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Ishigooka J, Nakagome K, Ohmori T, Iwata N, Inada K, Iga JI, Kishi T, Fujita K, Kikuchi Y, Shichijo T, Tabuse H, Koretsune S, Terada H, Terada H, Kishimoto T, Tsutsumi Y, Kanda Y, Ohi K, Sekiyama K. Discontinuation and remission rates and social functioning in patients with schizophrenia receiving second-generation antipsychotics: 52-week evaluation of JUMPs, a randomized, open-label study. Psychiatry Clin Neurosci 2022; 76:22-31. [PMID: 34626144 PMCID: PMC9299006 DOI: 10.1111/pcn.13304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/01/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
AIM Globally, evidence from short-term studies is insufficient for the guidelines to uniformly recommend a particular antipsychotic(s) for the maintenance treatment of schizophrenia. Therefore, long-term comprehensive evaluation of antipsychotics is required from a social rehabilitation perspective, especially for drugs that have not yet been studied. The Japan Useful Medication Program for Schizophrenia (JUMPs) is a large-scale, long-term naturalistic study to present pivotal 52-week data on the continuity of second-generation antipsychotics (SGA: aripiprazole, blonanserin, and paliperidone). METHODS JUMPs was an open-label, three-arm, randomized, parallel-group, 52-week study. Enrolled patients had schizophrenia, were ≥20 years old, and required antipsychotic treatment or switched from previous therapy. The primary endpoint was treatment discontinuation rate over 52 weeks. Secondary outcomes included remission rate, social functioning, and quality-of-life scores [Personal and Social Performance Scale (PSP) and EuroQol-5 dimensions], and safety. RESULTS In total, 251 patients received aripiprazole (n = 82), blonanserin (n = 85), or paliperidone (n = 84). The discontinuation rate (P = 0.9771) and remission rates (P > 0.05) over 52 weeks did not differ significantly between the three treatment groups. The discontinuation rates were 68.3%, 68.2%, and 65.5% in the aripiprazole, blonanserin, and paliperidone groups, respectively. Significant improvements (all P < 0.05) from baseline in PSP scores were observed at start of monotherapy, week 26, and week 52 in the overall cohort and blonanserin group and at week 26 in the aripiprazole group. The adverse event profile favored blonanserin. CONCLUSION All three SGAs evaluated in this study showed similar treatment discontinuation rates in patients with chronic schizophrenia in Japan.
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Affiliation(s)
- Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan
| | - Kazuyuki Nakagome
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake-shi, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan
| | - Jun-Ichi Iga
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake-shi, Japan
| | - Kiyoshi Fujita
- Okehazama Hospital Fujita Kokoro Care Center, Toyoake-shi, Japan
| | - Yuka Kikuchi
- Department of Psychiatry, Akita University Hospital, Akita, Japan
| | | | - Hideaki Tabuse
- Department of Psychiatry, Holy Cross Hospital, Toki-shi, Japan
| | | | | | | | | | | | - Yoshiki Kanda
- Musashikoganei Minamiguchi Shinryou Clinic, Koganei-shi, Japan
| | - Kazutaka Ohi
- Department of Neuropsychiatry, Kokubu Hospital, Osaka, Japan
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Rago A, Pezzullo E, Malvezzi Caracciolo d'Aquino M, Scognamiglio G, Caso VM, Martone F, Attena E, Parisi V, D'Onofrio A, Golino P, Nigro G, Russo V. Non Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients Scheduled for Electrical Cardioversion: A Real-Life Propensity Score Matched Study. J Blood Med 2021; 12:413-420. [PMID: 34113202 PMCID: PMC8187032 DOI: 10.2147/jbm.s299265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Aim The aim of the present study was to assess the safety and effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients undergoing electrical cardioversion (EC). Methods A propensity score-matched analysis was performed in order to identify two homogeneous groups including AF patients on NOACs and VKAs treatment scheduled for EC. The primary safety endpoint was major bleeding. The composite of stroke, transient ischemic attack (TIA) and systemic embolism (SE) was the primary effectiveness endpoint. The discontinuation rate of anticoagulant therapy was assessed. Results A total of 495 AF patients on NOACs therapy and scheduled for EC were compared to 495 VKAs recipients. No statistically significant differences in the incidence of both major bleeding (1.01% versus 1.4%; P= 0.5) and thromboembolic events (0.6% versus 0.8%; P= 0.7) were observed during a mean follow-up of 15 ± 3 months. The discontinuation rate of NOACs was significantly lower compared to VKAs (1.6% versus 3.6%, P=0.04). Conclusion We showed a safe and effective clinical profile of NOACs among AF patients scheduled for electrical cardioversion in real-life setting. Patients on NOACs therapy showed a lower discontinuation rate compared to those on VKAs.
