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Pungor K, Sanchez P, Pappa S, Attal J, Leopold K, Steegen G, Vita A, Marsella C, Verrijcken C, Lahaye M, Wooller A. The Patient, Investigator, Nurse, Carer Questionnaire (PINC-Q): a cross-sectional, retrospective, non-interventional study exploring the impact of less frequent medication administration with paliperidone palmitate 3-monthly as maintenance treatment for schizophrenia. BMC Psychiatry 2021; 21:300. [PMID: 34107886 PMCID: PMC8191017 DOI: 10.1186/s12888-021-03305-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/25/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To understand the implications of switching from paliperidone palmitate 1-monthly (PP1M) to paliperidone palmitate 3-monthly (PP3M) treatment of schizophrenia from the perspective of four key stakeholders: patients, physicians, nurses and carers. METHODS This was a cross-sectional, retrospective, non-interventional study comprising a one-time questionnaire (PINC-Q) for adult patients (aged ≥18 years) with schizophrenia (International Classification of Diseases; ICD-10) and their physician, nurse and carer. Questionnaires were developed in association with patient and carer advocacy groups (GAMIAN and EUFAMI) and following an advisory board formed of psychiatrists and nurses. The degree of alignment between stakeholders was also examined. RESULTS Responses were received from a total of 224 evaluable patients. For most patients (88.4%), responses were received from at least two other stakeholders. Patients were moderately ill with mild-to-moderate lack of insight and had received PP1M for a mean (standard deviation [SD]) of 23.9 (21.28) months before switching to PP3M (duration mean [SD] 12.8 [3.72] months). The most frequently reported reasons to switch from PP1M to PP3M were 'to live life as normally as possible' and 'patient convenience'. Over 79% of responses within each stakeholder group stated that PP3M helped the patients, with increased patient activity and social involvement, improved frequency and quality of physician-patient and nurse-patient communication and decreased perceived stigma. CONCLUSIONS The results of this study add to the increasing body of evidence supporting the benefits of PP3M in a population of patients with schizophrenia representative of real-world clinical practice.
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Affiliation(s)
- Katalin Pungor
- grid.497524.90000 0004 0629 4353Janssen-Cilag, Medical Affairs EMEA, Dusseldorf, Germany
| | - Pedro Sanchez
- grid.468902.10000 0004 1773 0974Treatment Resistant Psychosis Unit, Hospital Psiquiatrico de Alava, Osakidetza, Vitoria, Spain
| | - Sofia Pappa
- grid.439700.90000 0004 0456 9659West London NHS Trust, London, UK
| | - Jerome Attal
- grid.157868.50000 0000 9961 060XAcademic Department of Adult Psychiatry, Hospital La Colombière, CHU Montpellier, Montpellier, France
| | - Karolina Leopold
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine with Early Intervention and Recognition Centre (FRITZ), Vivantes Klinikum Am Urban and Klinikum im Friedrichshain, Teaching Hospital of Charité-Universitätsmedizin, Berlin, Germany
| | - Geertje Steegen
- grid.411371.10000 0004 0469 8354Psychiatry Department, CHU Brugmann, Brussels, Belgium
| | - Antonio Vita
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Marjolein Lahaye
- Janssen-Cilag BV, Statistics & Decision Sciences, Breda, The Netherlands
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Adler DA, Ben-Zeev D, Tseng VWS, Kane JM, Brian R, Campbell AT, Hauser M, Scherer EA, Choudhury T. Predicting Early Warning Signs of Psychotic Relapse From Passive Sensing Data: An Approach Using Encoder-Decoder Neural Networks. JMIR Mhealth Uhealth 2020; 8:e19962. [PMID: 32865506 PMCID: PMC7490673 DOI: 10.2196/19962] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/01/2020] [Accepted: 07/24/2020] [Indexed: 01/16/2023] Open
Abstract
Background Schizophrenia spectrum disorders (SSDs) are chronic conditions, but the severity of symptomatic experiences and functional impairments vacillate over the course of illness. Developing unobtrusive remote monitoring systems to detect early warning signs of impending symptomatic relapses would allow clinicians to intervene before the patient’s condition worsens. Objective In this study, we aim to create the first models, exclusively using passive sensing data from a smartphone, to predict behavioral anomalies that could indicate early warning signs of a psychotic relapse. Methods Data used to train and test the models were collected during the CrossCheck study. Hourly features derived from smartphone passive sensing data were extracted from 60 patients with SSDs (42 nonrelapse and 18 relapse >1 time throughout the study) and used to train models and test performance. We trained 2 types of encoder-decoder neural network models and a clustering-based local outlier factor model to predict behavioral anomalies that occurred within the 30-day period before a participant's date of relapse (the near relapse period). Models were trained to recreate participant behavior on days of relative health (DRH, outside of the near relapse period), following which a threshold to the recreation error was applied to predict anomalies. The neural network model architecture and the percentage of relapse participant data used to train all models were varied. Results A total of 20,137 days of collected data were analyzed, with 726 days of data (0.037%) within any 30-day near relapse period. The best performing model used a fully connected neural network autoencoder architecture and achieved a median sensitivity of 0.25 (IQR 0.15-1.00) and specificity of 0.88 (IQR 0.14-0.96; a median 108% increase in behavioral anomalies near relapse). We conducted a post hoc analysis using the best performing model to identify behavioral features that had a medium-to-large effect (Cohen d>0.5) in distinguishing anomalies near relapse from DRH among 4 participants who relapsed multiple times throughout the study. Qualitative validation using clinical notes collected during the original CrossCheck study showed that the identified features from our analysis were presented to clinicians during relapse events. Conclusions Our proposed method predicted a higher rate of anomalies in patients with SSDs within the 30-day near relapse period and can be used to uncover individual-level behaviors that change before relapse. This approach will enable technologists and clinicians to build unobtrusive digital mental health tools that can predict incipient relapse in SSDs.
