Using a treatment partner and text messaging to improve adherence to psychotropic medication: a qualitative formative study of service users and caregivers in Cape Town, South Africa. Increased prevalence of type 2 diabetes mellitus among psychiatric inpatients with bipolar I affective and schizoaffective disorders independent of psychotropic drug use. Posttraumatic stress disorder and depression in heart transplantation recipients: the relationship with outcome and adherence to medical treatment. Prevalence of DSM-IV psychiatric disorder in the French elderly population. Somatization Increases Disability Independent of Comorbidity Prevalence, burden, and treatment of insomnia in primary care. Non-adherence to medication in patients with psychotic disorders: epidemiology, contributing factors and management strategies. Lithium use and discontinuation in a health maintenance organization. Excess Burden of Depression among HIV-Infected Persons Receiving Medical Care in the United States: Data from the Medical Monitoring Project and the Behavioral Risk Factor Surveillance System Psychotropic Medication Use Among Medicaid-Enrolled Children With Autism Spectrum Disorders Depression, Anxiety Disorders and Type D Personality as Risk Factors for Delirium After Cardiac Surgery The Prevalence and Burden of Psychiatric Disorders in Primary Health Care Visits in Qatar: Too Little Time? Sexual abuse and psychiatric disorder in England: results from the 2007 Adult Psychiatric Morbidity Survey. Factors associated with treatment nonadherence among US bipolar disorder patients. Psychiatric comorbidity in depressed HIV-infected individuals: common and clinically consequential. Depression, psychotropic medication, and risk of myocardial infarction. Prospective data from the Baltimore ECA follow-up. Adherence to hepatitis C treatment in recovering heroin users maintained on methadone Adherence to Antidepressant Combinations and Monotherapy for Major Depressive Disorder: A CO-MED Report of Measurement-Based Care Effects of caregivers' perceived stigma and causal beliefs on patients' adherence to antidepressant treatment. Obesity and sickness absence: results from the CHAP study. Text Messaging to Improve Hypertension Medication Adherence in African Americans: BPMED Intervention Development and Study Protocol Treatment adherence: a hurdle for real-life effectiveness in psoriasis? Evaluation of an instructional program for improving medication compliance for chronically mentally ill outpatients.
OBJECTIVE Poor adherence to medications , including psychotropic medications contributes to the burden of disease . Mental health service users ( MHSU ) may also not attend follow-up appointments at their health care facilities where they could discuss adherence with their health care provider . This paper reports on preliminary qualitative research preceding a r and omised controlled trial that aims to improve adherence to psychotropic medication  and to follow up treatment visits . The intervention will entail the support of individuals with serious mental disorder by a treatment partner and short message service ( SMS ) text messaging . METHODS The preliminary research reported in this paper aim ed to extract views about the intervention from both mental health service users ( MHSU ) and caregivers through focus group discussion s and individual interviews . Data were analysed using ATLAS TI qualitative software . RESULTS The caregivers interviewed were all mothers of MHSU who took measures to encourage adherence . They held mixed opinions on whether the treatment partner should be a family member . Most participants expressed the view that due to living conditions , family members were natural treatment partners , but others stated that they would prefer a treatment partner who was not a family member . Similarly , while most MHSU supported the idea of a treatment partner , a minority were concerned that a treatment partner may potentially be too controlling and compromise their autonomy . The vast majority of participants supported SMS text messaging as a means of reminding MHSU to take their medication and attend follow-up appointments . One participant mentioned the importance of broader social inclusion issues that should be incorporated in the intervention . CONCLUSION Qualitative research may provide useful insights for the design of interventions of this nature related to social inclusion r and omised control trials with its focus on adherence BACKGROUND There are numerous reports of abnormal glucose metabolism , including increased rates of type 2 diabetes mellitus , in psychiatric patients . It remains unclear , however , whether there is an intrinsic relationship between abnormal glucose metabolism and particular psychiatric disorders , because the relationship is complicated by treatment with psychotropic medications that promote weight gain and hyperglycemia . This study aim ed to clarify this relationship . METHODS The medical records of 243 in patients , aged 50 - 74 years , with diagnoses of major depression , bipolar I disorder , schizoaffective disorder , schizophrenia , and dementia were review ed . Psychiatric and type 2 diabetes mellitus diagnoses , medications , body mass index ( BMI ) , age , gender , and race were recorded . Diabetes rates were compared to age , race , and gender-matched rates in the US general population . RESULTS Rates of type 2 diabetes mellitus were : schizoaffective ( 50 % ) > bipolar I ( 26 % ) > major depression ( 18 % ) = dementia ( 18 % ) > schizophrenia ( 13 % ) ( p < 0.006 ) . Diabetic patients had a higher mean BMI ( p = 0.01 ) , but not a significantly higher use of psychotropic medications previously reported to be associated with new-onset type 2 diabetes ( e.g. , phenothiazines , clozapine , olanzapine ) . Logistic regression revealed that psychiatric diagnosis and BMI were the only significant and independent predictors of diabetes diagnosis . Compared to national norms , diabetes rates were significantly elevated only in bipolar I affective and