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Affiliation(s)
- Anna Rago
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | | | | | | | - Valentina Maria Caso
- Department of Medical Translational Sciences, University of the Study of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Emilio Attena
- Departmental Unit of Electrophysiology, Monaldi Hospital, Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Monaldi Hospital, Naples, Italy
| | - Paolo Golino
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Vincenzo Russo
- Department of Cardiology, Monaldi Hospital, Naples, Italy
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Alghamdi MA, Amaro CP, Lee-Ying R, Sim HW, Samwi H, Chan KK, Knox JJ, Ko YJ, Swiha M, Batuyong E, Romagnino A, Cheung WY, Tam VC. Effect of sorafenib starting dose and dose intensity on survival in patients with hepatocellular carcinoma: Results from a Canadian Multicenter Database. Cancer Med 2020; 9:4918-4928. [PMID: 32529797 PMCID: PMC7367626 DOI: 10.1002/cam4.3228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background Sorafenib has been shown to improve survival in patients with advanced hepatocellular carcinoma (HCC), however, full dose can be difficult to tolerate. The aim of this study was to determine whether sorafenib starting dose and mean dose intensity affect survival. Methods Patients treated with sorafenib for HCC from January 2008 to July 2016 in several Canadian provinces were included and retrospectively analyzed. The primary end point was overall survival (OS) of patients starting on sorafenib full dose compared to reduced dose. Secondary analysis compared OS with different mean dose‐intensity groups. Survival outcomes were assessed with Kaplan‐Meier curves and Cox proportional hazards models. A propensity score analysis was performed to account for treatment bias and confounding. Results Of 681 patients included, sorafenib was started at full dose in 289 patients (42%). Median survival for starting full and reduced dose was 9.4 months and 8.9 months (P = .15) respectively. After propensity score matching and adjusting for potential confounders there was still no difference in survival (HR 0.8, 95% CI, 0.61‐1.06, P = .12). Almost half of the patients (45%) received a dose intensity < 50%. Median survival for mean dose intensity > 75%, 50%‐75%, and < 50% were 9.5 months, 12.9 months, and 7.1 months (P = .005) respectively. In multivariable models, starting dose(HR 1.16, 95% CI 0.93‐1.44, P = .180) and mean dose intensity were not associated with survival. Conclusions Starting HCC patients on a reduced dose of sorafenib compared to full dose may not compromise survival. Mean dose‐intensity of sorafenib may also not affect survival.
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Affiliation(s)
- Mohammed A Alghamdi
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.,College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Carla P Amaro
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Richard Lee-Ying
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Hao-Wen Sim
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Haider Samwi
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Kelvin K Chan
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Jennifer J Knox
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Yoo-Joung Ko
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Mina Swiha
- University of Western Ontario, London, ON, Canada.,Menoufia University, Shebin El Kom, Egypt
| | - Eugene Batuyong
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - Winson Y Cheung
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Vincent C Tam
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
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Sun GL, Lei L, Liu L, Liu J, He Y, Guo Z, Dai X, He L, Chen SQ, Liang Y, Ye J, Hu Y, Chen G, Chen JY, Liu Y. Rationale and design of the Web-basEd soCial media tecHnology to improvement in Adherence to dual anTiplatelet Therapy following Drug-Eluting Stent Implantation (WECHAT): protocol for a randomised controlled study. BMJ Open 2020; 10:e033017. [PMID: 31915170 PMCID: PMC6955490 DOI: 10.1136/bmjopen-2019-033017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) is frequently discontinued after drug-eluting stent (DES) implantation, which could increase the risk of major adverse cardiovascular events (MACEs). Few studies have attempted to improve DAPT adherence through web-based social media. OBJECTIVE To explore the effect of social media on DAPT adherence following DES implantation. METHODS/DESIGN The WeChat trial is a multicentre, single-blind, randomised study (1:1). It will recruit 760 patients with DES who require 12 months of DAPT. The control group will only receive usual care and general educational messages on medical knowledge. The intervention group will receive a personalised intervention, including interactive responses and medication and follow-up reminders beyond the general educational messages. The primary endpoint will be the discontinuation rate which is defined as the cessation of any dual antiplatelet drug owing to the participants' discretion within 1 year of DES implantation. The secondary endpoints will include medication adherence and MACEs. Both groups will receive messages or reminders four times a week with follow-ups over 12 months. ETHICS AND DISSEMINATION Ethical approval was granted by Ethics Committee of Guangdong Provincial People's Hospital (GDREC2018327H). Results will be disseminated via peer-reviewed publications and presentations at international conferences. TRIAL REGISTRATION NUMBER NCT03732066.