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Affiliation(s)
| | - Dror Ben-Zeev
- BRiTE Center, Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | | | - John M Kane
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Rachel Brian
- BRiTE Center, Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | | | - Marta Hauser
- Vanguard Research Group, Glen Oaks, NY, United States
| | - Emily A Scherer
- Biomedical Data Science Department, Dartmouth Geisel School of Medicine, Hanover, NH, United States
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Mulroy E, Balint B, Bhatia KP. Tardive syndromes. Pract Neurol 2020; 20:368-376. [PMID: 32487722 DOI: 10.1136/practneurol-2020-002566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/22/2020] [Accepted: 05/01/2020] [Indexed: 11/04/2022]
Abstract
Dopamine receptor-blocking antipsychotics, first introduced into clinical practice in 1952, were hailed as a panacea in the treatment of a number of psychiatric disorders. However, within 5 years, this notion was to be shattered by the recognition of both acute and chronic drug-induced movement disorders which can accompany their administration. Tardive syndromes, denoting the delayed onset of movement disorders following administration of dopamine receptor-blocking (and also other) drugs, have diverse manifestations ranging from the classic oro-bucco-lingual dyskinesia, through dystonic craniocervical and trunk posturing, to abnormal breathing patterns. Although tardive syndromes have been an important part of movement disorder clinical practice for over 60 years, their pathophysiologic basis remains poorly understood and the optimal treatment approach remains unclear. This review summarises the current knowledge relating to these syndromes and provides clinicians with pragmatic, clinically focused guidance to their management.
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Affiliation(s)
- Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.,Department of Neurology, University Hospital, Heidelberg, Germany
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
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Aldawsari HM, Hosny KM. Utilization of Nanotechnology and Thioctic Acid Against the Lithium Carbonate Toxicity in the Management of Schizophrenia. INT J PHARMACOL 2019. [DOI: 10.3923/ijp.2019.616.622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Adery LH, Ichinose M, Torregrossa LJ, Wade J, Nichols H, Bekele E, Bian D, Gizdic A, Granholm E, Sarkar N, Park S. The acceptability and feasibility of a novel virtual reality based social skills training game for schizophrenia: Preliminary findings. Psychiatry Res 2018; 270:496-502. [PMID: 30326433 PMCID: PMC6314809 DOI: 10.1016/j.psychres.2018.10.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/16/2018] [Accepted: 10/07/2018] [Indexed: 11/25/2022]
Abstract
Social impairment is a core feature of schizophrenia that presents a major barrier toward recovery. Some of the psychotic symptoms are partly ameliorated by medication but the route to recovery is hampered by social impairments. Since existing social skills interventions tend to suffer from lack of availability, high-burden and low adherence, there is a dire need for an effective, alternative strategy. The present study examined the feasibility and acceptability of Multimodal Adaptive Social Intervention in Virtual Reality (MASI-VR) for improving social functioning and clinical outcomes in schizophrenia. Out of eighteen patients with schizophrenia who enrolled, seventeen participants completed the pre-treatment assessment and 10 sessions of MASI-VR, but one patient did not complete the post-treatment assessments. Therefore, the complete training plus pre- and post-treatment assessment data are available from sixteen participants. Clinical ratings of symptom severity were obtained at pre- and post-training. Retention rates were very high and training was rated as extremely satisfactory for the majority of participants. Participants exhibited a significant reduction in overall clinical symptoms, especially negative symptoms following 10 sessions of MASI-VR. These preliminary results support the feasibility and acceptability of a novel virtual reality social skills training program for individuals with schizophrenia.
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Affiliation(s)
- Laura H Adery
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Megan Ichinose
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | - Joshua Wade
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Heathman Nichols
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Esube Bekele
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Dayi Bian
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Alena Gizdic
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Nilanjan Sarkar
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, TN, USA; Global Academy for Future Civilizations, Kyung Hee University, Seoul, Korea.
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Park SC, Choi MY, Choi J, Park E, Tchoe HJ, Suh JK, Kim YH, Won SH, Chung YC, Bae KY, Lee SK, Park CM, Lee SH. Comparative Efficacy and Safety of Long-acting Injectable and Oral Second-generation Antipsychotics for the Treatment of Schizophrenia: A Systematic Review and Meta-analysis. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2018; 16:361-375. [PMID: 30466208 PMCID: PMC6245299 DOI: 10.9758/cpn.2018.16.4.361] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/05/2018] [Indexed: 12/20/2022]
Abstract
We aimed to compare the efficacy and safety of long-acting injectable (LAI) and oral second-generation antipsychotics (SGAs) in treating schizophrenia by performing a systematic review and meta-analysis. MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library, as well as five Korean databases, were systemically searched to identify studies published from 2000 to 16 April 2015, which compared the efficacy and safety of LAI and oral SGAs. Using data from randomized controlled trials (RCTs), meta-analyses were conducted. In addition, the GRADE (the Grading of Recommendations, Assessment, Development and Evaluation) approach was applied to explicitly assess the quality of the evidence. A total of 30 studies including 17 RCTs and 13 observational studies were selected. The group treated with LAI SGAs was characterized by significantly lower relapse rates, longer times to relapse and fewer hospital days, but also by a higher occurrence of extrapyramidal syndrome and prolactin-related symptoms than that in the group treated with oral SGAs. Our findings demonstrate that there is moderate to high level of evidence suggesting that in the treatment of schizophrenia, LAI SGAs have higher efficacy and are associated with higher rates of extrapyramidal syndrome and prolactin-related symptoms. Additionally, the use of LAI SGAs should be combined with appropriate measures to reduce dopamine D2 antagonism-related symptoms.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Haeundae Paik Hospital, Inje University College of Medicine Busan, Korea
| | - Mi Young Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jina Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Eunjung Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Ha Jin Tchoe
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jae Kyung Suh
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Young Hoon Kim
- Department of Psychiatry, Gongju National Hospital, Gongju, Korea
| | - Seung Hee Won
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Korea
| | - Kyung-Yeol Bae
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Kyu Lee
- Department of Psychiatry, Hallym University Chuncheon Sacred Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Chan Mi Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, Korea
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Travaglini LE, Li L, Brown CH, Bennett ME. Predictors of smoking cessation group treatment engagement among veterans with serious mental illness. Addict Behav 2017; 75:103-107. [PMID: 28728038 PMCID: PMC5616105 DOI: 10.1016/j.addbeh.2017.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/29/2017] [Accepted: 07/08/2017] [Indexed: 12/31/2022]
Abstract
High prevalence rates of tobacco use, particularly cigarettes, pose a serious health threat for individuals with serious mental illness (SMI), and research has demonstrated the effectiveness of pharmacotherapy and psychosocial interventions to reduce tobacco use in this group. However, few studies have considered predictors of tobacco cessation treatment engagement among individuals with SMI. The current study examined predictors of engagement in smoking cessation groups among veterans with SMI engaged in mental health services at three VA medical centers. All veterans were participating in a smoking cessation treatment study. Of 178 veterans who completed baseline assessments, 127 (83.6%) engaged in treatment, defined as attending at least three group sessions. Forty-one (N=41) predictors across five domains (demographics, psychiatric concerns, medical concerns, smoking history, and self-efficacy to quit smoking) were identified based on previous research and clinical expertise. Using backward elimination to determine a final multivariable logistic regression model, three predictors were found to be significantly related to treatment engagement: marital status (never-married individuals more likely to engage); previous engagement in group smoking cessation services; and greater severity of positive symptoms on the Brief Psychiatric Rating Scale. When included in the multivariable logistic regression model, the full model discriminates between engagers and non-engagers reasonably well (c statistic=0.73). Major considerations based on these findings are: individuals with SMI appear to be interested in smoking cessation services; and serious psychiatric symptomatology should not discourage treatment providers from encouraging engagement in smoking cessation services.