schizoaffective patients . LIMITATIONS This study was a retrospective chart review of older , hospitalized patients . CONCLUSIONS This is the first published study to show an increased prevalence of type 2 diabetes mellitus among psychiatric patients with particular psychiatric illnesses independent of the effects of age , race , gender , medication , and body mass . This finding , which requires replication in a larger scale , prospect i ve study , suggests an intrinsic relationship between abnormal glucose metabolism and bipolar I affective and schizoaffective disorders OBJECTIVE There is growing evidence of the importance of psychiatric risk factors for predicting the outcome of heart transplantation ( HT ) recipients . The aim of our study was to investigate the role of major depression and posttraumatic stress disorder ( PTSD ) in the prediction of the outcome of HT in a consecutive sample of 107 recipients . METHOD All subjects of the study underwent a structured diagnostic interview for assessing the presence of pretransplant and posttransplant major depression and transplantation-related PTSD 1 to 5 years after HT . The  adherence to medical treatment  was assessed some months after the structured interview . The medical outcome ( acute rejections , cancer , mortality ) was followed up for 8 years on average after the interview , using a prospect i ve design . RESULTS Estimated frequency of psychiatric diagnoses after HT was 12 % for transplantation-related PTSD and 41 % for major depression . The presence of an episode of major depression prior to HT is a significant independent risk factor for posttransplant malignancies . Age , posttransplant malignancies and poor adherence are significant predictors of mortality in the survival analyses . CONCLUSIONS The present study highlights the importance of the assessment of psychosocial variables and psychiatric diagnoses before and after transplantation in HT recipients . Our findings have important clinical implication s and require replication with larger sample BACKGROUND France has high rates of psychotropic drug consumption and suicide in the elderly population , but it has not yet been possible to determine whether this is due to exceptionally high morbidity rates . AIMS To describe the first longitudinal population study of psychiatric disorder undertaken in France , and to estimate current and lifetime prevalences and age of onset of psychiatric disorder . METHOD A study group of 1873 non-institutionalised persons aged 65 years and over was r and omly recruited from the Montpellier district electoral rolls . The  Mini International Neuropsychiatric Interview  was used to assess current and lifetime symptoms . Cases identified by the application of DSM-IV criteria were re-examined by a clinical panel . RESULTS Forty-six per cent of the study population had experienced a mental disorder in their lifetime , and 3.7 % had made a suicide attempt . Lifetime prevalence of major depression was 26.5 % and 30 % for anxiety disorders . Current prevalence rates were 14.2 % for anxiety disorders , 10.7 % for phobia , 3 % for major depression and 1.7 % for psychosis . CONCLUSIONS Results show very high rates of lifetime but not current major depression . Rates of current phobia and suicidal ideation in the very elderly are also high compared with other studies . The rates reported are likely to be underestimates Background Somatoform disorders are an important factor in functional disability and role impairment , though their independent contribution to disability has been unclear because of prevalent medical and psychiatric comorbidity . Objectives To assess the extent of the overlap of somatization with other psychiatric disorders and medical problems , to compare the functional disability and role impairment of somatizing and non-somatizing patients , and to determine the independent contribution of somatization to functional disability and role impairment . Design Patients were surveyed with self-report question naires assessing somatization , psychiatric disorder , and role impairment . Medical morbidity was indexed with a computerized medical record audit . Participants Consecutive adults making scheduled visits to their primary care physicians at two hospital-affiliated primary care practice s on r and omly chosen days . Measurements Intermediate activities of daily living , social activities , and occupational disability . Results Patients with somatization , as well as those with serious medical and psychiatric illnesses , had significantly more impairment of activities of daily life and social activities . When these predictors were considered simultaneously in a multivariable regression , the association with somatization remained highly significant and was comparable to or greater than many major medical conditions . Conclusions Patients with somatization had substantially greater functional disability and role impairment than non-somatizing patients . The degree of disability was equal to or greater than that associated with many major , chronic medical disorders . Adjusting the results for psychiatric and medical co-morbidity had little effect on these findings OBJECTIVE The prevalence , burden , and management of insomnia among primary care patients were evaluated . METHOD Consecutive patients aged 18 to 65 years in primary care clinics of a staff-model health maintenance organization ( N = 1,962 ) were screened with the 12-item General Health Question naire . A stratified r and om sample ( N = 373 ) completed face-to-face diagnostic assessment s including the Composite International Diagnostic Interview , a brief self-rated disability question naire ( Brief Disability Question naire ) , and the interviewer-rated Social Disability Schedule . A telephone follow-up survey was completed 3 months later . Use of psychotropic drugs , use of mental health services , and direct health care costs were assessed by using the health plan 's automated data systems . RESULTS Approximately 10 % of the primary care patients reported major current