Adherence According to Mary Poppins: Strategies to Make the Medicine Go Down

PURPOSE. This article reviews the prevalence, risk factors, and burden of nonadherence in mood and psychotic disorders, and presents evidence-based, disease-specific strategies shown to improve adherence. CONCLUSION. A comprehensive approach based on the goal of remission, designed around the patient's individual needs, facilitates adherence, leads to improved quality of life, and reduces disease burden. PRACTICE IMPLICATIONS. Adherence in mood and psychotic disorders can be improved when providers take time to build trusting relationships; identify risk factors; anticipate nonadherence; individualize treatment; and educate patients, families, and other healthcare providers.     

Relapse to substance use: A concept analysis

The concept of relapse is ubiquitous in the health literature related to addiction. Nevertheless, relapse is—and has been—described and measured under various definitions, which precipitates confusion, inconsistency, and stigma. This study aimed to (a) clarify the meaning of relapse and (b) present a comprehensive definition of relapse vis-à-vis substance use. Walker and Avant's method of concept analysis was followed to analyze the relapse using CINAHL, PsychINFO, and PubMed databases. Three key attributes of relapse were identified: (a) interruption of abstinence, (b) vulnerability to uncontrollable substance-related behavior and/or cues, (c) a transition to potential progression or regression. Antecedents and consequences of attributes were identified, followed by the construction of the model and additional cases. Relapse is defined conceptually as either a transition to regression or a progression in the process of recovery, prompted by a return to the previous behavior of substance use, despite the intention to stay abstinent. A standardized definition and understanding of relapse not only minimize confusion, inconsistency, and social and self-stigma associated with the term but also helps provide relapse-sensitive care with accurate methods of assessment and evaluation.     

The Risks and Benefits of Switching Antipsychotics: A Case Study Approach

PURPOSE.  Progression of metabolic illness in a patient with schizophrenia who was stabilized on an atypical antipsychotic is described using a case study framework. Risks and benefits of staying on current treatment versus switching to another agent and switching strategies are described.
CONCLUSIONS.  Switching an antipsychotic with more favorable side effects may improve metabolic parameters if other weight loss strategies have failed. Switching or stopping medications too quickly may exacerbate psychiatric symptoms. There is little evidence to support which is the best switching strategy.
PRACTICE IMPLICATIONS.  The psychiatric mental health nurse practitioner carries a significant responsibility of discussing risks and benefits of switching and closely monitoring the patient during a switch of medications. Ensuring that the patient decides and agrees upon the treatment plan will improve the overall outcome.     

Factors related to mental health effect among nursing students in Japan and the United States during the coronavirus pandemic: A cross-sectional study

In the context of mental health, university students have been considered a vulnerable population. However, limited studies have underscored the association between preventive health behaviour levels and mental health effects among nursing students. The current cross-sectional study provides a comparative analysis of the impact of mental health factors on nursing students in Japan and the United States (US) in the context of the coronavirus disease 2019 (COVID-19) pandemic. The study consisted of 878 participants, comprising both undergraduate and graduate nursing students from four universities in Japan, and one from the US. Hierarchical logistic regression was used to analyse the participant data in this study. In contrast to the American students, the Japanese students demonstrated significantly lower levels of perceived control and significantly higher levels of preventive health behaviours. Furthermore, Japanese students exhibited significantly higher levels of stress and/or symptoms of depression induced by the social distancing orders compared to the American students (z = −4.218, P < 0.001). However, no difference was observed after adjusting for perceived control, individual factors, socio-economic factors, and preventive behaviours. During the pandemic, risk factors that can worsen mental health among the nursing students included younger age [odds ratio (95%CI) = 0.62 (0.48–0.81)], women [OR = 2.17 (1.02–4.61)], higher preventive health behaviour [OR = 1.05 (1.02–1.08)], lower perceived control [OR = 0.97 (0.94–0.99)], and lower perceived health competence [OR = 0.93 (0.90–0.96)]. Thus, this study recommends establishing training programmes that enhance perceived control and perceived health competence while encouraging preventive behaviour to support the mental health of nursing students, particularly young female students.     

Causal Attribution Among Cancer Survivors of the 10 Most Common Cancers

Life is a hollow gift unless cancer survivors emerge from treatment as competent and worthy individuals, able to obtain insurance, equipped to earn a living, and prepared to participate in a medical surveillance program to "keep" the life they have won. The author describes the obstacles involving schooling, military service, employment, and insurance hat hinder a full life after cure and suggests strategies for supporting a partnership consisting of the medical team, the patient and family, and peer organizations to overcome these obstacles.