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Affiliation(s)
- Letitia E Travaglini
- VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Lan Li
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Clayton H Brown
- VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Melanie E Bennett
- VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
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Schafer KM, Gionfriddo MR, Boehm DH. Shared decision making and medication therapy management with the use of an interactive template. J Am Pharm Assoc (2003) 2016; 56:166-72. [PMID: 27000167 DOI: 10.1016/j.japh.2015.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the preliminary efficacy, feasibility, and acceptability of a template-based intervention to facilitate shared decision making (SDM) in medication therapy management (MTM) consultations; and to examine the type and number of drug therapy problems (DTPs) discussed and how resolution was communicated to patients' primary care providers (PCPs). SETTING An internal medicine clinic at a large safety-net hospital. PRACTICE DESCRIPTION Hennepin County Medical Center is an urban safety net hospital serving an ethnically-diverse population with about 50 percent of patients enrolled in Medicaid. Within its internal medicine clinic, the study setting, over 100 clinicians participate in the primary care of approximately 25,000 discrete patients. PRACTICE INNOVATION This is the first study to use a template format to facilitate SDM with pharmacists in MTM consultations. The template approach is more flexible than the use of decision aids, facilitating discussion around various issues. INTERVENTIONS Patients completed template-guided interventions with pharmacists trained in SDM. EVALUATION We analyzed the electronic health record used during the intervention, as well as post-appointment surveys administered to patients and pharmacists, for indications of SDM efficacy, feasibility, and acceptability. RESULTS Twenty patients and four pharmacists participated in the study. Free-text comments demonstrated that both patients and pharmacists appreciated the intervention, although some pharmacists had concerns including consultation length and SDM applicability. On average, two DTPs were identified per consultation and were most commonly related to appropriate compliance (30% of DTPs), appropriate indication (26%), medication effectiveness (23%), and safety (21%). CONCLUSION Using a template to facilitate SDM within MTM consultations appears to be effective, feasible, and acceptable. DTP identification exemplifies a potential application of template-guided SDM. These results will be used to inform future work refining the intervention and developing robust comparative analyses.
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Gaudiano BA, Moitra E, Ellenberg S, Armey MF. The Promises and Challenges of Ecological Momentary Assessment in Schizophrenia: Development of an Initial Experimental Protocol. Healthcare (Basel) 2015; 3:556-73. [PMID: 26689969 PMCID: PMC4683929 DOI: 10.3390/healthcare3030556] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/09/2015] [Indexed: 12/15/2022] Open
Abstract
Severe mental illnesses, including schizophrenia and other psychotic-spectrum disorders, are a major cause of disability worldwide. Although efficacious pharmacological and psychosocial interventions have been developed for treating patients with schizophrenia, relapse rates are high and long-term recovery remains elusive for many individuals. Furthermore, little is still known about the underlying mechanisms of these illnesses. Thus, there is an urgent need to better understand the contextual factors that contribute to psychosis so that they can be better targeted in future interventions. Ecological Momentary Assessment (EMA) is a dynamic procedure that permits the measurement of variables in natural settings in real-time through the use of brief assessments delivered via mobile electronic devices (i.e., smart phones). One advantage of EMA is that it is less subject to retrospective memory biases and highly sensitive to fluctuating environmental factors. In the current article, we describe the research-to-date using EMA to better understand fluctuating symptoms and functioning in patients with schizophrenia and other psychotic disorders and potential applications to treatment. In addition, we describe a novel EMA protocol that we have been employing to study the outcomes of patients with schizophrenia following a hospital discharge. We also report the lessons we have learned thus far using EMA methods in this challenging clinical population.
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Affiliation(s)
- Brandon A. Gaudiano
- Butler Hospital and Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI 02906, USA; E-Mails: (S.E.); (M.F.A.)
| | - Ethan Moitra
- Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; E-Mail:
| | - Stacy Ellenberg
- Butler Hospital and Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI 02906, USA; E-Mails: (S.E.); (M.F.A.)
| | - Michael F. Armey
- Butler Hospital and Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI 02906, USA; E-Mails: (S.E.); (M.F.A.)
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Kim J, Macmaster E, Schwartz TL. Tardive dyskinesia in patients treated with atypical antipsychotics: case series and brief review of etiologic and treatment considerations. Drugs Context 2014; 3:212259. [PMID: 24744806 PMCID: PMC3989508 DOI: 10.7573/dic.212259] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 03/19/2014] [Accepted: 12/12/2013] [Indexed: 01/23/2023] Open
Abstract
Tardive dyskinesia (TD) is a disfiguring side-effect of antipsychotic medications that is potentially irreversible in affected patients. Newer atypical antipsychotics are felt by many to have a lower risk of TD. As a result, many clinicians may have developed a false sense of security when prescribing these medications. We report five cases of patients taking atypical antipsychotics who developed TD, review the risk of TD, its potential etiologic mechanisms, and treatment options available. The goal of this paper is to alert the reader to continue to be diligent in obtaining informed consent and monitoring for the onset of TD in patients taking atypical antipsychotics.
