schizophrenia

Medication Noncompliance and Substance Abuse Among Patients with Schizophrenia

09/16/2008 , 9:42 AM by Alex Sicre

Today’s medication adherence related abstract comes from Psychiatry Online. It is from a Veterans Affairs Field Program for Mental Health and was originally published over 10 years ago, however it is still often cited. The results are not that surprising, however it brought to mind alcoholism and how it is related to medication non-adherence and to mental health.

With both schizophrenia and bipolar disorder, the rates of alcoholism are much higher than the average. I have always viewed this alcoholism as self-medicating behavior – thus the patients are adherent to their self prescribed drinking regime. I wonder how side effects came into play as most of the psychiatric medications heighten the effects to alcohol?

OBJECTIVE:
The study examined the effect of medication noncompliance and substance abuse on symptoms of schizophrenia.

METHODS:
Short-term inpatients with a diagnosis of schizophrenia were enrolled in a longitudinal outcomes study and continued to receive standard care after discharge. At baseline and six-month follow-up, Brief Psychiatric Rating Scale (BPRS) scores and data on subjects’ reported medication compliance, drug and alcohol abuse, usual living arrangements, and observed side effects were obtained. The number of outpatient contacts during the follow-up period was obtained from medical records. Relationships between the dependent variables-medication noncompliance and follow-up BPRS scores-and the independent variables were analyzed using logistic and linear regression models.

RESULTS:
Medication noncompliance was significantly associated with substance abuse. Subjects who abused substances, had no outpatient contact, and were noncompliant with medication had significantly greater symptom severity than other groups.

CONCLUSIONS:
Substance abuse is strongly associated with medication noncompliance among patients with schizophrenia. The combination of substance abuse, medication noncompliance, and lack of outpatient contact appears to define a particularly high-risk group.

Telenursing Intervention Increases Psychiatric Medication Adherence in Schizophrenia Outpatients

07/30/2008 , 10:43 AM by Alex Sicre

And here is today’s medication adherence abstract from Journal of the American Psychiatric Nurses Association:

BACKGROUND:
Promoting medication adherence is a critical issue in optimizing both physical and mental health in persons with schizophrenia. Average antipsychotic medication adherence is only 50%; few studies have examined nonpsychiatric medication adherence. Psychosocial interventions with components of problem solving and motivation have shown promise in improving adherence behaviors.

OBJECTIVES:
This study examines telephone intervention problem solving (TIPS) for outpatients with schizophrenia. TIPS is a weekly, provider-initiated, proactive telenursing intervention designed to help persons with schizophrenia respond to a variety of problems, including adherence problems.

STUDY DESIGN:
The authors completed objective measures of adherence to psychiatric and nonpsychiatric medications in 29 community-dwelling persons with schizophrenia, monthly for 3 months.

STUDY RESULTS:
Persons receiving TIPS had significantly higher objective adherence to psychiatric medications throughout the study period, F(1, 20) = 5.47, p = .0298.

CONCLUSIONS:
Clinicians should consider using TIPS as an adjunct to face-to-face appointments to support adherence in persons at risk. J Am Psychiatr Nurses Assoc, 2008; 14(3), 217–224. DOI: 10.1177/1078390308318750

Injectable Resperdal To The Rescue for Schizophrenia Patients

04/04/2008 , 9:53 AM by Alex Sicre

From PyschCentral.com

Thursday, Apr. 3 (Psych Central) — With medication compliance a significant issue in some people who grapple with schizophrenia, drug companies often look toward injectable forms of their psychiatric medications to help with this issue. A new study suggests that an atypical antipsychotic in injectable form looks to be just as effective as its non-injectable counterpart.

Patients with psychosis treated early on in the course of their illness with risperidone long-acting injection demonstrated high response and remission rates with low relapse rates according to the study.

A reduction of the Positive and Negative Syndrome Scale (PANSS) total score of at least 50% was experienced by 84% of the 51 patients included in the study, with only four of these patients relapsing by the study endpoint. During the two-year trial period, the study also showed 64% of patients achieved remission.

Non-compliance or partial compliance remain key barriers in the management of schizophrenia and are often significant contributing factors in relapse. Relapse is associated with increased risk of hospitalization and a dramatically poorer quality of life. Patients experiencing numerous relapses are at high risk of never regaining previous levels of functioning.

Prevention of relapse, therefore, becomes an important factor to help support patients toward remission and recovery. It may be of particular importance in the early stages of the disorder to prevent irreversible decrease of functioning.

“The trial suggests that an atypical long-acting formulation introduced as first-line treatment may play an important role in the management of schizophrenia,” commented lead investigator of the study Professor Robin Emsley from the Department of Psychiatry at the University of Stellenbosch. “Whilst this is a small study, any data suggesting low relapse and high remission rates during this critical stage in a patient’s treatment pathway are welcome.”

In the study, risperidone long-acting injection (also known by its brand name, Risperdal Consta) was administered every two weeks to patients with an age range of 15 – 43 years with recent onset schizophrenia or schizophreniform disorder. A total of 27 patients had not been previously prescribed any medication.

The study period ran over two years in order to assess the effects of risperidone long-acting injection on symptom reduction and assess whether it can be used as a first-line treatment in early psychosis. Results showed that 84% of patients experienced a clinical response of at least 50% reduction of symptom severity on the PANSS. Of these patients, only four relapsed during the study. 92% of patients experienced a clinical response of at least 20% reduction of symptom severity.