insomnia ( e.g. , taking at least 2 hours to fall asleep nearly every night ) . Current insomnia was associated with significantly greater functional impairment ( according to both Brief Disability Question naire and Social Disability Schedule ) , more days of disability due to health problems , and greater general medical service utilization . While insomnia was associated with depressive disorder and chronic medical illness , adjustment for these factors only partially accounted for the association of insomnia with disability and with health care utilization . Of the patients with current insomnia , 28 % received any psychotropic drug ; 14 % received benzodiazepines and 19 % received antidepressants . CONCLUSIONS Insomnia among primary care patients is associated with greater functional impairment , lost productivity , and excess health care utilization Although non-adherence is common across all branches of medicine , psychotic disorders pose additional challenges that increase its risk . Despite the importance of non-adherence , clinicians generally spend too little time on assessing and addressing adherence attitudes and behaviors . Importantly , how adherence is measured significantly impacts the findings , and the most frequently employed methods of asking patients or judging adherence indirectly based on efficacy or tolerability information have poor validity . Novel technologies are being developed that directly assess adherence and that can also be used to both provide real-time feedback to clinicians and serve as an intervention with patients . Several treatments are available that can positively impact adherence . Among psychosocial interventions , those combining multiple approaches and involving multiple domains seem to be most effective . Although long-acting injectable antipsychotics are theoretically a very powerful tool to assure adherence and signal non-adherence , recent results from r and omized controlled trials failed to show superiority compared to oral antipsychotics . These data are in contrast to nationwide cohort studies and mirror-image studies , which arguably include more representative patients receiving long-acting antipsychotics in clinical practice . This disconnect suggests that traditional r and omized controlled trials are not necessarily the best way to study interventions that are thought to work via reducing non-adherence . Clearly , non-adherence is likely to remain a major public health problem despite treatment advances . However , increasing knowledge about factors affecting adherence and leveraging novel technologies can enhance its early assessment and adequate management , particularly in patients with psychotic disorders OBJECTIVE For decades , lithium has been prescribed to treat bipolar disorder . Its efficacy has been documented by clinical trials and by data from specialized clinics . An issue of considerable interest is the use of lithium in managed care systems . This project examined the use of lithium and its continuity of use by enrollees of a health maintenance organization ( HMO ) . METHOD In a 6-year longitudinal cohort study , 1,594 lithium users aged 15 years and older who were enrolled in an HMO were followed from 1986 - 1991 . Data were obtained from automated data bases and from medical record review of a r and om 5 % sub sample of the group ( N = 74 ) . RESULTS Bipolar disorder was the most frequent morbidity treated . Eighty-four percent ( N = 62 or 74 ) received services from a psychiatrist . Annual prevalence of lithium use increased over the 6-year period from 1.4 to 2.3 persons per thous and HMO members . Duration of use varied widely with some long-term but many short-term users . Discontinuation of treatment was associated with evaluated rates of psychiatric hospitalization and use of psychiatric emergency services .  Lithium users were much more likely to receive a variety of other psychotropic drugs than nonusers of the same sex and age . CONCLUSIONS Lithium use in this population was more often sporadic than continuous . Discontinuation of lithium was associated with psychiatric hospitalization . If lithium is to be a cost-effective treatment for bipolar disorder , managed care systems will need to improve adherence to drug treatment regimens Background With increased life expectancy for HIV-infected persons , there is concern regarding comorbid depression because of its common occurrence and association with behaviors that may facilitate HIV transmission . Our objectives were to estimate the prevalence of current depression among HIV-infected persons receiving care and assess the burden of major depression , relative to that in the general population . Methods and Findings We used data from the Medical Monitoring Project ( MMP ) and the Behavioral Risk Factors Surveillance System ( BRFSS ) . The eight-item Patient Health Question naire was used to identify depression . To assess the burden of major depression among HIV-infected persons receiving care , we compared the prevalence of current major depression between the MMP and BRFSS population s using stratified analyses that simultaneously controlled for gender and , in turn , each of the potentially confounding demographic factors of age , race/ethnicity , education , and income . Each unadjusted comparison was summarized as a prevalence ratio ( PR ) , and each of the adjusted comparisons was summarized as a st and ardized prevalence ratio ( SPR ) . Among HIV-infected persons receiving care , the prevalence of a current episode of major depression and other depression , respectively , was 12.4 % ( 95 % CI : 11.2 , 13.7 ) and 13.2 % ( 95 % CI : 12.0 % , 14.4 % ) . Overall , the PR comparing the prevalence of current major depression between HIV-infected persons receiving care and the general population was 3.1 . When controlling for gender and each of the factors age , race/ethnicity , and education , the SPR ( 3.3 , 3.0 , and 2.9 , respectively ) was similar to the PR . However , when controlling for gender and annual household income , the SPR decreased to 1.5 . Conclusions Depression remains a common comorbidity among HIV-infected persons . The overall excess burden among HIV-infected persons receiving care is about three-times that among the general population and is associated with differences in annual household income between the two population s. Relevant efforts are needed to reduce this burden OBJECTIVE . The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use . METHODS . This cross-sectional study used Medicaid cl aims for calendar year 2001 from all 50 states and Washington , DC , to examine 60641 children with an autism spectrum disorder diagnosis .  