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
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
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 .