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1.
A. Tinland K. Zemmour P. Auquier M. Boucekine V. Girard S. Loubière G. Fond Laurent Boyer French Housing First Study Group 《Social psychiatry and psychiatric epidemiology》2017,52(9):1113-1122
Objective
The aim of this study was to investigate the factors associated with non-adherence to medication in a large multi-center sample of homeless schizophrenia (HSZ) patients.Methods
This multi-center study was conducted in four French cities: Lille, Marseille, Paris, and Toulouse. In addition to the Medication Adherence Rating Scale (MARS), sociodemographic information, history of homelessness, illness severity using the Modified Colorado Symptom Index (MCSI) and the Multnomah Community Integration Scale (MCAS), and drug information were collected.Results
In total, 218 HSZ patients (16.1% women, mean age 36.8 ± 9.3 years) were included in this study. In the multivariate analysis, being a woman and having higher illness severity (MCSI score) and lower “acceptance of illness” (MCAS score) were significantly associated with lower MARS index scores. Compared to men, women had lower MARS dimension 1 (‘medication adherence behavior’) and dimension 3 (‘negative side effects and attitudes toward psychotropic medication’) scores. First-generation antipsychotic use was also associated with lower MARS dimension 3 scores.Conclusion
HSZ women reported lower adherence than men, mainly due to having more subjective negative side effects and worse attitudes toward psychotropic medication. Future longitudinal studies should confirm these findings and explore the applicability of specific pharmacological and non-pharmacological treatment strategies for HSZ women, including treatment dose adaptation and psychoeducation. Clinical trial number NCT01570712.2.
Background
Barriers to HIV medication adherence may differ by levels of dosing schedules.Purpose
The current study examined adherence barriers associated with medication regimen complexity and simplification.Methods
A total of 755 people living with HIV currently taking anti-retroviral therapy were recruited from community services in Atlanta, Georgia. Participants completed audio-computer-assisted self-interviews that assessed demographic and behavioral characteristics, provided their HIV viral load obtained from their health care provider, and completed unannounced phone-based pill counts to monitor medication adherence over 1 month.Results
Participants taking a single-tablet regimen (STR) were more likely to be adherent than those taking multi-tablets in a single-dose regimen (single-dose MTR) and those taking multi-tablets in a multi-dose regimen (multi-dose MTR), with no difference between the latter two. Regarding barriers to adherence, individuals taking STR were least likely to report scheduling issues and confusion as reasons for missing doses, but they were equally likely to report multiple lifestyle and logistical barriers to adherence.Conclusions
Adherence interventions may need tailoring to address barriers that are specific to dosing regimens.3.
4.
Elise Crayton Marion Fahey Mark Ashworth Sarah Jane Besser John Weinman Alison J. Wright 《Annals of behavioral medicine》2017,51(6):833-845
Background
Medications targeting stroke risk factors have shown good efficacy, yet adherence is suboptimal. To improve adherence, its determinants must be understood. To date, no systematic review has mapped identified determinants into the Theoretical Domains Framework (TDF) in order to establish a more complete understanding of medication adherence.Purpose
The aim of this study was to identify psychological determinants that most influence stroke survivors’ medication adherence.Methods
In line with the prospectively registered protocol (PROSPERO CRD42015016222), five electronic databases were searched (1953–2015). Hand searches of included full text references were undertaken. Two reviewers conducted screening, data extraction and quality assessment. Determinants were mapped into the TDF.Results
Of 32,825 articles, 12 fulfilled selection criteria (N = 43,984 stroke survivors). Tested determinants mapped into 8/14 TDF domains. Studies were too heterogeneous for meta-analysis. Three TDF domains appeared most influential. Negative emotions (‘Emotions’ domain) such as anxiety and concerns about medications (‘Beliefs about Consequences’ domain) were associated with reduced adherence. Increased adherence was associated with better knowledge of medications (‘Knowledge’ domain) and stronger beliefs about medication necessity (‘Beliefs about Consequences’ domain). Study quality varied, often lacking information on sample size calculations.Conclusions
This review provides foundations for evidence-based intervention design by establishing psychological determinants most influential in stroke survivors’ medication adherence. Six TDF domains do not appear to have been tested, possibly representing gaps in research design. Future research should standardise and clearly report determinant and medication adherence measurement to facilitate meta-analysis. The range of determinants explored should be broadened to enable more complete understanding of stroke survivors’ medication adherence.5.