Logistic regression with r and om effects was used to examine the child , county , and state factors associated with psychotropic medication use . RESULTS . Of the sample , 56 % used at least 1 psychotropic medication , 20 % of whom were prescribed ≥3 medications concurrently . Use was common even in children aged 0 to 2 years ( 18 % ) and 3 to 5 years ( 32 % ) . Neuroleptic drugs were the most common psychotropic class ( 31 % ) , followed by antidepressants ( 25 % ) and stimulants ( 22 % ) . In adjusted analyses , male , older , and white children ; those who were in foster care or in the Medicaid disability category ; those who received additional psychiatric diagnoses ; and those who used more autism spectrum disorder services were more likely to have  used psychotropic drugs  . Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications . CONCLUSIONS . Psychotropic medication use is common among even very young children with autism spectrum disorders . Factors unrelated to clinical presentation seem highly associated with prescribing practice s. Given the limited evidence base , there is an urgent need to assess the risks , benefits , and costs of medication use and underst and the local and national policies that affect medication use Objectives : To determine the prognostic risk of incident delirium after cardiac surgery attributable to preoperative affective disorders and Type D personality . Methods : Patients awaiting elective coronary revascularization surgery ( N = 158 ; 20.9 % female ; 11.4 % concomitant valve surgery ; age M = 64.7 , SD = 10.6 ) underwent the structured MINI International Neuropsychiatric Interview and completed a measure of Type D personality . Postoperative incident delirium was established prior to discharge from the index hospitalization with structured psychiatric interview . Results : The prevalence of psychiatric disorders before cardiac surgery was 17.1 % for major depression , 7.6 % for panic disorder , 10.1 % for generalized anxiety disorder , and 13.3 % for Type D personality , while there were 49 ( 31 % of total ) cases of delirium after surgery . After adjustment for sex , older age , cross-clamp time , haemoglobin ( Hb ) and psychotropic drug use , major depression was significantly associated with delirium , odds ratio ( OR ) = 3.86 ( 95 % confidence interval ( CI ) 1.42 to 10.52 , p = 0.001 ) . Adjustment for clinical covariates suggested that Type D personality was not significantly associated with delirium , OR = 2.85 ( 95%CI 0.97 to 8.38 , p = 0.06 ) . Conclusions : Major depression was significantly associated with incident delirium after cardiac surgery . These findings suggest that the risk of incident delirium attributable to major depression was not merely a reflection of common diagnostic features in prospect ively examined cardiac surgery patients Background : Psychiatric disorders including anxiety , depression , somatization , obsessive compulsive , and bipolar disorders are recognized as causing the biggest burden of disease worldwide . Aim : In this study , we aim ed to assess the prevalence and burden of common mental disorders at Primary Health Care Centers ( PHCC ) using the World Health Organization Composite International Diagnostic Interview ( WHO-CIDI ) in the Qatari population , aged 18–65 who attended Primary Health Care ( PHC ) setting s. Design : A prospect i ve cross-sectional study conducted during November 2011 to October 2012 . Setting : Primary Health Care Centers of the Supreme Council of Health , Qatar . Subjects : A total of 2,000 Qatari subjects aged 18–65 years were approached ; 1475 ( 73.3 % ) agreed to participate . Methods : Prevalence and severity of International Classification of Disease-10 disorders were assessed with the WHO-CIDI ( Version 3.0 ) . Results : Of the 1475 participants , 830 ( 56.3 % ) were females and 645 ( 43.7 % ) was males . One-third were aged 35–49 years 558 ( 37.8 % ) . The three most common disorders were major depression disorders ( 18.31 % ) , any anxiety disorders ( 17.3 % ) , any mood disorders ( 16.95 % ) , followed by separation anxiety disorders ( 15.25 % ) , personality disorder ( 14.1 % ) . In the present study , prevalence in women was significantly higher than men for the most common psychiatric disorders , specifically generalized anxiety disorder , panic disorder , social phobia , specific phobias , obsessive compulsive disorders , posttraumatic disorder , somatization , major depressive disorder , bipolar disorder , dysthymia , and oppositional defiant disorder . Of the total 20 % had only one psychiatric diagnosis and 12 % had two disorders , 9.7 % respondents with three diagnoses , and finally 4.3 % of respondents had four or more diagnoses . Conclusion : One-fifth of all adults who attended the PHCC ( 20 % ) had at least one psychiatric diagnosis . The CIDI is a useful instrument for psychiatric diagnosis in community setting s such as PHC clinics , clinical research and intervention studies . There is an urgent need to not only assess prevalence , but also risk factors , burden , treatment gaps and outcomes to obtain evidence for policy making BACKGROUND Evidence is accumulating that child sexual abuse ( CSA ) is associated with many psychiatric disorders in adulthood . This paper uses the detailed information available from the 2007 Adult Psychiatric Morbidity Survey of Engl and ( APMS 2007 ) to quantify links between CSA and a range of