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Affiliation(s)
- Jungjin Kim
- SUNY Upstate Medical University, Department of Psychiatry, Syracuse, New York, USA
| | - Eric Macmaster
- SUNY Upstate Medical University, Department of Psychiatry, Syracuse, New York, USA
| | - Thomas L Schwartz
- SUNY Upstate Medical University, Department of Psychiatry, Syracuse, New York, USA
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Abstract
BACKGROUND Supportive, positive family environments have been shown to improve outcomes for patients with schizophrenia in contrast with family environments that express high levels of criticism, hostility, or over-involvement, which have poorer outcomes and have more frequent relapses. Forms of psychosocial intervention, designed to promote positive environments and reduce these levels of expressed emotions within families, are now widely used. OBJECTIVES To assess the effects of brief family interventions for people with schizophrenia or schizophrenia-like conditions. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (July 2012), which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies for further trials. We contacted authors of trials for additional information. SELECTION CRITERIA All relevant randomised studies that compared brief family-oriented psychosocial interventions with standard care, focusing on families of people with schizophrenia or schizoaffective disorder were selected. DATA COLLECTION AND ANALYSIS We reliably selected studies, quality assessed them and extracted data. For binary outcomes, we calculated standard estimates of risk ratio (RR) and their 95% confidence intervals (CI). For continuous outcomes, we estimated a mean difference (MD) between groups and their 95% CIs. We used GRADE to assess quality of evidence for main outcomes of interest and created a 'Summary of findings' table. We assessed risk of bias for included studies. MAIN RESULTS Four studies randomising 163 people could be included in the review. It is not clear if brief family intervention reduces the utilisation of health services by patients, as most results are equivocal at long term and only one study reported data for the primary outcomes of interest of hospital admission (n = 30, 1 RCT, RR 0.50, 95% CI 0.22 to 1.11, very low quality evidence). Data for relapse are also equivocal by medium term (n = 40, 1 RCT, RR 0.50, 95% CI 0.10 to 2.43, low quality evidence). However, data for the family outcome of understanding of family member significantly favoured brief family intervention (n = 70, 1 RCT, MD 14.90, 95% CI 7.20 to 22.60, very low quality evidence). No study reported data for other outcomes of interest including days in hospital; adverse events; medication compliance; quality of life or satisfaction with care; or any economic outcomes. AUTHORS' CONCLUSIONS The findings of this review are not outstanding due to the size and quality of studies providing data; the analysed outcomes were also minimal, with no meta-analysis possible. All outcomes in the 'Summary of findings' table were rated low or very low quality evidence. However, the importance of brief family intervention should not be dismissed outright, with the present state of demand and resources available. The designs of such brief interventions could be modified to be more effective with larger studies, which may then have enough power to inform clinical practice.
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Affiliation(s)
- Uzuazomaro Okpokoro
- The University of NottinghamDivision of PsychiatryRoom B21 The Sir Colin Campbell BuildingJubilee CampusNottinghamUKNG7 2TU
| | - Clive E Adams
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph Road,NottinghamUKNG7 2TU
| | - Stephanie Sampson
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph Road,NottinghamUKNG7 2TU
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Zhao J, Ou J, Xue H, Liu L, Montgomery W, Treuer T. Clinical utility of orally disintegrating olanzapine in Chinese patients with schizophrenia: a review of effectiveness, patient preference, adherence, and other properties. Neuropsychiatr Dis Treat 2014; 10:355-9. [PMID: 24600225 PMCID: PMC3933704 DOI: 10.2147/ndt.s39055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The primary objective of this systematic review was to examine the evidence for the efficacy, effectiveness, and safety of orally disintegrating olanzapine in Chinese populations. A systematic literature search was conducted using databases covering international and Chinese journals, ClinicalTrials.gov, and internal and external trial registries at Eli Lilly and Company using search terms related to target countries (People's Republic of China, Hong Kong, and Taiwan) and orally disintegrating olanzapine treatment. A publication and one clinical study report were retrieved. The clinical study showed orally disintegrating olanzapine and the standard oral tablet to have similar efficacy and tolerability profiles. A bioequivalence study has shown that orally disintegrating olanzapine and the standard oral tablet have similar pharmacokinetic profiles. Orally disintegrating olanzapine and the standard oral tablet have similar efficacy and tolerability profiles.
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Affiliation(s)
- Jingping Zhao
- Mental Health Institute of The Second Xiangya Hospital, Hunan Province Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, People's Republic of China
| | - Jianjun Ou
- Mental Health Institute of The Second Xiangya Hospital, Hunan Province Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, People's Republic of China
| | - Haibo Xue
- Lilly Suzhou Pharmaceutical Co, Ltd, Jiangsu, People's Republic of China
| | - Li Liu
- Lilly Suzhou Pharmaceutical Co, Ltd, Jiangsu, People's Republic of China
| | | | - Tamas Treuer
- Emerging Markets Business Unit (Neuroscience), Eli Lilly and Company, Budapest, Hungary
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Stanhope V, Barrenger SL, Salzer MS, Marcus SC. Examining the Relationship between Choice, Therapeutic Alliance and Outcomes in Mental Health Services. J Pers Med 2013; 3:191-202. [PMID: 25562652 PMCID: PMC4251393 DOI: 10.3390/jpm3030191] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Self-determination within mental health services is increasingly recognized as an ethical imperative, but we still know little about the impact of choice on outcomes among people with severe mental illnesses. This study examines whether choice predicts outcomes and whether this relationship is mediated by therapeutic alliance. METHOD The study sample of 396 participants completed a survey measuring choice, therapeutic alliance, recovery, quality of life and functioning. Multivariate analyses examined choice as a predictor of outcomes, and Sobel tests assessed alliance as a mediator. RESULTS Choice variables predicted recovery, quality of life and perceived outcomes. Sobel tests indicated that the relationship between choice and outcome variables was mediated by therapeutic alliance. IMPLICATIONS The study demonstrates that providing more choice and opportunities for collaboration within services does improve consumer outcomes. The results also show that collaboration is dependent on the quality of the relationship between the provider and consumer.