Sandra Feodor Nilsson Thomas Munk Laursen Carsten Hjorthøj Merete Nordentoft 《Social psychiatry and psychiatric epidemiology》2018,53(1):63-75
Purpose
The purpose of this study was to examine the association between homelessness and psychiatric disorders, including substance use disorders, on one hand, and cause-specific and all-cause mortality on the other in a high-income country.Methods
A historical nationwide register-based cohort study of the Danish population from 15 years of age between 2000 and 2011 was conducted. The association between homelessness, psychiatric disorders, and mortality was analysed by Poisson Regression adjusting for important confounders. Standardised mortality ratios (SMRs) were calculated for people with a history of homelessness compared with the general population using direct age-standardisation.Results
During 51,892,324 person-years of observation, 656,448 died. People with at least one homeless shelter contact accounted for 173,592 person-years with 4345 deaths. The excess mortality in the population experiencing homelessness compared with the general population was reduced by 50% after adjusting for psychiatric diagnoses, including substance use disorders (mortality rate ratio (MRR) for men 3.30, 95% CI 3.18–3.41; women 4.41, 95% CI 4.14–4.71). Full adjustment including physical comorbidity and socioeconomic factors in a sub-cohort aged 15–29 years resulted in an MRR of 3.94 (95% CI 3.10–5.02) compared with the general population. The excess mortality associated with homelessness differed according to psychiatric diagnosis, sex, and cause of death.Conclusions
A mental health or a substance use disorder combined with homelessness considerably increases the risk of death. However, homelessness is also independently associated with high mortality. Differences in the association between homelessness and mortality in men and women suggest the need for sex-tailored interventions.6.
Jorun Rugkåsa Ksenija Yeeles Constantinos Koshiaris Tom Burns 《Social psychiatry and psychiatric epidemiology》2017,52(4):465-472
Purpose
Community Treatment Orders lack evidence of effectiveness. Very little is known about how they are used in practice and over time in terms of what it obliges patients to do and the judicial threshold for remaining on an order.Aims
To investigate CTO implementation in England in terms of the use of specified conditions, and judicial hearings; whether these change over time, and; the level of continued coercion.Method
36-month observational prospective study of patients on CTO in the OCTET follow-up study.Results
The number of CTO conditions remained stable over time but consolidated around medication adherence and remaining in contact with services. Ten percent of Mental Health Tribunal Hearings and only 1 percent of Hospital Managers Hearings resulted in discharge. Twenty-seven percent of patients experienced more than one CTO episode and eighteen percent remained under compulsion until the end of follow-up.Conclusions
CTOs seem to be used primarily to oblige patients to take medication and stay in contact with services. There is agreement between clinical and legal judgements about their appropriateness and threshold for use. A pattern of continuous coercion for a significant group of patients raises concerns. If CTOs are to be continued to be imposed, their use should be carefully monitored with further cohort studies with long-term follow-up.7.
Jennifer A. Pellowski Seth C. Kalichman Sabrina Cherry Christopher Conway-Washington Chauncey Cherry Tamar Grebler Larissa Krug 《Annals of behavioral medicine》2016,50(6):844-853
Background
Limited access to resources can significantly impact health behaviors. Previous research on food insecurity and HIV has focused on establishing the relationship between lacking access to nutritious food and antiretroviral (ARV) medication non-adherence in a variety of social contexts.Purpose
This study aims to determine if several aspects of food insecurity co-occur with missed doses of medication on a daily basis among a sample of people living with HIV who have recently experienced hunger.Methods
The current study utilized a prospective, observational design to test the daily relationship between food insecurity and medication non-adherence. Participants were followed for 45 days and completed daily assessments of food insecurity and alcohol use via interactive text message surveys and electronic medication adherence monitoring using the Wisepill.Results
Fifty-nine men and women living with HIV contributed a total of 2,655 days of data. Results showed that severe food insecurity (i.e., hunger), but not less severe food insecurity (i.e., worrying about having food), significantly predicted missed doses of medication on a daily level. Daily alcohol use moderated this relationship in an unexpected way; when individuals were hungry and drank alcohol on a given day, they were less likely to miss a dose of medication.Conclusions
Among people living with HIV with recent experiences of hunger, this study demonstrates that there is a daily relationship between hunger and non-adherence to antiretroviral therapy. Future research is needed to test interventions designed to directly address the daily relationship between food insecurity and medication non-adherence.8.