psychiatric conditions . METHOD The prevalence of psychiatric disorder was established in a r and om sample of the English household population ( n=7403 ) , which also provided sociodemographic and experiential information . RESULTS We analyzed six types of common mental disorder , alcohol abuse and drug abuse , and people who screened positively for post-traumatic stress disorder ( PTSD ) and eating disorders . All were strongly and highly significantly associated with  CSA  , particularly if non-consensual sexual intercourse was involved , for which odds ratios ( ORs ) ranged from 3.7 to 12.1 . These disorders were also related to adult sexual abuse ( ASA ) , although the likelihood of reverse causality is then increased . Revictimization in adulthood was common , and increased the association of CSA with disorder . For several disorders , the relative odds were higher in females but formal tests for moderation by gender were significant only for common mental disorders and only in relation to non-consensual sexual intercourse . The population attributable fraction ( PAF ) was higher in females in all cases . CONCLUSIONS The detailed and high- quality data in APMS 2007 provided important confirmation both of the strength of association of CSA with psychiatric disorder and of its relative non-specificity . Our results have major implication s at the public health level and the individual level , in particular the need for better recognition and treatment of the sequelae of CSA OBJECTIVE Since sustained treatment-adherence is often problematic and may limit clinical outcomes among bipolar disorder ( BPD ) patients , we sought risk factors to guide clinical prediction of nonadherence . METHODS Data were from a 2005 US national sample providing question naire responses by 131 r and omly selected prescribing psychiatrists and their adult BPD patients . We contrasted demographic and clinical factors in treatment-adherent versus nonadherent patients ( strictly defined as missing > or = 1 dose within 10 days ) in univariate analyses followed by multivariate logistic-regression modeling . RESULTS Of 429 DSM-IV BPD patients ( 79 % type-I ; 62 % women ; 17 % minorities ) , 34 % reported missing > or = 1 dose of  psychotropic medication within 10 days , 20 % missed entire daily doses at least once , and only 2.5 % missed all doses for 10 days . However , their prescribing psychiatrists considered only 6 % as treatment-nonadherent . Factors significantly associated with nonadherence in multivariate modeling ranked : alcohol-dependence > youth > greater affective morbidity > various side effects > or = comorbid obsessive-compulsive disorder > or = recovering from mania-hypomania . Unrelated were sex , diagnostic subtype , and other comorbidities . Since most patients received > or = 2 psychotropics , potential relationships between treatment-complexity and adherence were obscured . CONCLUSIONS Prevalent treatment-nonadherence among American BPD patients , and striking underestimation of the problem by prescribing clinicians may encourage increasingly complex treatment-regimens of untested value , but added expense , risk of adverse effects , and uncertain impact on treatment-adherence itself OBJECTIVE To report on the prevalence of psychiatric comorbidity and its association with illness severity in depressed HIV patients . METHODS As part of a multi-site r and omized controlled trial of depression treatment for HIV patients , 304 participants meeting criteria for current Major Depressive Disorder ( MDD ) were assessed for other mood , anxiety and substance use disorders with the Mini-International Neuropsychiatric Interview , a structured psychiatric diagnostic interview . We also assessed baseline adherence , risk , and health measures . RESULTS Complicated depressive illness was common . Only 18 % of participants experienced MDD with no comorbid psychiatric diagnoses ; 49 % had comorbid dysthymia , 62 % had ≥1 comorbid anxiety disorder , and 28 % had a comorbid substance use disorder . Self-reported antiretroviral adherence  did not differ by the presence of psychiatric comorbidity . However , psychiatric comorbidity was associated with worse physical health and functioning : compared to those with MDD alone , individuals with ≥1 comorbidity reported more HIV symptoms ( 5.1 vs. 4.1 , P=.01 ) , and worse mental health-related quality of life on the SF-12 ( 29 vs. 35 , P<.01 ) . CONCLUSION For HIV patients with MDD , chronic depression and psychiatric comorbidity are strikingly common , and this complexity is associated with greater HIV disease severity and worse quality of life . Appreciating this comorbidity can help clinicians better target those at risk of harder-to-treat HIV disease , and underscores the challenge of treating depression in this population BACKGROUND There is suggestive evidence that depression increases risk of myocardial infa rct ion ( MI ) , but there are no prospect i ve studies in which the measure of depression corresponds to clinical criteria . This study examines prospect ively whether a major depressive episode increases the risk of incident MI and evaluates the role of psychotropic medication use in this relationship . METHODS AND RESULTS The study is based on a follow-up of the Baltimore cohort of the Epidemiologic Catchment Area Study , a survey of psychiatric disorders in the general population . A history of major depressive episode , dysphoria ( 2 weeks of sadness ) , and psychotropic medication use were assessed in 1981 , and self-reported MI was assessed in 1994 . Sixty-four MIs were reported among 1551 respondents free of heart trouble in 1981 . Compared with respondents with no history of dysphoria , the odds ratio for MI associated with a history of dysphoria was 2.07 ( 95 % CI , 1.16 to 3.71 ) , and the odds ratio associated with a history of major depressive episode was 4.54 ( 95 % CI , 1.65 to 12.44 ) , independent of coronary risk factors . In multivariate models , use of barbiturates , meprobamates , phenothiazines , and lithium was associated with an