Insight and medication adherence in schizophrenia: An analysis of the CATIE trial

Kim, Julia; Ozzoude, Miracle; Nakajima, Shinichiro; Shah, Parita; Caravaggio, Fernando; Iwata, Yusuke; Luca, Vincenzo De; Graff‐Guerrero, Ariel; Gerretsen, Philip

doi:10.1016/j.neuropharm.2019.05.011

Cited by 66 publications

(47 citation statements)

References 60 publications

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“…Quizás si analizamos la adherencia según el tipo de diagnóstico: en sujetos con esquizofrenia, los cuales fueron los más adherentes en el grupo estudiado, el resultado se encuentra dentro del amplio rango reportado en la literatura 24% hasta el 70% (36) (37) (38). En el trastorno afectivo bipolar la literatura mundial oscila entre 35-50% (9) (37).…”

Section: Discussionunclassified

Adherencia farmacológica en relación con funcionalidad familiar en el tratamiento ambulatorio de pacientes con esquizofrenia, depresión y trastorno bipolar.

2019

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Introducción: la escasez de estudios epidemiológicos acerca de las características clínicas y farmacológicas de pacientes con enfermedades mentales manejados de forma ambulatoria a nivel nacional y local, acarrea un insuficiente conocimiento médico para realizar un seguimiento eficaz en el manejo de patologías tan comunes en psiquiatría como la esquizofrenia, el trastorno bipolar y la depresión.Objetivo: caracterizar clínica y farmacológicamente a pacientes ambulatorios manejados en una clínica psiquiatrica en Cartagena, e identificar si hay relación entre la adherencia farmacológica, tipo de diagnóstico y grado de disfunción de familiar.Métodos: estudio descriptivo de corte transversal con 160 pacientes ambulatorios mayores de 18 años y menores de 65 años diagnosticados con esquizofrenia, trastorno bipolar y depresión, a quienes se les aplicó un cuestionario de características clínico-farmacológicas, el cuestionario de Morisky-Green y el Test de Apgar Familiar.Resultados: el 68,1% de los encuestados refirieron conocer su diagnóstico psiquiátrico, el principal diagnóstico fue el trastorno afectivo bipolar (35,6%), seguido de la esquizofrenia (34,4%) La aplicación del APGAR familiar mostró una frecuencia de familia disfuncional en el 36,3%, La escala de Morisky Green mostró una no adherencia total al tratamiento de 53,8%. Al comparar la frecuencia de diagnósticos, funcionalidad familiar, estratificado, por grupos de pacientes con y sin adherencia al tratamiento, no se observaron diferencias estadísticamente significativas.Conclusiones: Se encontró un alto porcentaje de no adherencia farmacológica y la gran mayoría reportó tener familias funcionales. Sin embargo, no se encontró relación estadísticamente significativa entre la adherencia al tratamiento, el tipo de diagnóstico ni el grado de disfunción familiar.

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Section: Discussionunclassified

Adherencia farmacológica en relación con funcionalidad familiar en el tratamiento ambulatorio de pacientes con esquizofrenia, depresión y trastorno bipolar.

2019

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“…The secondary effectiveness measures will be medication adherence. The medication adherence will be measured using the proportion of dosage taken and good adherence will be defined as taking more than 80% of monthly pill counts, as stated in a previous study conducted among people with schizophrenia [ 29 ]. Adherence will be assessed using two unannounced home-based pill counts 30 days apart at the 6-month endpoint.…”

Section: Methodsmentioning

confidence: 99%

An economic evaluation of a mobile text messaging intervention to improve mental health care in resource-poor communities in China: a cost-effectiveness study