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Affiliation(s)
- Victoria Stanhope
- Silver School of Social Work, New York University, 1 Washington Square N, New York, NY 10003, USA.
| | - Stacey L Barrenger
- Silver School of Social Work, New York University, 1 Washington Square N, New York, NY 10003, USA.
| | - Mark S Salzer
- Department of Rehabilitation, Temple University, 1700 N. Broad Street, Suite 304, Philadelphia, PA 19122, USA.
| | - Stephen C Marcus
- School of Social Policy and Practice, Caster Building, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Thomas SP, Nandhra HS, Singh SP. Pharmacologic treatment of first-episode schizophrenia: a review of the literature. Prim Care Companion CNS Disord 2012; 14:11r01198. [PMID: 22690369 DOI: 10.4088/pcc.11r01198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 06/22/2011] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE To review the evidence base for the efficacy and tolerability of antipsychotic medication for the treatment of the first episode of schizophrenia. DATA SOURCE MEDLINE databases were searched for published articles in English over the last 25 years, from January 1986 to January 2011, on choice of antipsychotic treatment for the first episode of schizophrenia, with an emphasis on efficacy and tolerability of antipsychotic drugs in the acute phase of psychotic illness. STUDY SELECTION The keywords antipsychotic drugs and schizophrenia were used in combination with drug treatment, pharmacologic treatment, efficacy, and tolerability in addition to atypical antipsychotics, first-generation antipsychotics, second-generation antipsychotics, first-episode psychosis, and acute psychotic episode. DATA SYNTHESIS At present, there is no convincing evidence to guide clinicians in choosing a single first-line antipsychotic that is effective in treating the positive and negative symptoms of the first episode of schizophrenia. Even though second-generation antipsychotic drugs offer potential benefits in terms of less extrapyramidal side effects and some benefits in treating negative, affective, and cognitive symptoms, these drugs are not without their own side effects. CONCLUSIONS With the introduction of a number of second-generation antipsychotic drugs there have been significant advances in antipsychotic drug treatment over the last decade. Despite these advances, there are still a number of limitations in continued use of some antipsychotic medications due to their efficacy and tolerability issues in the acute and early maintenance phases of psychosis. Active research in this area would provide more promising results of improved efficacy and tolerability of antipsychotic medication.
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Affiliation(s)
- Shibu P Thomas
- Departments of General Adult Psychiatry, Coventry and Warwickshire Partnership Trust, Warwickshire, United Kingdom
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Montgomery W, Treuer T, Karagianis J, Ascher-Svanum H, Harrison G. Orally disintegrating olanzapine review: effectiveness, patient preference, adherence, and other properties. Patient Prefer Adherence 2012; 6:109-25. [PMID: 22346347 PMCID: PMC3277801 DOI: 10.2147/ppa.s27344] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Orally disintegrating olanzapine (ODO) is a rapid-dissolving formulation of olanzapine which disintegrates in saliva almost immediately, developed as a convenient and adherence-enhancing alternative to the standard olanzapine-coated tablet (SOT). Clinical studies, which form the basis of this review, have shown ODO and SOT to have similar efficacy and tolerability profiles. However, ODO appears to have a number of advantages over SOT in terms of adherence, patient preference, and reduction in nursing burden. Overall, the existing clinical data suggests that compared to SOT, ODO is not only well-suited for difficult-to-treat, agitated, and/or nonadherent patients but, due to its potential ability to improve adherence and greater patient preference, may also be an appropriate formulation for the majority of patients for which olanzapine is the antipsychotic of choice.
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Affiliation(s)
- William Montgomery
- Global Health Outcomes, Eli Lilly and Company, Sydney, Australia
- Correspondence: William Montgomery, Eli Lilly Australia, 112 Wharf Road, West Ryde, NSW 2114, Australia, Tel +61 2 9325 4335, Fax +61 2 9325 4334, Email
| | - Tamas Treuer
- Emerging Markets Business Unit (Neuroscience), Eli Lilly and Company, Budapest, Hungary
| | | | | | - Gavan Harrison
- Asia-Pacific Medical Communications, Eli Lilly and Company, Sydney, Australia
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16
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Kelin K, Lambert TJR, Brnabic AJM, Newton R, Ye W, Escamilla RI, Chen KP, Don L, Montgomery W, Karagianis J, Ascher-Svanum H. Treatment discontinuation and clinical outcomes in the 1-year naturalistic treatment of patients with schizophrenia at risk of treatment nonadherence. Patient Prefer Adherence 2011; 5:213-22. [PMID: 21660103 PMCID: PMC3105874 DOI: 10.2147/ppa.s16800] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study aimed to improve physicians' understanding of the treatment circumstances and needs of outpatients with schizophrenia at risk of nonadherence, by naturalistically assessing antipsychotic treatment patterns, clinical outcomes, and health care service use in this little-studied patient population. METHODS In this one-year, prospective, multicenter, noninterventional, observational study, patients considered at risk of nonadherence by their physicians were switched from their primary oral antipsychotic to another oral or a depot antipsychotic at study entry. All cause treatment discontinuation (antipsychotic switch, augmentation, or discontinuation) during the study was assessed using Kaplan-Meier survival analyses and descriptive statistics. Patients' illness severity, quality of life, attitude towards medication, patient-reported adherence, and health care resource utilization were assessed during the study. RESULTS Of the 406 enrolled patients, 43 (10.6%) were switched to depot and 363 (89.4%) were switched to oral antipsychotics at study entry. During the study, 99 (24.4%) patients switched, augmented, or discontinued their antipsychotic (all cause treatment discontinuation). Of the 99 patients who switched, augmented, or discontinued their antipsychotic, 8 (18.6%) were taking depot and 91 (25.0%) were taking oral antipsychotics. These patients were switched to either depot (n = 15) or oral (n = 78) antipsychotics, or discontinued their antipsychotic medication (n = 6). Inadequate response was the most frequently reported reason for medication discontinuation. During the study, patients' clinical and functional status improved significantly and service use was low. Most patients considered themselves to be adherent at study entry, and this favorable self-perception increased during the study (from 68.5% to 88.1%). CONCLUSION Although identified as at risk of nonadherence, few patients in this naturalistic study discontinued their prescribed antipsychotic medication during the study. The discrepancy between the physicians' perception of their patient's medication adherence and the patients' self-perceived adherence highlights the need to better understand the underlying reasons for this phenomenon.
