with relapse in patients with schizophrenia. Int J Psychiatry Clin Pract 2013; 17:2-9. [PMID: 22731397 DOI: 10.3109/13651501.2012.687452] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess risk factors for relapse in patients with schizophrenia attended in daily practice. METHODS Patients with schizophrenia admitted consecutively to short-stay/acute-care psychiatric units over a 6-month period were eligible. Variables statistically significant in the univariate logistic regression analysis were then subjected to multivariate analysis. RESULTS The study population included 1646 patients (67.6% men). In the univariate analysis, low family support, duration of illness > 5 years, number of previous hospitalizations, cocaine and cannabis consumption, and number of different antipsychotic drug classes were risk factors for relapse. In the multivariate analysis, number of previous hospitalizations (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.21-1.36) and number of different antipsychotics previously used (OR = 1.13, 95% CI 1.03-1.24) were significant predictors of relapse. The absence of cannabis consumption was a protective factor (OR = 0.72, 95% CI 0.58-0.89). Neither adherence to treatment in the previous 3 years nor type of antipsychotic regimen was significantly associated with relapse. CONCLUSIONS Number of previous hospitalizations and number of different types of antipsychotic drugs were associated with relapse. Absence of cannabis consumption was a protective factor.
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Affiliation(s)
- Luis San
- Department of Child and Adolescent Psychiatry, Hospital Sant Joan de Déu , CIBERSAM, Esplugues del Llobregat, Barcelona, Spain.
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Utility of Two PANSS 5-Factor Models for Assessing Psychosocial Outcomes in Clinical Programs for Persons with Schizophrenia. SCHIZOPHRENIA RESEARCH AND TREATMENT 2013; 2013:705631. [PMID: 24381761 PMCID: PMC3871510 DOI: 10.1155/2013/705631] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/28/2013] [Indexed: 11/25/2022]
Abstract
Using symptom factors derived from two models of the Positive and Negative Syndrome Scale (PANSS) as covariates, change over time in consumer psychosocial functioning, medication adherence/compliance, and treatment satisfaction outcomes are compared based on a randomized, controlled trial assessing the effectiveness of antipsychotic medications for 108 individuals diagnosed with schizophrenia. Random effects regression analysis was used to determine the relative performance of these two 5-factor models as covariates in estimating change over time and the goodness of fit of the regression equations for each outcome. Self-reported psychosocial functioning was significantly associated with the relief of positive and negative syndromes, whereas patient satisfaction was more closely and significantly associated with control of excited/activation symptoms. Interviewer-rated psychosocial functioning was significantly associated with relief of positive and negative symptoms, as well as excited/activation and disoriented/autistic preoccupation symptoms. The VDG 5-factor model of the PANSS represents the best "goodness of fit" model for assessing symptom-related change associated with improved psychosocial outcomes and functional recovery. Five-factor models of the syndromes of schizophrenia, as assessed using the PANSS, are differentially valuable in determining the predictors of psychosocial and satisfaction changes over time, but not of improved medication adherence/compliance.
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Gardner KN, Bostwick JR. Antipsychotic treatment response in schizophrenia. Am J Health Syst Pharm 2012; 69:1872-9. [PMID: 23111671 DOI: 10.2146/ajhp110559] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Jolene R. Bostwick
- Department of Clinical, Social, and Administrative Sciences, College of Pharmacy, University of Michigan, and Clinical Pharmacist, Adult Psychiatry, University of Michigan Health System, Ann Arbor
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Stephenson JJ, Tunceli O, Tuncelli O, Gu T, Eisenberg D, Panish J, Crivera C, Dirani R. Adherence to oral second-generation antipsychotic medications in patients with schizophrenia and bipolar disorder: physicians' perceptions of adherence vs. pharmacy claims. Int J Clin Pract 2012; 66:565-73. [PMID: 22574724 PMCID: PMC3489041 DOI: 10.1111/j.1742-1241.2012.02918.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare physician-reported adherence of specific patients to oral second-generation antipsychotics vs. actual adherence rates determined from the patients' pharmacy claims. METHODS Claims data from the HealthCore Integrated Research Database identified patients with schizophrenia or bipolar disorder with ≥ 1 oral second-generation antipsychotic prescription. The prescribing physicians were identified from the pharmacy claims and asked to complete an Internet survey assessing their perception of medication adherence for 1-2 of their patients and their beliefs regarding adherence to second-generation antipsychotics in general for a 1-year period. Adherence to second-generation antipsychotics was determined for each patient by pharmacy claims for the same period. Physician survey data were merged with patient claims data via unique patient identifiers, and physician-reported adherence rates were compared with claims-based rates as measured by the medication possession ratio. RESULTS One hundred and fifty-three physicians responded to the survey, representing 214 patients (44 with claims for schizophrenia, 162 with bipolar disorder, 8 with claims for bipolar disorder and schizophrenia). Most physicians (60%) had no formal adherence training. More than two-thirds (68%) reported emphasising the importance of adherence and reported approximately 76% of their patients were adherent (≥ 71% of the time). In the schizophrenia group, 16 of 17 (94%) patients with low-to-moderate (≤ 70%) adherence levels had high (≥ 71%) physician-estimated adherence. In the bipolar disorder group, 62 of 92 (67%) patients with low-to-moderate adherence levels had high physician-estimated adherence. CONCLUSIONS/INTERPRETATION These analyses suggest that, even when physicians are asked about specific patients in their practice, there is discordance between physician perceptions and adherence as measured through pharmacy claims. This disparity may delay appropriate interventions, potentially contributing to relapses.