Dev

Zhang

et al. 2020

BMC Health Serv Res

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Background Severe mental disorders, a leading cause of disability has become a major public health problem. In order to promote mental health, a series of programs have been promulgated by the Chinese government. However, economic evaluations of such programs are lacking. The purpose of this study is to develop and validate an economic model to assess the cost and health outcomes of the LEAN (Lay health supporters, E-platform, Award, and iNtegration) program, and to perform an economic evaluation of LEAN versus the nationwide community-based mental health program that provides free antipsychotic medications. Methods A cost-effectiveness and cost-utility analysis of the LEAN intervention will be performed. A Markov model will be developed, validated and used to assess and compare the costs and outcomes for the LEAN intervention versus nationwide community-based mental health program. The calculated sample size is 258 participants for the analysis. A societal perspective will be applied with the time horizon of 1-year after the termination of the LEAN program. The cost-utility will be measured primarily using Quality Adjusted Life Years and the cost-effectiveness will be measured using number of relapses and number of re-hospitalizations avoided 6-month after the intervention. Univariate and probabilistic sensitivity analysis will be conducted for the analysis of uncertainty. Discussion If proven cost-effective, this study will contribute to the nationwide implementation of the program, not only for schizophrenia but for all kind of severe mental disorders. Markov model developed as part of the study will benefit potential researchers in analyzing cost-effectiveness of other programs. The Chinese context of the study may limit the generalizability of the study results to some extent. Trial registration This study was registered in a Chinese Clinical Trial Registry (ChiCTR2000034962) on 25 July 2020.

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“…116 The scientific literature indicates a strong link between impaired insight and nonadherence to psychiatric medication. 117,118 For this reason, in order to increase the validity of the adherence tool when we first published it, we proposed the incorporation of a new Insight subscale into the questionnaire. 50 The insight literature frequently focus in schizophrenia and includes 3 relevant components: 1) awareness of having an illness, 2) attribution of one's symptoms to the illness and 3) acknowledgment of a need for treatment.…”

Section: Future Studies Of Insight In Outpatientsmentioning

confidence: 99%

<p>Self-Report for Measuring and Predicting Medication Adherence: Experts’ Experience in Predicting Adherence in Stable Psychiatric Outpatients and in Pharmacokinetics</p>

Cuevas

Leon

2020

PPA

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Poor adherence to appropriately prescribed medication is a global challenge for psychiatrists. Prior Studies: Measuring adherence is complicated. In our recent three-country naturalistic study including more than 1000 patients and their adherence to multiple medication prescriptions at the same time, patients' self-report of adherence to each specific drug was the only practical option for measuring adherence. Systematic literature reviews provide inconsistent results for sociodemographic, clinical and medication variables as predictors of adherence to psychiatric drugs. Our studies over the last 10 years in relatively stable psychiatric outpatients have shown that some self-reported health beliefs had consistent, strong effects and a better predictive role. Three dimensions of these health beliefs are characteristics of the individual: 1) attitudes toward psychiatric medication such as pharmacophobia (fear of taking drugs or medicines), 2) health locus of control (the belief patients have about who or what agent determines the state of their health), 3) psychological reactance (an emotional reaction in direct contradiction to rules or regulations that threaten or suppress certain freedoms in behavior). They can be measured by the Patient Health Beliefs Questionnaire on Psychiatric Treatment. The attitude toward each specific medication can be measured by the necessity-concern framework and summarized as the presence or absence of skepticism about that drug. After 25 years conducting pharmacokinetic studies in psychiatric drugs, particularly antipsychotics, we have limited understanding of how to use blood levels to predict the effects of non-adherence or to establish it. Expert Opinion on Future Studies: Future studies to predict adherence should include the inpatient setting and explore insight. Studying the pharmacokinetics associated with nonadherence in each psychiatric drug is a major challenge. Medication adherence is a complex and dynamic process changing over time in the same patient. Personalizing adherence using psychological or pharmacological variables are in their initial stages.

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Insight and medication adherence in schizophrenia: An analysis of the CATIE trial

Cited by 66 publications

References 60 publications

Adherencia farmacológica en relación con funcionalidad familiar en el tratamiento ambulatorio de pacientes con esquizofrenia, depresión y trastorno bipolar.

Adherencia farmacológica en relación con funcionalidad familiar en el tratamiento ambulatorio de pacientes con esquizofrenia, depresión y trastorno bipolar.

An economic evaluation of a mobile text messaging intervention to improve mental health care in resource-poor communities in China: a cost-effectiveness study

<p>Self-Report for Measuring and Predicting Medication Adherence: Experts’ Experience in Predicting Adherence in Stable Psychiatric Outpatients and in Pharmacokinetics</p>

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