Xiaomeng Xu Tricia M. Leahey Katherine Boguszewski Katie Krupel Kimberly A. Mailloux Rena R. Wing 《Annals of behavioral medicine》2017,51(1):13-17
Background
Previous studies have shown that self-expansion (e.g., increasing positive self-content via engaging in novel, rewarding activities) is associated with smoking cessation and attenuated cigarette-cue reactivity.Purpose
This study examined whether self-expansion is associated with better adherence, weight loss, and physical activity (PA) outcomes within a weight loss intervention.Methods
Participants from Shape Up Rhode Island 2012, a Web-based community wellness initiative, took part in a randomized controlled trial that involved a 12-week behavioral weight loss intervention [1]. At baseline and post-intervention, objective weights and self-reported self-expansion and PA were obtained from 239 participants. Treatment adherence was assessed objectively.Results
Self-expansion during treatment was significantly associated with percent weight loss including clinically significant weight loss (i.e., 5 %), minutes of PA, and treatment adherence. These results held after controlling for relevant covariates.Conclusions
This is the first study to show that self-expansion is associated with better behavioral weight loss outcomes including weight loss, adherence, and PA. These results suggest that self-expansion is a promising novel target for future research which could inform health interventions.9.
Background
We examined gender difference in QTc interval distribution and its related factors in people with mental disorders.Methods
We retrospectively reviewed medical charts of patients discharged from a university psychiatric unit between November 1997 and December 2000. Subjects were 328 patients (145 males and 183 females) taking psychotropics at their admission. We examined patient characteristics, medical history, diagnosis, and medication before admission.Results
Mean QTc interval was 0.408 (SD = 0.036). QTc intervals in females were significantly longer than those in males. QTc of females without comorbidity was significantly longer than that of males.Conclusion
The influence of gender difference on QTc prolongation in people with mental disorders merits further research.10.
Background
Postoperative delirium is a topic of great importance in the geriatric surgical specialty. Although antipsychotic drugs are the medications most frequently used to treat this syndrome, these drugs are associated with a variety of adverse events, including sedation, extrapyramidal side effects, and cardiac arrhythmias. Drug treatment for postoperative delirium requires careful consideration of the balance between the effective management of symptoms and potential adverse effects.Methods
We report on a Japanese woman (an 86-year-old (open reduction and internal fixation of the right femoral neck fracture), and two Japanese men (an 86-year-old (abdominal aortic aneurysm stent grafting), and a 77-year-old (right upper lobectomy due to lung tumour)) in which the selective serotonin reuptake inhibitor and sigma-1 receptor agonist fluvoxamine was effective in ameliorating the postoperative delirium of these patients.Results
Delirium Rating Scale scores in these patients dramatically decreased after treatment with fluvoxamine.Conclusions
Doctors should consider fluvoxamine as an alternative approach to treating postoperative delirium in older patients in order to avoid the risk of side effects and increased mortality by antipsychotic drugs.11.
12.
Ludovic Samalin Jean-Baptiste Genty Laurent Boyer Jorge Lopez-Castroman Mocrane Abbar Pierre-Michel Llorca 《Current psychiatry reports》2018,20(4):23
Purpose of Review
This study aims to provide a review of the randomized controlled studies evaluating the effects of shared decision-making (SDM) intervention in comparison to care as usual in patients with mood disorders.Recent Findings
Of the 14 randomized controlled studies identified, only three 6-month studies evaluated the interest of SDM interventions using decision aids in depressed patients. All of them showed that the intervention effectively improved patient satisfaction and engagement in the decision-making process. Only one study in patients with bipolar disorder (BD) showed improvement of depressive symptoms, functioning, and quality of life. Other included studies were collaborative care interventions using a SDM approach in patients with depression in specific populations depending on age, gender, income, and physical comorbidities. All of them showed significant improvement in depression outcomes or medication adherence.Summary
SDM interventions using decision aids and collaborative care showed evidence of improvements in the management of depression. Stronger evidence of SDM interest in BD is needed.13.
