Adherence to Treatment Regimen in a Lithium Carbonate Clinic

Connelly, Catherine E.; Davenport, Yolande B.; Nürnberger, John I.

doi:10.1001/archpsyc.1982.04290050057011

Cited by 76 publications

(47 citation statements)

References 25 publications

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“…In literature also it is opined that socio-demographic factors are the least rewarding of the predictors of compliance1. 16,17 Diagnosis of substance abuse did not correlate significantly with nonadherence in our sample. In some studies it has been considered one of the most important reasons for nonadherence (substance abuse seems to be a strong predictor of non-compliance in psychosis 18 while in others it did not play a major role but any definitive conclusion should not be drawn as in our study incidence of substance abuse was 10%, while in others where it has been found significant, the incidence was more than 30%.…”

Section: Discussioncontrasting

confidence: 53%

Factors affecting adherence in patients with schizophrenia

2016

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INTRODUCTIONSchizophrenic illnesses are typically long term illnesses. Nonadherence to medication can lead to relapse, which can mean more visits to the emergency room, rehospitalizations and increased need for clinician intervention -all of which lead to increased costs to healthcare systems. 1Rates of non-compliance in psychotic disorders have been reported to vary from 11 to 80% and in most of the cases it would result in relapse.2,3 Nonadherent patients have an average risk of relapse that is 3.7 times greater than that of adherent patients. 4 As per World Health Organization (WHO) estimates the median treatment gap for schizophrenia, including other non-affective psychosis, was 32.2 % and so the poor adherence results in wastage and under utilization of already limited treatment resources and compounds the challenges of improving health in poor populations. 5 Weiden and Olfson found that nonadherence in schizophrenia accounted for about 40% of the annual costs of rehospitalization.6 Johnson et al, reported that patients with schizophrenia who experienced a relapse did not return to their pre relapse level of social adjustment 1 year after recovery, implying that the cost of relapse is much greater than just the cost of rehospitalization.7 The cost of relapse may be particularly severe for patients with jobs and family responsibilities since they have the most to lose. Knowledge of how to improve adherence ABSTRACT Background: Nonadherence with medication regimens is among the most common causes of psychotic relapse and the need for rehospitalisation. This study was designed to look into the factors affecting attitude towards medication adherence in Schizophrenia and its relationship with severity of illness, side effects of medication. Methods: Adult males and females in the age range of 18-55 years fulfilling criteria for schizophrenia according to ICD -10, DCR, and reporting at outpatient department were taken up for this study. Severity of illness was assessed by Brief Psychiatric Rating Scale (BPRS), Side effects to medication were assessed by Udvalg for Kliniske Undersogelser (UKU) side effect scale, and Adherence was assessed by Medication adherence rating scale (MARS). Results: Adherence negatively correlated with severity of illness, and side effects in the form of increased sleep duration, asthenia, increased fatigability, lassitude and diminished sexual desire. Regression analysis with MARS as dependent variable showed side effects of medication in the form of increased sleep duration in followed by asthenia, lassitude, and increased fatigability to be predictors of poor adherence in the sample. Conclusions: Poor adherence is associated with severity of schizophrenia, sedation and asthenia like side effects due to medication. Sedation and asthenia like side effects caused a decline in adherence.

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Section: Discussioncontrasting

confidence: 53%

Factors affecting adherence in patients with schizophrenia

2016

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“…Previous attempts to apply HBMs to psychiatric populations have produced inconsistent results [10,11]. This may mean that HBMs are not a useful model for people with severe mental disorders.…”

Section: Scottmentioning

confidence: 99%

“…However, it is unclear which of these factors is most important and the data from population studies do not help clinicians predict which individual from an 'at risk' group will become nonadherent. An alternative approach to exploring medication adherence, used extensively in research in other chronic medically ill populations, is to examine health beliefs, factors that influence those beliefs, and the prompts that lead people to engage in certain behaviours [8][9][10][11]. We explored the utility of two Health Belief Models (HBMs) [5,8] in identifying individuals at risk of nonadherence.…”

Section: Introductionmentioning

confidence: 99%

Using Health Belief Models to Understand the Efficacy-Effectiveness Gap for Mood Stabilizer Treatments

Scott¹

2002

Neuropsychobiology

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Objective: This study explored the utility of Health Belief Models (HBM) in explaining medication adherence in subjects with severe affective disorders. Method: Well-established measuring instruments, with confirmed reliability and validity, were used to assess each component of two HBMs and adherence to mood-stabilising medication in 98 subjects with either bipolar (805 subjects) or unipolar disorders. Results: About 30% of subjects met criteria for partial adherence to medication. Demographic and diagnostic variables did not predict adherence status. Subjects’ beliefs about themselves and their control over the disorder were more important than side-effects in predicting medication adherence. Self-reported assessments were predictive of admission to hospital in the year after the interview. Conclusion: Although the study has a number of methodological limitations, the results suggest that clinical assessment of components of HBMs may improve the detection of patients at risk of non-adherence to mood-stabilising medication.