increased risk of MI , whereas use of tricyclic antidepressants and benzodiazepines was not . Among individuals with no history of dysphoria , only lithium use was significantly associated with MI . CONCLUSIONS These data suggest that a history of dysphoria and a major depressive episode increase the risk of MI . The association between psychotropic medication use and MI is probably a reflection of the primary relationship between depression and MI Objectives Injection drug users are often denied hepatitis C ( HCV ) treatment due to concerns about adherence , despite limited data about the impact of such common issues as psychiatric illness and intercurrent drug use . We sought to define the impact of these and other potential adherence barriers in a real-world sample of recovering drug users . Methods We conducted a prospect i ve observational study of 71 methadone-maintained patients who received interferon and ribavirin combination therapy in a community-based clinic with expertise in treating addictive disorders .  Adherence measures were conducted with monthly interview , medication counts , and urine toxicology testing . Results Overall , 48 ( 68 % ) were adherent , and adherent patients were significantly more likely to achieve a sustained virologic response ( 42 vs. 4 % in nonadherent patients ) . Patients with and without a prior psychiatric history were similarly adherent ( 64 vs. 72 % , respectively , P>0.5 ) , and the initiation of new psychiatric medications during HCV treatment was associated with improved adherence overall ( P=0.02 ) and in patients that did not report a preexisting psychiatric diagnosis ( P=0.04 ) . Trend towards reduced adherence in patients without a period of abstinence was seen before initiating HCV treatment , 46 vs. 72 % of those who had been abstinent for at least 1 month ( P=0.10 ) . Although occasional drug users were similarly adherent to those who were completely abstinent , patients who relapsed to regular drug use showed a significantly lower level of adherence ( P=0.03 ) . Conclusions We conclude that the majority of methadone-maintained drug users can adhere to HCV treatment , even those with psychiatric illness and relatively limited pretreatment drug abstinence . Lack of pre-HCV treatment drug abstinence and regular drug use during HCV treatment may be relative barriers to medication adherence , but the initiation of psychiatric medications during HCV treatment may be a helpful intervention . This report provides further evidence for an individualized approach to HCV treatment that does not categorically exclude patients with potential barriers such as mental illness and limited drug abstinence Background . Non-adherence to antidepressant treatment is not routinely measured in practical clinical trials . It has not been related to outcomes in a large sample of adults with chronic and /or recurrent major depressive disorder ( MDD ) or any sample treated with antidepressant combinations . Methods . Adult out patients with chronic and /or recurrent MDD were r and omized to 12 weeks of treatment with bupropion-SR plus escitalopram , venlafaxine – XR plus mirtazapine , or escitalopram plus placebo . We compared non-adherence ( the frequency with which daily medications were not taken ) and specifically the frequency of temporarily stopping and /or skipping medication , or reducing or increasing the dose across treatments in 567 participants using a self-report question naire collected at each visit . We tested the association between non-adherence , and both treatment type and outcomes . Results . A non-adherence rate under 10 % was reported by 77.9 % , 70.9 % , and 71.6 % of participants during weeks 1–4 , 5–12 , and 1–12 , respectively . Antidepressant combinations were associated with a higher non-adherence rate than monotherapy during weeks 1–4 and 1–12 . During weeks 1–4 , 24.1 % stopped/skipped doses and 6.1 % reduced the dose . During weeks 5–12 , 34.7 % stopped/skipped doses and 9.4 % reduced the dose . Across 12 weeks , 43.2 % stopped/skipped doses , and 12.9 % reduced the dose . Stopping/skipping doses during all time frames and dose decreases during weeks 1–12 occurred most frequently with combination treatments . Non-adherence was unrelated to symptom remission , response , or symptom change . Conclusions . With closely monitored treatment , non-adherence is low and unrelated to depressive symptom outcome . Nonadherence is highest with antidepressant combinations . Specific non-adherent events are most often sporadic . ( Journal of Psychiatric Practice 2014;20:118–132 OBJECTIVE Nonadherence to prescribed medications is a significant problem in the treatment of mood disorders . Previously proposed adherence models have not been sufficiently accurate in identifying patients who do not adhere to treatment . This study evaluated the importance of the social context in adherence by using a prospect i ve , longitudinal analysis . Specifically , this study evaluated the effects of caregivers ' causal beliefs about depression and their perceptions of stigma on three-month treatment adherence among patients with depression . METHODS Fifty patients with major depressive disorder and their primary caregivers were identified at a psychiatric hospital 's outpatient clinic .  