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Affiliation(s)
- Guo-Li Sun
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
| | - Li Lei
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Liwei Liu
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
| | - Yibo He
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
| | - Zhaodong Guo
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
| | - Xiaohua Dai
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou, China
| | - Lihao He
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shi-Qun Chen
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
| | - Yan Liang
- Department of Cardiology, Maoming General Hospital, Guangzhou, China
| | - Jianfeng Ye
- Department of Cardiology, Dongguan People's Hospital, Dongguan, China
| | - Yunzhao Hu
- Department of Cardiology, First People's Hospital, Shunde, China
| | - Guoqin Chen
- Department of Cardiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Teunissen AM, Merry AHH, Devies IEC, Roumen FJME. Differences in continuation rates and early removal between contraceptive and therapeutic use of the levonorgestrel-releasing intrauterine system 52 mg. EUR J CONTRACEP REPR 2019; 24:449-456. [PMID: 31696740 DOI: 10.1080/13625187.2019.1682134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To investigate differences in continuation rates between contraceptive and therapeutic use of the levonorgestrel-releasing intrauterine system 52 mg (LNG-IUS) and factors associated with early removal.Methods: Study design: Retrospective consecutive cohort design.Cohort: Women with the insertion of the LNG-IUS for contraceptive or therapeutic use from 1 January 2006 through 1 January 2009 at the Zuyderland Medical Centre, The Netherlands, with a follow-up of 5 years. The continuation period and reasons of early removal were noted. Univariable and multivariable analysis were performed.Results: Follow-up was possible in 2481 women, 1855 (74.8%) in the contraception group, and 626 (25.2%) in the therapy group. Multivariable Cox proportional hazards models showed, that therapeutic use was associated with an increased risk of early removal of the LNG-IUS (HR 1.23; 95% CI 1.08-1.41), as was having one child (HR 1.20; 95% CI 1.04-1.38), and a decreased risk with advancing age (HR 0.96; 95% CI 0.95-0.97). In both groups, an unacceptable bleeding pattern and adverse events were the main reasons of early removal, resulting in very low continuation rates over the years.Conclusion: Therapeutic use, having one child and a younger age are independent risk factors of early removal of the LNG-IUS, in contrast with previous LNG-IUS use which is associated with a lower risk. In both the contraception group and the therapy group, the main reasons for LNG-IUS discontinuation are continuation with a new LNG-IUS, and no more need for an LNG-IUS (for contraception or therapy). An unacceptable bleeding pattern or adverse events are associated with the lowest continuation rates in both groups.
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Affiliation(s)
- Anna M Teunissen
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, The Netherlands
| | - Audrey H H Merry
- Zuyderland Medical Centre, Zuyderland Academy, Heerlen/Sittard-Geleen, The Netherlands
| | - Ingrid E C Devies
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, The Netherlands
| | - Frans J M E Roumen
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, The Netherlands
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Gentile S. Discontinuation rates during long-term, second-generation antipsychotic long-acting injection treatment: A systematic review. Psychiatry Clin Neurosci 2019; 73:216-230. [PMID: 30687998 DOI: 10.1111/pcn.12824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/07/2019] [Accepted: 01/16/2019] [Indexed: 12/11/2022]
Abstract
AIM The aim of this review was to analyze the discontinuation rates during long-term treatment with second-generation antipsychotic long-acting injection (SGA-LAI) in adults with either schizophrenia spectrum or bipolar disorders. METHODS A systematic search (PubMed, Scopus, and the Cochrane Library) of studies published in English (1 January 2001-12 October 2018) identified 1214 abstracts, which were analyzed independently by the author and two colleagues. Studies were retrieved and reviewed if they reported primary data on the discontinuation rate before the study end during treatment lasting ≥36 weeks. Data were extracted from 51 articles meeting the inclusion criteria. RESULTS In all head-to-head comparisons, and studies on patients with schizophrenia spectrum or bipolar disorders, the discontinuation rate before the study end in patients treated with SGA-LAI was, at best, similar to that recorded in patients treated with first-generation antipsychotics in either oral or LAI formulations or with oral SGA. In particular, in most of the SGA-LAI long-term studies, the rate of premature dropout was higher than 50%. CONCLUSION Reviewed data suggest that SGA-LAI show no clear superiority over less expensive drugs (including first-generation antipsychotic LAI and oral antipsychotic formulations) in reducing the risk of premature antipsychotic discontinuation. Thus, alternative strategies should be considered to improve medication persistence and lower discontinuation rates in patients with severe psychiatric disorders. Planning tailored, individualized, and integrated approaches (including frequent clinical evaluations, and behavioral or other flexible techniques adaptable to different settings and patients) may be an effective intervention for improving patient adherence in long-term pharmacological treatment regimens.