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Ye W, Ascher-Svanum H, Tanji Y, Flynn JA, Takahashi M. Predictors of continuation with olanzapine during the 1-year naturalistic treatment of patients with schizophrenia in Japan. Patient Prefer Adherence 2011; 5:611-7. [PMID: 22259238 PMCID: PMC3259076 DOI: 10.2147/ppa.s26002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Treatment continuation is considered an important measure of antipsychotic effectiveness in schizophrenia, reflecting the medication's efficacy, safety, and tolerability from both patients' and clinicians' perspectives. This study identified characteristics of patients with schizophrenia who continue olanzapine therapy for a 1-year period in Japan. METHODS In a large (N = 1850), prospective, observational study, Japanese patients with schizophrenia who initiated treatment with olanzapine were followed for 1 year. Baseline characteristics were compared using t-tests and chi-square tests. Stepwise logistic regression was used to identify independent baseline predictors of treatment continuation. RESULTS Most patients (68.2%) continued with olanzapine therapy for the full 1-year study period, with an average duration of 265.5 ± 119.4 days. At baseline, patients who continued were significantly more likely to be male, older, and inpatients; have longer illness duration, higher negative and cognitive symptoms, better health-related quality of life, and prior anticholinergic use. Continuers were significantly less likely to engage in social activities, live independently, work for pay, or have prior antidepressant use. Continuers showed significantly greater early (3-month) improvement in global symptom severity. Logistic regression found that continuation was significantly predicted by longer illness duration, lower positive symptoms, higher negative symptoms, and better health-related quality of life. CONCLUSIONS In this large naturalistic study in Japan, most patients with schizophrenia stayed on olanzapine therapy for the full 1-year study period. Treatment completion with olanzapine was independently predicted by longer illness duration, lower positive symptoms, higher negative symptoms, and better health-related quality of life.
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Affiliation(s)
- Wenyu Ye
- Lilly Suzhou Pharmaceutical Co, Shanghai, People’s Republic of China
| | | | - Yuka Tanji
- Lilly Research Laboratories Japan, Eli Lilly Japan KK, Kobe
| | | | - Michihiro Takahashi
- Lilly Research Laboratories Japan, Eli Lilly Japan KK, Kobe
- Terauchi-Takahashi Psychiatric Clinic, Ashiya, Japan
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Abstract
Interventions often involve a sequence of decisions. For example, clinicians frequently adapt the intervention to an individual's outcomes. Altering the intensity and type of intervention over time is crucial for many reasons, such as to obtain improvement if the individual is not responding or to reduce costs and burden when intensive treatment is no longer necessary. Adaptive interventions utilize individual variables (severity, preferences) to adapt the intervention and then dynamically utilize individual outcomes (response to treatment, adherence) to readapt the intervention. The Sequential Multiple Assignment Randomized Trial (SMART) provides high-quality data that can be used to construct adaptive interventions. We review the SMART and highlight its advantages in constructing and revising adaptive interventions as compared to alternative experimental designs. Selected examples of SMART studies are described and compared. A data analysis method is provided and illustrated using data from the Extending Treatment Effectiveness of Naltrexone SMART study.
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Affiliation(s)
- H. Lei
- Department of Statistics, University of Michigan, Ann Arbor, Michigan 48109;
| | - I. Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan 48106;
| | - K. Lynch
- Treatment Research Center and Center for Studies of Addictions, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104;
| | - D. Oslin
- Philadelphia Veterans Administration Medical Center, Philadelphia, Pennsylvania 19104, and Treatment Research Center and Center for Studies of Addictions, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104;
| | - S.A. Murphy
- Department of Statistics, Institute for Social Research, and Department of Psychiatry, University of Michigan, Ann Arbor, Michigan 48109;
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