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Affiliation(s)
| | - Timothy JR Lambert
- Discipline of Psychiatry, Brain and Mind Research Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Alan JM Brnabic
- Intercontinental Information Sciences, Eli Lilly Australia Pty Ltd, Macquarie Park, NSW, Australia
| | - Richard Newton
- Peninsula Health Psychiatric Services, Frankston Hospital, Frankston, VIC, Australia (current affiliation: Department of Psychiatry, Austin Hospital, Heidelberg, VIC, Australia)
| | - Wendy Ye
- Intercontinental Information Sciences, Eli Lilly Australia Pty Ltd, Macquarie Park, NSW, Australia
| | - Raúl I Escamilla
- Schizophrenia Clinic, National Institute of Psychiatry, Mexico City, Mexico
| | - Kuang-Peng Chen
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin, Taiwan
| | - Liana Don
- Department of Psychiatry, University of Medicine Iuliu Hatieganu Cluj Napoca, Romania
| | | | | | - Haya Ascher-Svanum
- Global Health Outcomes, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
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Brown CH, Bennett ME, Li L, Bellack AS. Predictors of initiation and engagement in substance abuse treatment among individuals with co-occurring serious mental illness and substance use disorders. Addict Behav 2011; 36:439-47. [PMID: 21196081 DOI: 10.1016/j.addbeh.2010.12.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 11/18/2010] [Accepted: 12/05/2010] [Indexed: 10/18/2022]
Abstract
Research has documented the significant challenges of engaging individuals with comorbid serious mental illness (SMI) and substance use disorders (SUDs) in substance abuse treatment. To date it is unclear which factors predict treatment initiation and engagement in this group of individuals with SUDs. In this study we conducted two analyses using data from a randomized trial of substance abuse treatment in outpatients with SMI: the first examining predictors (collected during screening) of completing an initial intake assessment and the second examining predictors (collected during the intake assessment) of becoming engaged in treatment. Results indicated that males and those with schizophrenia spectrum diagnoses were less likely to complete the intake assessment. Participants who reported more positive feelings about their family were more likely to engage in substance abuse treatment. Participants who were recently arrested were less likely to engage in treatment. Those who met criteria for current drug dependence were less likely to engage in treatment. Overall, these findings are a useful step in determining factors that predict substance abuse treatment initiation and engagement in individuals with SMI and SUDs.
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TAMAJI A, SAKAI A, SATO M, IKEMA Y, MATSUZAKI K, TABUSE H, NODA Y. Development of Clinical Pharmacy Services to Improve Drug Adherence in Psychiatric Hospital Patients. YAKUGAKU ZASSHI 2010; 130:1565-72. [DOI: 10.1248/yakushi.130.1565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ai TAMAJI
- Division of Clinical Science and Neuropsychopharmacology, Graduate School of Pharmaceutical Sciences, Meijo University
- Department of Pharmacy, Holly Cross Hospital
| | - Akira SAKAI
- Department of Pharmacy, Holly Cross Hospital
| | - Motoko SATO
- Department of Pharmacy, Holly Cross Hospital
| | | | | | | | - Yukihiro NODA
- Division of Clinical Science and Neuropsychopharmacology, Graduate School of Pharmaceutical Sciences, Meijo University
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19
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Glazer WM, Byerly MJ. Tactics and technologies to manage nonadherence in patients with schizophrenia. Curr Psychiatry Rep 2008; 10:359-69. [PMID: 18627676 DOI: 10.1007/s11920-008-0057-7] [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: 02/04/2023]
Abstract
The occurrence of treatment nonadherence among patients with schizophrenia is clinically significant. However, studies show that clinicians do not make systematic efforts to identify and monitor it over time. This paper reviews the various tactics for identifying and monitoring adherence behavior. A comprehensive review of published studies comparing typical and atypical antipsychotics in terms of medication adherence yields mixed results at best. Changing forces in the delivery of health care in the United States will promote efforts to improve the recognition of nonadherence in patients with schizophrenia and develop strategies and tactics to decrease the current rates of nonadherence. Such tactics are described in this paper, and emerging best practices are identified. Ultimately, if nonadherence rates are to decrease, it will be necessary to align the incentives of the treater and the treated.
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Affiliation(s)
- William M Glazer
- Glazer Medical Solutions, 8 Nassau Lane, Key West, FL 33040, USA.
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20
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Rummel-Kluge C, Pitschel-Walz G, Bäuml J, Kissling W. Psychoeducation in schizophrenia--results of a survey of all psychiatric institutions in Germany, Austria, and Switzerland. Schizophr Bull 2006; 32:765-75. [PMID: 16844723 PMCID: PMC2632267 DOI: 10.1093/schbul/sbl006] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Psychoeducation can reduce rehospitalization rates and mental health costs in schizophrenia. The aims of this study were to investigate the percentage of patients and family members participating in psychoeducation in the year 2003 and to evaluate how psychoeducation was conducted. METHODS Part I of a 2-part postal survey was sent to the heads of all psychiatric institutions in Germany, Austria, and Switzerland; part II was sent directly to the moderators of psychoeducational groups. Responses were analyzed using descriptive statistics. RESULTS Psychoeducation was offered in 86% of the responding institutions and in 84% of these for schizophrenia (response quotas: part I, 54%; part II, 55%). A mean of 21% of the patients with schizophrenia and 2% of their family members had taken part in psychoeducation in the responding institutions in the year 2003. DISCUSSION Many readmissions and thus significant costs to the health system and substantial human suffering could be avoided if more patients and their family members participated in psychoeducation. New approaches to offering more psychoeducation would consist in integration of the entire psychiatric team into psychoeducation and peer-to-peer strategies.
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Affiliation(s)
- Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar der Technischen Universität München, Möhlstrasse 26, 81675 München, Germany.
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21
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Pratt SI, Mueser KT, Driscoll M, Wolfe R, Bartels SJ. Medication nonadherence in older people with serious mental illness: prevalence and correlates. Psychiatr Rehabil J 2006; 29:299-310. [PMID: 16689041 DOI: 10.2975/29.2006.299.310] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medication nonadherence in people with schizophrenia and other serious mental illnesses (SMI) is multidetermined and has been consistently associated with relapse and rehospitalization, but little is known about the prevalence and correlates of nonadherence in older people with SMI. This study evaluated the interrelationships between different measures of medication adherence (including pill counts, self-report, informant report, and attitudes toward medications), and their associations with demographic characteristics, and clinical, functional, skill, and cognitive measures in a group of 72 older people with SMI living in the community. Pill counts of adherence to psychotropic medications were highly correlated with pill counts for nonpsychiatric medications. However, pill counts were weakly correlated with self-report and informant ratings, which tended to overestimate adherence. Lower medication adherence was associated with: mood disorder (compared to schizophrenia), lack of supervision, fewer prescription medications, less insight, more severe negative symptoms, and worse community functioning. Among individuals with little or no supervision of their medications, higher adherence was related to better performance on the Medication Management Administration Assessment (MMAA) role-play, which was highly correlated with several domains of cognitive functioning, suggesting that the MMAA may be a more ecologically valid measure of cognitive functioning related to medication adherence. This study highlights the importance of using multiple measures for the assessment of medication adherence in older people with SMI, including pill counts, and suggests that interventions are needed to improve adherence in this population.