Attributions for the causes of depression ( either cognitive and attitudinal or medical and biological ) and perceived stigma were assessed among caregivers at baseline , and patients ' adherence was evaluated three-months after treatment began . RESULTS Data were available for 47 patients at follow-up . Caregivers ' attribution of depression to cognitive and attitudinal problems significantly predicted patients ' decreased adherence . However , the degree of patients ' adherence was not predicted by caregivers ' attributions to medical and biological causes and caregivers ' perceived stigma . CONCLUSIONS The findings stress the importance of patients ' social environment in determining treatment adherence and the necessity of educating caregivers about the impact that their causal attributions have on patients ' behavior . Involving caregivers in treatment may improve their attitude toward patients with depression and , in doing so , enhance patients ' adherence and outcome BACKGROUND Obesity is an increasing public health problem . A small number of studies have examined the relationship between obesity and sickness absence , with mixed results , particularly regarding short-term sickness absence . AIMS To determine if obesity is associated with short- and long-term sickness absence and to investigate the mechanisms that may underlie any association . METHODS  Cross-sectional ( n = 1489 ) and prospect i ve ( n = 625 ) analyses were conducted on staff from London Underground Ltd. All participants underwent regular clinical examinations that involved their height and weight being measured , obesity-related medical problems being diagnosed and psychiatric disorders being identified . The number of days taken for short- ( < 10 days in an episode ) and  long-term sickness absence  were recorded by managers on an electronic data base . RESULTS There was a positive linear association between employees '  body mass index ( BMI ) and the number of days ' work missed due to sickness absence on both cross-sectional and prospect i ve analyses ( P < 0.001 ) . Obesity was a risk factor for both short- and long-term sickness absence . Obese individuals typically took an extra 4 days sick leave every year . The majority of the increased risk for long-term sickness absence appeared to be mediated via co-morbid chronic medical conditions . The excess short-term sickness absence was not explained by obesity-related medical problems , psychiatric disorders or workplace factors . CONCLUSIONS Obese employees take significantly more short- and long-term sickness absence than workers of a healthy weight . There is growing evidence to support employers becoming more involved in tackling obesity Background Hypertension ( HTN ) is a major public health concern in the United States , with almost 78 million Americans age 20 years and over suffering from the condition . Moreover , HTN is a key risk factor for health disease and stroke . African Americans disproportionately shoulder the burdens of HTN , with greater prevalence , disease severity , earlier onset , and more HTN-related complications than age-matched whites . Medication adherence for the treatment of HTN is poor , with estimates indicating that only about half of hypertensive patients are adherent to prescribed medication regimens . Although no single intervention for improving medication adherence has emerged as superior to others , text message medication reminders have the potential to help improve medication adherence in African Americans with uncontrolled HTN as mobile phone adoption is very high in this population . Objective The purpose of this two-phased study was to develop ( Phase I ) and test in a r and omized controlled trial ( RCT ) ( Phase II ) a text message system , BPMED , to improve the quality of medication management through increasing medication adherence in African Americans with uncontrolled HTN . Methods In Phase I , we recruited 16 target end-users from a primary care clinic , to assist in the development of BPMED through participating in one of three focus groups . Focus groups sought to gain patient perspectives on HTN , medication adherence , mobile phone use , and the use of text messaging to support medication adherence . Potential intervention design s were presented to participants , and feedback on the design s was solicited . In Phase II , we conducted two pilot RCTs to determine the feasibility , acceptability , and preliminary efficacy of BPMED in primary care and emergency department setting s. Both pilot studies recruited approximately 60 participants , who were r and omized equally between usual care and the BPMED intervention . Results Although data collection is now complete , data analysis from the two pilot RCTs is still ongoing and results are expected in 2015 . Conclusions This study was design ed to determine preliminary feasibility and acceptability of our approach among African Americans with uncontrolled HTN in primary care and emergency department setting s. Results from these studies are of great interest as little work has been done to document the use of text message medication reminders to improve HTN-related outcomes , particularly within underserved urban minorities . Trial Registration Clinical trials.gov NCT01465217 ; https:// clinical trials.gov/ct2/show/NCT01465217 ( Archived by WebCite at http://www.webcitation.org/6V0tto0lZ ) Treatment adherence is a vital determinant to achieving successful outcomes for patients using long-term therapy for a chronic disease . Poor adherence to treatment of chronic diseases is a worldwide problem and a key factor impacting the real-life effectiveness of treatment , as defined by a combination of clinical efficacy , adherence and safety . Over the last 50 years there has been a global shift in disease burden from acute to chronic diseases , according to the World Health Organization ( WHO ) . Therefore , as the prevalence of chronic diseases continues to increase , the challenge of poor adherence is likely to rise in magnitude . Adherence is a complex issue that can have a significant impact on quality of life for patients and methods aim ing to improve the patient experience are widely sought . There has been a transition over time from a more traditional ‘ compliance’-focused medical environment to one of ‘ adherence ’ , which actively involves the patient in their care regimen and this change is promoted by WHO as part of a multifaceted approach . In a study investigating the redemption of initial prescriptions of topical and systemic treatments for dermatologic conditions , psoriasis patients appeared to be least adherent with nearly 50 % of prescriptions unfilled . To maximize positive patient outcomes to therapy for psoriasis , it is essential that we underst and the reasons underlying non-adherence . In psoriasis , adherence has been linked with factors including efficacy , safety perceptions , ease of use , and the healthcare professional – patient relationship . For topical products , non-adherence may be further exacerbated by the necessity of application , which can be cumbersome and time consuming ; this is combined with patients ’ poor acceptability of certain treatment vehicles , such as ointments , that tend to be perceived as messy . Psoriasis , although generally not life-threatening , can have a significant impact on physical , psychological and social wellbeing , particularly related to the overt appearance of skin lesions and the psychological burden of stigma . Nonadherence and the challenges that ensue are discussed in greater depth with respect to topical psoriasis treatment in the article entitled , ‘ Non-adherence and measures to improve adherence in the topical treatment of psoriasis ’ , pages 4–9 within this supplement . Current guidelines for the first-line treatment of mild-tomoderate psoriasis recommend the topical use of vitamin D analogues and corticosteroids . The development of a fixeddose combination topical gel containing the vitamin D analogue calcipotriol and the corticosteroid betamethasone dipropionate has provided a user-friendly once-daily therapy option and shows superior efficacy over the individual active components administered as monotherapies and is well tolerated in patients with mild-to-moderate psoriasis .  Safety concerns associated with the single agents are also attenuated as the steroid component of the fixed combination gel lowers the incidence of skin irritation sometimes experienced with use of vitamin D analogues , and calcipotriol potentially reduces steroid-induced skin atrophy . Twelve clinical trials have evaluated the efficacy and safety of calcipotriol plus betamethasone dipropionate gel ( referred to here as a ‘ fixed combination ’ gel ) , for the treatment of psoriasis of the scalp ( seven studies ) and body ( five studies ) , with 3767 patients receiving this treatment in total . All studies demonstrated improved efficacy of the fixed combination gel versus active and vehicle comparators with a favourable safety and tolerability profile . Four international , Phase 3 trials ( two each for scalp and body psoriasis ) assessed short-term ( 8-week ) treatment , and an additional Phase 3 study in scalp psoriasis assessed the safety of long-term ( 52-week ) treatment . Across all clinical trials , increased efficacy over time ( week 8 versus week 4 ) has been demonstrated with the fixed combination gel for treatment of psoriasis of both body and scalp . A recent , pooled analysis of 8-week safety data from 9 of these 12 clinical trials evaluating once-daily fixed combination gel treatment of the scalp ( six studies ) and body ( three studies ) , is presented in an article within this supplement by Kragballe and van de Kerkhof , pages 10–21 . The incidence of adverse events and adverse drug reactions is consistently low in patients treated with the fixed combination gel , providing evidence for the good overall tolerability of this topical treatment for psoriasis . Accompanying pharmacovigilance data supports the favourable tolerability profile demonstrated in the clinical trials for the fixed combination gel and also its use in a real-world setting . The notion of real-life effectiveness of treatment has been described as a product of clinical efficacy , adherence and safety . However , in a real-life setting , less constrained by clinical rigours , there is a paucity of data to shed light on effectiveness . As described in the article on expert recommendations , of which we are co- authors , pages 22–32 , only two prospect i ve , short-term ( 4-week ) , non-interventional studies assessing the effectiveness of the fixed combination gel in daily practice ( both in Germany ) have been published to date . By the end of treatment there was an approximate decrease of 60–70 % in the proportions of patients presenting with at least moderate severity scalp psoriasis , as assessed by the investigator ’s global assessment ( IGA ) Outpatient medication adherence is a major problem , especially for patients repeatedly hospitalized for psychiatric disorders . This study included 39 such patients who were receiving case management services from a community mental health center . Patients were matched and r and omly assigned to receive in a single session either ( 1 ) information regarding medication and its benefits , ( 2 ) guidelines for assuring adherence which encompassed all phases related to pill-taking including filling prescriptions , use of a pill container , transportation , self-reminders , doctor 's appointments and so forth , or ( 3 ) the same guidelines as ( 2 ) above but given in the presence of a family member who was enlisted in support . The results showed that adherence increased to about 94 % after the guidelines were given for both the individual and family guideline procedure , whereas adherence remained unchanged at 73 % after the medication information procedure . These results suggest a practical means for assuring a high level of medication adherence for patients with psychiatric disorders
Individual patient ’s behaviors , lack of social support , clinical or treatment and illness-related , and health system factors influenced psychotropic medication non-adherence .
Conclusion Psychotropic medication non-adherence was high .
It was influenced by various factors operating at different levels .
Background Major psychiatric disorders are growing public health concern that attributed 14 % of the global burden of diseases .
The management of major psychiatric disorders is challenging mainly due to medication non-adherence .
However , there is a paucity of summarized evidence on the prevalence of psychotropic medication non-adherence and associated factors .
Therefore , we aim ed to summarize existing primary studies ’ finding to determine the pooled prevalence and factors associated with psychotropic medication non-adherence .