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“…Although it has been found to be predictive of adherence in some studies of the mentally ill (Perkins et al, 2006), research on the applicability of the HBM to bipolar disorder has produced mixed results. That is, scales based on the HBM have correlated only modestly with treatment adherence in bipolar disorder (Cohen, Parikh, & Kennedy, 2000;Connelly, Davenport, & Nurnberger, 1982;Scott, 2002).Another widely researched model of adherence, the self-regulatory model (SRM), was formulated to help explain treatment adherence among the chronically ill (Leventhal, Meyer, & Nerenz, 1980). The SRM, also known as the common sense model, perceives taking medication as a response to the interpretation of threat for the individual, including physical symptoms and recognition of disease.…”

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confidence: 99%

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confidence: 99%

Development of the treatment attitudes questionnaire in bipolar disorder

Johnson

Fulford

2008

J Clin Psychol

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Despite the success of pharmacotherapy in the management of bipolar disorder, as many as one-half of those in treatment discontinue their medication over time. Currently, no self-report measure is available that predicts treatment engagement in bipolar disorder. The goal of the current study was to develop a measure of awareness of symptoms and attitudes toward treatment among those with bipolar disorder. Sixty-six participants diagnosed with bipolar I disorder on the SCID completed the Treatment Attitudes Questionnaire (TAQ) and were then followed for up to 2 years to assess symptom levels. Medication data were available for 37 participants. Analyses of the TAQ were conducted to examine reliability, predictors of subscales, and how well scores predicted medication and symptom levels over time. Results indicate that previous episodes of depression, but not episodes of mania, correlated with increased scores on the Insight and the Enjoyment of Mania subscales. Scores on the Nonbiological Attributions subscale predicted lower levels of lithium as well as increased depressive symptoms over time. Although the current study includes limited measurement of treatment engagement and a small sample size, this easily administered scale may help treatment planning for those with bipolar disorder. Keywords bipolar disorder; treatment adherence; treatment attitudes; treatment attitudes questionnaire "I had become addicted to my high moods; I had become dependent upon their intensity, euphoria, assuredness, and their infectious ability to induce high moods and enthusiasms in other people" (Jamison, 1996).With the introduction of lithium treatment in the late 1960s (Baastrup & Schou, 1967), and the development of other pharmacotherapy approaches, including divalproex, carbamazepine, lamotrigine, and atypical antipsychotics, a range of effective treatments are now available (Muzina & Calabrese, 2005). Although symptoms remain a concern for some on these medications (Judd et al., 2003), evidence has accrued to suggest that mood-stabilizing medications substantially diminish symptoms as well as hospitalization rates (cf., Smith, Cornelius, Warnock, Bell, & Young, 2007). Despite this, estimates suggest that one-third to one-half of patients with bipolar disorder discontinue medication treatment over time (Basco & Rush, 1995;Svarstad, Shireman, & Sweeney, 2001). Lack of adherence to mood stabilizers has been shown to contribute to poorer course of disorder and more frequent hospitalization (Scott & Pope, 2002). Thus, a fundamental challenge in the effective care of bipolar disorder appears to be promoting medication adherence. © 2008 Wiley Periodicals, Inc. Correspondence concerning this article should be addressed to: Daniel Fulford, 5665 Ponce de Leon Blvd, Coral Gables, FL; e-mail: dfulford@psy.miami.edu. NIH Public AccessAuthor Manuscript J Clin Psychol. Author manuscript; available in PMC 2010 January 29. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptTo date, adherence has been a fairly p...

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Adherence to Treatment Regimen in a Lithium Carbonate Clinic

Cited by 76 publications

References 25 publications

Factors affecting adherence in patients with schizophrenia

Factors affecting adherence in patients with schizophrenia

Using Health Belief Models to Understand the Efficacy-Effectiveness Gap for Mood Stabilizer Treatments

Development of the treatment attitudes questionnaire in bipolar disorder

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