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Affiliation(s)
- Sarah I Pratt
- Dartmouth Medical School NH, Dartmouth Psychiatric Research Center, NH 03301, USA.
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22
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Abstract
Psychiatric rehabilitation services are primarily delivered using group modalities. Recent evidence points to the deleterious effects of poor cognitive functioning on group involvement, skill development and functional outcomes. This paper reviews the impact of individual cognitive deficits on group functioning, discusses the rationale for using a cognitive framework for group development, and presents multiple examples of group programming with compensatory and remediation techniques to improve group functioning. Examples include modifying groups to address cognitive limitations, as well as developing groups targeting specific cognitive functions. The groups described are suitable for persons with serious and persistent mental illness across hospital and community treatment settings.
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Affiliation(s)
- Nadine Revheim
- Program in Cognitive Neuroscience and Schizophrenia, Nathan S Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA.
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23
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Masand PS. A review of pharmacologic strategies for switching to atypical antipsychotics. Prim Care Companion CNS Disord 2005; 7:121-9. [PMID: 16027767 PMCID: PMC1163273 DOI: 10.4088/pcc.v07n0309] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2004] [Accepted: 04/07/2005] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND In daily clinical practice, frequent switching of antipsychotic medications is widespread. There are various reasons for switching, including a partial or complete lack of efficacy, adverse side effects, and partial or noncompliance with medication. Patients switched from conventional drugs to oral atypical antipsychotic drugs have been shown to benefit from significant improvements in clinical response and tolerability. This review examines the strategies for switching patients from conventional antipsychotic drugs to both oral and long-acting formulations of atypical antipsychotic drugs that are the recommended treatment in the majority of patients with schizophrenia. DATA SOURCES AND STUDY SELECTION An electronic literature search of relevant studies using MEDLINE (January 1994-June 2004) was performed using the search terms antipsychotic, atypical, conventional, schizophrenia, and switching. English-language articles, references from bibliographies of reviews, original research articles, and other articles of interest were reviewed. DATA EXTRACTION AND SYNTHESIS Data quality was determined by publication in the peer-reviewed literature and the most important information identified. Data from clinical trials suggest that switching to an atypical antipsychotic drug is beneficial for the patient with schizophrenia. CONCLUSIONS If initiated appropriately, switching to atypical antipsychotic medications should not compromise patient functioning; indeed, individualized strategies have been shown to provide continuous treatment efficacy. Switching to atypical antipsychotic therapy should, therefore, be employed as a pharmacologic strategy to maximize patient outcomes.
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Abstract
The elderly are at increased risk for psychosis because of age-related deterioration of cortical areas and neurochemical changes, comorbid physical illnesses, social isolation, sensory deficits and polypharmacy. The prevalence of psychiatric and neuropsychiatric disorders requiring treatment with an antipsychotic agent is expected to increase dramatically among people aged >64 years. Antipsychotic agents are effective in the treatment of schizophrenia, schizoaffective disorder, behavioural symptoms in patients with dementia, and mood disorders with psychosis. However, failure to adhere to a prescribed medication regimen by patients with psychosis is one of the most frustrating problems faced by mental healthcare providers, because of the high risk of relapse associated with partial compliance. For patients with psychosis who will not or cannot take oral medications on a regular daily basis or have other characteristics, such as memory, vision or auditory impairment, which contribute to partial compliance, long-acting injectable antipsychotic medication offers a solution. Older patients are especially at risk of adverse effects associated with traditional antipsychotic agents, such as motor effects, postural hypotension, excessive sedation, and anticholinergic effects because of age-related pharmacokinetic and pharmacodynamic factors, coexisting medical illnesses and concomitant medications. Therefore, drug dosage recommendations in the elderly are much more conservative than in younger patients. The appropriate starting dose of an antipsychotic in older individuals is 25% of the usual adult dose; total daily maintenance doses ranges from 25-50% of the adult dose. There are few studies regarding the use of depot antipsychotics in elderly patients. Studies that are available indicate that traditional antipsychotic agents given as depot injections are associated with positive outcomes in the elderly. Because the risks for extrapyramidal symptoms and tardive dyskinesia are reduced dramatically with atypical antipsychotics compared with traditional agents, the development of long-acting atypical antipsychotic formulations has been pursued. Of the atypical antipsychotics, risperidone is the first agent to be approved in a long-acting injectable formulation. Unpublished clinical data have revealed that patients treated with long-acting injectable risperidone (25mg, 50mg or 75mg) are more likely to show significant clinical improvement than placebo. In addition, hospitalisation rates decreased continuously and significantly during 1 year of treatment for patients who received long-acting injectable risperidone.Long-acting injectable antipsychotic medication should be considered for older patients for whom long-term treatment is indicated. The choice of which drug to use should be based on patients' history of response and personal preference, clinician's previous experience and pharmacokinetic properties.
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Affiliation(s)
- Prakash S Masand
- Program for Continuing Medical Education, Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA.
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25
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Rüsch N, Corrigan PW. Motivational interviewing to improve insight and treatment adherence in schizophrenia. Psychiatr Rehabil J 2002; 26:23-32. [PMID: 12171279 DOI: 10.2975/26.2002.23.32] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Poor insight and low treatment adherence are common features among persons with schizophrenia that are often related to poor outcome. While insight is a multidimensional phenomenon, common measures of insight have shortcomings and do not include all items relevant for insight and compliance. Different causes of poor insight and compliance such as neurocognitive deficits and psychological coping mechanisms are considered and also the role of awareness in the context of health behavior theory and the stages of change-model. Motivational Interviewing can, with specific modifications for persons with schizophrenia, successfully increase their insight and compliance, because it allows them to explore their own goals and to take a more active role in treatment.
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Affiliation(s)
- Nicolas Rüsch
- Department of Psychiatry, University of Freiburg, Germany.
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26
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Abstract
The health goals of persons with serious mental illness are greatly improved when their personal power is advanced. Two targets of empowerment are discussed in this paper: treatment partnerships and community opportunities. Strategies that enhance treatment partnerships include provider endorsement of recovery rather than promoting an approach that suggests poor prognoses, treatment plans that are collaborative rather than unilateral decision making that is perceived as coercive, and treatment services provided in the person's community rather than geographically or psychological distant institutions. Approaches that focus on the person and treatment relationship are not sufficient however. Stigma and discrimination are significant barriers to the kind of community opportunities that are necessary to help people attain life goals. Communities that substitute stigmatizing attitudes and discriminatory behaviors with realistic views of mental illness are more likely to provide the kind of reasonable accommodations that some people need for work and independent living opportunities.