Purpose of Review
Pharmacogenomics (PGx) of antipsychotic drug response is an active area of research in the past few years. We reviewed recent PGx studies with an emphasis of development of new methodologies and new research directions.Recent Findings
Traditional candidate gene approach continues to generate evidence to support the associations of antipsychotic response with genes coding for drug targets such as DRD2. Genome-wide association studies have found a few novel genes that may be associated with drug efficacy and adverse events. Recent application of polygenic risk score makes it possible to combine many genetic variants to predict clinical response. Finally, epigenetic research including DNA methylation is emerging and promises new findings that potentially can be applied in clinical practice.Summary
New methodologies may advance PGx closer to clinical application. Multiple genes and epigenomic markers can be used in prediction of clinical phenotypes.14.
Philippe Conus Sue Cotton Benno G. Schimmelmann Patrick D. McGorry Martin Lambert 《Social psychiatry and psychiatric epidemiology》2017,52(9):1089-1099
Objectives
Most first episode psychosis (FEP) outcome studies are based on patient samples enrolled through an informed consent procedure, which may induce important biases. Our aim was to study the 18-month outcome of FEP in an epidemiological sample of patients treated at the Early Psychosis Prevention and Intervention Centre (EPPIC).Methods
The files of 661 FEP patients treated for up to 18 months between 1998 and 2000 were assessed. Symptomatic remission was defined as receiving a score ≤3 on the Clinical Global Impressions (CGI) scales, and functional remission as concurrent fulfillment of occupation/employment and independent living. Predictors were analyzed using stepwise logistic regression models.Results
At endpoint, 63% of FEP patients had reached symptomatic remission and 44% functional remission. Duration of untreated psychosis, baseline symptom intensity, time in service and decrease or remission of substance use, predicted both symptomatic and functional outcome. A history of suicide attempt or non-adherence to medication was linked to lower likelihood to reach symptomatic remission while pre-morbid GAF and employment at baseline were linked to functional outcome.Conclusions
The development of early intervention strategies should be pursued, in order both to provide treatment before symptoms reach a high intensity and to maintain social integration. Specific strategies need to promote engagement, facilitate adherence to medication and to create a framework where key issues such as substance abuse co-morbidity can be addressed.15.
Annie S. K. Jones Justin Fernandez Andrew Grey Keith J. Petrie 《Annals of behavioral medicine》2017,51(6):899-911
Background
Osteoporosis is a degenerative bone disorder that disproportionately affects older women worldwide. Raising awareness regarding osteoporosis within this demographic is significant for health promotion. Initial evidence suggests that visualisations of illness and treatment can improve illness perceptions, increase treatment motivations and even promote health behaviours. We are yet to understand whether different visualisation mediums vary in their impact on perceptions and motivations.Purpose
We investigated whether physical models or virtual animations had a greater impact on changing perceptions of osteoporosis and treatment motivation in an at-risk population of older women.Methods
A total of 128 women aged 50 and over were randomly assigned to view a brief presentation about osteoporosis using either 3-D printed bone models or electronic tablet animations. Illness perceptions, medication beliefs and motivations were measured at baseline and post-presentation. Mixed ANOVAs were used to identify significant changes over time between groups.Results
There were no significant interaction effects, revealing that neither medium had a greater impact on beliefs over time. Significant main effects of time revealed that from baseline to post-presentation, both mediums increased consequence beliefs, personal and treatment control, understanding of osteoporosis, motivations to take treatment if needed and medication necessity beliefs. Timeline beliefs and medication concerns decreased over time for both groups.Conclusions
Both 3-D models and animations of osteoporosis are equally effective in changing beliefs and treatment motivation in an at-risk population. Visualisation devices are brief, cost-effective, have high acceptability and have considerable clinical applicability to promote awareness and prevention.16.
