Dosage deviation and drug effects in drug trials

Clinical trial of a test stick to control patient compliance under nomifensine treatment

A reliable and rapid way of assessing patient compliance is the use of a semi-quantitative drug determination in the urine. Almost all urines were positive to a microchromatographic test stick 2-6 hours after 25 or 100 mg nomifensine was taken orally by healthy normal volunteers. The test reliability between different observers varied between 76 and 100 per cent. False positive results were regularly observed with carbamazepine and triamterene, and false negatives or weakened reactions with lithium. The test is reliable and highly 'time-specific'. Its applicability is, therefore, restricted to very specific questions.

Compliance with ocular therapy

Patient noncompliance with the physician's prescribed therapeutic regimen can present serious obstacles both to individual patient care and to the obtaining of information necessary for controlled drug trials. Unfortunately, the physician often is unable to determine whether and to what extent a patient is not complying with therapy. This article reviews the problem of patient noncompliance with particular emphasis on how and why noncompliance occurs, and methods of predicting, detecting and coping with the defaulting patient.

Factors related to drug compliance and attrition in neurotic outpatients treated with anxiolytics

Forty-six outpatients with anxiety-tension states took part in a study on the effects of anxiolytic drugs. At the first interview ratings were performed and the patients answered a questionnaire as to their experience of the consultation (n = 42). Based on follow-up examinations after 2, 4 and 8 weeks, three groups were formed: completers, who did not experience side-effects to be of such intensity that they changed the recommended dose (n = 15); deviators, who due to side-effects changed the recommended dose temporarily or permanently (n = 20); and attritors (n = 7). One to two years after the end of the drug study a personality inventory was sent out by post. It was returned by 35 patients. 1) Completers, deviators and attritors were similar with regard to age, education and social class. 2) They were also similar with regard to initial distress level. 3) Completers had the highest scores on scales measuring the personality traits defence of status and guilt-feelings and on the factor inex neurotic self-assertiveness, while attritors had the lowest scores. 4) Completers, deviators and attritors were similar with regard to experience of the first consultation. 5) Patients with a more favourable experience of the first consultation reported taking lower doses of the drugs.

Treatment adherence

A large part of medical practice is complicated by two problems; the degree to which treatments are specific (the placebo problem) and the extent to which they are implemented (the adherence problem). Depending on setting and circumstance, up to half of the benefits of treatment are either non-specific or never obtained. This review considers the problem of adherence in the context of use of medication in psychiatry.

The effect of forewarning on the occurrence of side-effects and discontinuance of medication in patients on dothiepin

Dothiepin was prescribed for 100 depressed out-patients alternately allocated to one of two groups. Patients in Group A were forewarned about side-effects and patients in Group B were not forewarned. None of the patients had previously received dothiepin. After two weeks the patients were questioned regarding side-effects and continuance with medication. Eighty-nine patients were included in the final analysis. The results failed to confirm the hypotheses that forewarning patients of side-effects causes a greater number of patients to complain of such effects, or that where patients experience side-effects, forewarning is associated with any less frequent discontinuance of therapy. Compared with a previous study with amitriptyline, the results of this study are much closer to statistical significance. This may be due to the lower overall incidence of side-effects with dothiepin and calls for further work with a larger sample of patients.