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Affiliation(s)
- Patrick W Corrigan
- University of Chicago, Center for Psychiatric Rehabilitation, 7230 Arbor Drive, Tinley Park, IL 60477, USA.
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27
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Leo RJ, Regno PD. Atypical Antipsychotic Use in the Treatment of Psychosis in Primary Care. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2000; 2:194-204. [PMID: 15014629 PMCID: PMC181141 DOI: 10.4088/pcc.v02n0601] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2000] [Accepted: 10/14/2000] [Indexed: 10/20/2022]
Abstract
Atypical antipsychotics are a class of novel agents increasingly employed for the treatment of psychotic disorders. The pharmacodynamic properties of the atypicals appear to impact a broader spectrum of psychotic symptoms than had been appreciated with older generation antipsychotics. In addition, the atypical agents appear to have a reduced risk of neurologic side effects compared with conventional antipsychotic use. Both of these features enhance the appeal of the atypical antipsychotics and may be associated with enhanced patient compliance. The atypical antipsychotics appear to be effective for schizophrenia as well as other psychotic disorders, including schizoaffective disorder and mood disorders with psychotic features. Consequently, atypical antipsychotics are now considered to be the first-line treatment for schizophrenia, with the exception of clozapine, which is considered a second-line agent because of risks associated with its use. This review will discuss the literature on atypical antipsychotic efficacy in psychotic disorders. Issues related to antipsychotic use, dosing, adverse effects, and drug interactions are also discussed.
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Affiliation(s)
- Raphael J. Leo
- Department of Psychiatry, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, Buffalo
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28
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Rafal S, Tsuang MT, Carpenter WT. A dilemma born of progress: switching from clozapine to a newer antipsychotic. Am J Psychiatry 1999; 156:1086-90. [PMID: 10401457 DOI: 10.1176/ajp.156.7.1086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Rafal
- Department of Psychiatry, Massachusetts Mental Health Center, Harvard Medical School, Boston 02115, USA
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29
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Segal SP, Bola JR, Watson MA. Race, quality of care, and antipsychotic prescribing practices in psychiatric emergency services. Psychiatr Serv 1996; 47:282-6. [PMID: 8820552 PMCID: PMC7306413 DOI: 10.1176/ps.47.3.282] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The study examined whether the prescription practices of clinicians in psychiatric emergency services differed for African-American patients. Prescription of antipsychotic medications and its relation to quality of care was a particular focus. METHODS Data from 442 independently observed evaluations of patients in psychiatric emergency services were examined using multivariate analyses. The observations were made during a five-year period at four urban general hospitals in California. RESULTS Clinicians in the four emergency services, most of whom were Caucasian, prescribed more psychiatric medications to African Americans than to other patients and devoted significantly less time to their evaluations. African Americans received more oral doses and more injections of antipsychotic medications, and the mean 24-hour dosage of antipsychotics (1,321 milligrams) was significantly higher than for other patients (825 milligrams). The tendency to overmedicate African-American patients was lower when clinicians' efforts to engage the patients in treatment were rated higher. CONCLUSIONS The results highlight the importance of efforts to engage African Americans in the treatment process and the need for clinical skills and training to help bridge cultural distances.
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Affiliation(s)
- S P Segal
- Mental Health and Social Welfare Research Group, University of California, Berkeley 94720, USA
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Kemp R, Hayward P, Applewhaite G, Everitt B, David A. Compliance therapy in psychotic patients: randomised controlled trial. BMJ (CLINICAL RESEARCH ED.) 1996; 312:345-9. [PMID: 8611831 PMCID: PMC2350295 DOI: 10.1136/bmj.312.7027.345] [Citation(s) in RCA: 421] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine whether compliance therapy, a cognitive-behavioural intervention, could improve compliance with treatment and hence social adjustment in acutely psychotic inpatients, and if so, whether the effect persisted six months later. DESIGN Randomised controlled trial of compliance therapy and non-specific counselling, each comprising 4-6 sessions lasting 10-60 minutes. SETTING Acute psychiatric admissions ward serving an inner London catchment area. SUBJECTS 47 patients with psychosis. MAIN OUTCOME MEASURES Informant and observer reported measure of compliance; observer assessed global functioning after intervention and three and six months later; self-rated attitudes to drug treatment after the intervention and one month later; symptom scores after intervention and six months later. RESULTS 25 patients received compliance therapy and showed significantly greater improvements in their attitudes to drug treatment and in their insight into illness and compliance with treatment compared with the control group. These gains persisted for six months. The intervention group was 5.2 times more likely than the control group to reach a criterion level of compliance (95% confidence interval 1.5 to 18.3). Global functioning showed a tendency to improve more in the intervention group after a delay (odds ratio 3.0 (0.8 to 11.5) to reach the criterion level at six months). Four subjects given compliance therapy and six in the control group were readmitted during follow up (odds ratio 2.0 (0.48 to 8.2)). CONCLUSIONS Compliance therapy is a pragmatic method for improving compliance with drug treatment in psychotic inpatients and its gains persist for at least six months. Overall functioning may also be enhanced.
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Affiliation(s)
- R Kemp
- Department of Psychological Medicine, King's College Hospital, London
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Abstract
1. There is a strong correlation between medication noncompliance and higher rates of illness relapse. The causes of noncompliance include side effects, knowledge deficits, and patient/therapist relationships. 2. The nurse's ongoing assessment and understanding of the patients' reasons for treatment resistance is the key to promoting medication compliance. 3. Because compliance requires patients' complete understanding of their illness and their need for medication treatment, patient education is the initial intervention in promoting medication adherence. 4. The patient must no longer be viewed as the guilty party. The promotion of medication compliance must be the responsibility of both the health care professional and the patient.
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Affiliation(s)
- L Forman
- Southern Winds Hospital, Miami, FL
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Hale T. Will the new antipsychotics improve the treatment of schizophrenia? BMJ (CLINICAL RESEARCH ED.) 1993; 307:749-50. [PMID: 8106051 PMCID: PMC1696416 DOI: 10.1136/bmj.307.6907.749-a] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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