Purpose
In individuals with a comorbid autistic spectrum disorder and medically refractory epilepsy, vagus nerve stimulation may offer the potential of seizure control and a positive behavioral side effect profile. We aimed to examine the behavioral side effect profile using longitudinal and quantitative data and review the potential mechanisms behind behavioral changes.Methods
We present a case report of a 10-year-old boy with autistic spectrum disorder and epilepsy, who underwent vagus nerve stimulation subsequent to unsuccessful treatment with antiepileptic medication.Results
Following vagus nerve stimulation implantation, initial, if temporary, improvement was observed in seizure control. Modest improvements were also observed in behavior and development, improvements which were observed independent of seizure control.Conclusions
Vagus nerve stimulation in autistic spectrum disorder is associated with modest behavioral improvement, with unidentified etiology, although several candidates for this improvement are evident.17.
Background
Children and adolescents with ADHD treated with central stimulants (CS) often have growth deficits, but the implications of such treatment for final height and stature remain unclear.Methods
Weight and height were assessed multiple times in 410 children and adolescents during long-term treatment with CS, which lasted between 0.9 and 16.1 years. Weight and height measures were converted to z-scores based on age- and sex-adjusted population tables.Results
CS treatment was associated with (1) a relative reduction in body weight and a temporary halt in growth, (2) a weight and height lag after 72 months compared with relative baseline values. No relation to early start of medication (<6 years), gender, comorbid ODD/CD or emotional disorders was observed.Conclusions
Treatment with central stimulants for ADHD impacts growth in children and adolescents, and growth should be continuously monitored in patients on chronic treatment with these medications.18.
Dorothy Gotlib Rachel Ramaswamy Jacob E. Kurlander Alana DeRiggi Michelle Riba 《Current psychiatry reports》2017,19(9):58
Purpose of Review
The aim of this paper is to evaluate recent literature on valproic acid (VPA) in women and girls of childbearing age and to emphasize new findings.Recent Findings
Recent research confirms VPAs teratogenicity and risk of hormone disruption. VPA exposure in utero increases the risk for a variety of major congenital malformations (MCMs), reduced IQ and behavioral problems. In girls and women, VPA increases the risk of hormone abnormalities, obesity, and polycystic ovarian syndrome (PCOS). Despite guidelines recommending caution, VPA use continues to be prescribed to reproductive-aged women and girls.Summary
Despite significant and well-documented risk, adherence to guidelines in VPA use in reproductive-aged girls and women remains low.19.
Laura M. Bogart Matt G. Mutchler Bryce McDavitt David J. Klein William E. Cunningham Kathy J. Goggin Bonnie Ghosh-Dastidar Nikki Rachal Kelsey A. Nogg Glenn J. Wagner 《Annals of behavioral medicine》2017,51(6):868-878
Background
Evidence-based HIV treatment adherence interventions have typically shown medium-sized effects on adherence. Prior evidence-based HIV treatment adherence interventions have not been culturally adapted specifically for Black/African Americans, the population most affected by HIV disparities in the USA, who exhibit lower adherence than do members of other racial/ethnic groups.Purpose
We conducted a randomized controlled trial of Rise, a 6-month culturally congruent adherence counseling intervention for HIV-positive Black men and women.Methods
Rise was delivered by a trained peer counselor who used a problem-solving approach to address culturally congruent adherence barriers (e.g., medical mistrust, HIV stigma) and assisted with linkage to supportive services. A total of 215 participants were randomized to the intervention group (n = 107) or a wait-list control group (n = 108). Adherence was assessed daily via electronic monitoring.Results
In a repeated measures multivariate logistic regression model of dichotomous adherence (using a clinically significant cutoff of 85% of doses taken), adjusted for sociodemographic and medical covariates, adherence in the intervention group improved over time relative to the control group, (OR = 1.30 per month (95% CI = 1.12–1.51), p < 0.001), representing a large cumulative effect after 6 months (OR = 4.76, Cohen’s d = 0.86).Conclusions
Rise showed a larger effect on adherence than prior HIV adherence intervention studies. For greater effectiveness, interventions to improve adherence among Black people living with HIV may need to be customized to address culturally relevant barriers to adherence. (ClinicalTrials.gov #NCT01350544)20.
Hua Bai Sonja A. Wilhelm Stanis Andrew T. Kaczynski Gina M. Besenyi 《Annals of behavioral medicine》2013,45(1):39-48