Young patients who have never received previous medication treatment for their disorder may manifest high sensitivity to antipsychotics, both in terms of responsiveness and to side effects such as extrapyramidal symptoms and weight gain.

Therefore, the lowest dose of antipsychotic medication was used and patients were closely monitored throughout the study. Overall, the results suggest the treatment was well tolerated and the majority of patients responded well to treatment. As previously reported in studies of patients with early onset psychosis, weight gain was reported, particularly in the first 12 months. At endpoint, mean BMI gain was 4.8 (SD 3.8 [n=50]) from 20.6 (SD 4.6) at baseline (p< .001).

More Information and Facts About the Friday Post from NCCBH

06/18/2007 , 1:53 PM by Alex Sicre

As I stated, I am a little behind the times, but this is the press release from the National Council for Community Behavioral Healthcare from June 13th addressing the “lawyer ads” about Zyprexa.

Survey results released today shed light on a new barrier to treatment affecting people with severe mental illness. The findings show fears raised by product liability litigation involving antipsychotic drugs may be putting patients with schizophrenia and bipolar disorder at risk for relapse. These fears add to the already heavy burden that patients face as they work to manage symptoms, stay on their medication and work with their treatment providers to improve their mental and physical health.

The survey, which was conducted among 402 psychiatrists who treat patients with schizophrenia and bipolar disorder, showed that, even when patients were responding well to their prescribed antipsychotic treatment, many requested a medication change because these drugs are featured in law firm advertisements. Other patients stopped taking their medication, often without telling their psychiatrist, for the same reason.

“Many of our patients already struggle with accepting their illness and staying on their prescribed treatment, and now they are experiencing new levels of fear due to the increasing incidence of these jarring advertisements,” said Dr. Ralph Aquila, assistant clinical professor of psychiatry, Columbia College of Physicians and Surgeons; director, residential community services, St Luke’s-Roosevelt Hospital Center, New York, NY. “This irresponsible advertising is hindering the progress of therapy for many of these patients and disrupting the important relationship between them and their healthcare providers. Plaintiffs attorneys need to consider the consequences that these advertisements may have on patients.”

The findings from this survey, which was commissioned by the National Council for Community Behavioral Healthcare and Eli Lilly and Company, are consistent with a Harris Interactive® poll of 250 physicians commissioned by the U.S. Chamber of Commerce in 2003 that examined how pharmaceutical litigation impacts prescribing decisions across disease states. However, this new survey went one step further by asking psychiatrists to examine the potential impact of this type of litigation on patient care. These new findings have implications for doctors who treat serious and persistent mental illnesses, and confirm trends in clinical practice that many people in the mental health community have observed, but have not been quantified until now.

Ninety-seven percent of surveyed psychiatrists had one or more patients who stopped taking medication or reduced their dosage. Of these psychiatrists, 52 percent believed patients took this action due to law firm advertisements about antipsychotic drugs, and reported the following:
• Ninety-three percent stated that one or more of their patients made medication changes without consulting them first, and the majority of these psychiatrists (94 percent) reported patient relapse as a result of discontinuing medication.
• The most frequent consequences of relapse were symptom recurrence (93 percent), hospitalization (75 percent), loss of an important relationship (40 percent) and suicide attempts (26 percent).

Even when patients were improving on their prescribed medication, they still approached their psychiatrists about stopping or changing. Ninety-seven percent of surveyed psychiatrists received one or more patient requests to stop or switch their medication. Of these psychiatrists, 59 percent felt patients made these requests based on concerns raised by law firm advertisements about antipsychotic drugs, and reported the following:
• The majority of these psychiatrists (93 percent) felt these patients were responding to treatment.
• Of the patients that were responding but requested a stop or switch, 71 percent of psychiatrists reported that one or more experienced a relapse, which also led to symptom recurrence, hospitalization, loss of an important relationship and suicide attempts.
• Half of the surveyed psychiatrists reported that patient caregivers also requested a medication switch or stop due to concerns generated by law firm advertisements, even if their loved one was responding to treatment.

“Doctors and patients need to discuss the risks and benefits of any medication in order to determine what is appropriate for each patient,” said Linda Rosenberg, MSW, president and CEO of the National Council. “That assessment becomes difficult in today’s atmosphere because so much of the advertising is alarmist and frightening. It’s especially crucial for patients to speak with their doctor before stopping their medication. Such discussions are an important part of the therapeutic relationship.”

The findings from the survey are especially pertinent given the number of barriers that already exist in helping patients adhere to their treatment. Among the many challenges psychiatrists noted they faced when selecting an antipsychotic medication to treat schizophrenia and bipolar disorder, the five most challenging issues identified were:
• Side effects (75%),
• Lack of adherence due to unwillingness to accept illness (73%),
• Medication costs (58%),
• Lack of adherence due to lack of support (50%), and
• Co-occurring mental illnesses (49%).

More than half (55%) of surveyed psychiatrists indicated that they had changed their prescribing practices over the last five years due to product liability cases involving antipsychotic medications – and reported frustration and concern that this type of litigation sometimes interferes with patient treatment. Furthermore, many psychiatrists (62%) reported that they know of colleagues who have made similar changes in their prescribing practices.