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Oze T, Hiramatsu N, Yakushijin T, Yamada R, Harada N, Morishita N, Oshita M, Mita E, Ito T, Inui Y, Inada M, Tamura S, Yoshihara H, Imai Y, Kato M, Miyagi T, Yoshida Y, Tatsumi T, Kasahara A, Hayashi N, Takehara T. The real impact of telaprevir dosage on the antiviral and side effects of telaprevir, pegylated interferon and ribavirin therapy for chronic hepatitis C patients with HCV genotype 1. J Viral Hepat 2015; 22:254-62. [PMID: 25081140 DOI: 10.1111/jvh.12289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 05/14/2014] [Indexed: 01/28/2023]
Abstract
Triple therapy with telaprevir, pegylated interferon and ribavirin has been reported to improve antiviral efficacy but have potentially severe adverse effects in patients with chronic hepatitis C. To avoid the severe effects of telaprevir, lowering the dose has been suggested. However, impact of dosage changes on antiviral and adverse effects remains unclear. One hundred and sixty-six Japanese patients with HCV genotype 1 were treated with triple therapy. The drug exposure of each medication was calculated by averaging the dose actually taken. The overall SVR rate was 82%. The telaprevir discontinuation rate was 26%. The factors associated with discontinuation were an older age (≥65 y.o.) and a higher average dose during treatment. The telaprevir discontinuation rates were 42%, 25% and 14% in patients at ≥35, 25-35 and <25 mg/kg/day of telaprevir and 58% in older patients at ≥35 mg/kg/day of TVR. The factors associated with SVR were treatment-naïve, relapse to previous treatment, higher average telaprevir dose during treatment and completion of treatment. The SVR rate was higher, at 91%, in patients at 25-35 mg/kg/day of telaprevir than the 71% and 78% observed in those at <25 and ≥35 mg/kg/day of drug. In Japanese patients, a mean telaprevir dose of 25-35 mg/kg/day during treatment can augment its efficacy in triple therapy for patients with HCV genotype 1.
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Affiliation(s)
- T Oze
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Chen M, Wu G, Wang Z, Yan J, Zhou J, Ding Y, Jiang Y, Rao S, Zhou Q, Ni H, Zhao J, Su Y, Hu J, Zhang Y, Yi Z, Yang W, Song L. Two-year prospective case-controlled study of a case management program for community-dwelling individuals with schizophrenia. Shanghai Arch Psychiatry 2014; 26:119-28. [PMID: 25114486 PMCID: PMC4118008 DOI: 10.3969/j.issn.1002-0829.2014.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 04/08/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND A community-based rehabilitation program is an essential element of the comprehensive treatment of individuals with schizophrenia. OBJECTIVE Assess the long-term effects of a community-based case management program for providing rehabilitations services to individuals with schizophrenia. METHODS A total of 730 community-residing participants who met ICD-10 diagnostic criteriafor schizophrenia were enrolled, 380 in the case management group and 350 in the control group from two districts in Shanghai. Case management involved monthly training visits with patients and their co-resident family members that focused on encouraging medication adherence. Participants were assessed every three months for 24 months with the Camberwell Assessment of Need (CAN), Positive and Negative Syndrome Scale (PANSS), WHO-Disability Assessment Scale (WHO-DAS), and the Quality of Life Scale (QOLS). Level of discomfort due to side-effects was also assessed every three months. Individuals who discontinued their antipsychotic medication without physician approval for one month or longer at any time during follow-up were classified as 'self-determined medication discontinuation'. RESULTS Compared to the treatment as usual group (i.e., follow-up management every 3 months), by the end of the two-year follow-up those who participated in the case management program had significantly lower rates of medication discontinuation, significantly less severe negative symptoms, lower relapse rates and lower rehospitalization rates. Other factors that had an independent effect on discontinuation of medication included educational level (those with more education had higher discontinuation rates), lack of family supervision of medication, higher dosages of medication, and greater medication-related discomfort. CONCLUSIONS Case management is a feasible and effective long-term method for improving the rehabilitation outcomes of community residents with schizophrenia. Our results highlight the need to involve family members in the management of patients' medication, to use the minimum effective dosage of medication, and to aggressively manage all side-effects.
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Affiliation(s)
- Meijuan Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guojun Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zuowei Wang
- Hongkou Mental Health Center, Shanghai, China
| | - Jun Yan
- Hongkou Mental Health Center, Shanghai, China
| | | | - Yan Ding
- Hongkou Mental Health Center, Shanghai, China
| | - Yaqin Jiang
- Hongkou Mental Health Center, Shanghai, China
| | | | - Qing Zhou
- Xuhui Mental Health Center, Shanghai, China
| | - Hua Ni
- Xuhui Mental Health Center, Shanghai, China
| | - Jun Zhao
- Xuhui Mental Health Center, Shanghai, China
| | - Yanli Su
- Xuhui Mental Health Center, Shanghai, China
| | - Jun Hu
- Xuhui Mental Health Center, Shanghai, China
| | - Yi Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenghui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weimin Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lisheng Song
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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