171 research outputs found
The predictive validity of subjective adherence measures in patients with schizophrenia
No full textDespite frequent use of subjective adherence measures in patients with schizophrenia as well as other chronic conditions, there are several reports that question the validity of these instruments. Three well known, representative subjective measures are the Medication Adherence Questionnaire (MAQ), the Drug Attitude Inventory (DAI), and the Compliance Rating Scale (CRS). In this study we explored the predictive validity of these instruments in a European sample of 119 stabilized outpatients with schizophrenia. Clinical outcome variables were relapse and admission to a psychiatric hospital during a follow-up period of 12 months. Results indicate that the predictive validity of all three measures was poor. The MAQ was the least problematic predictor for relapse (Nagelkerke R(2) = 0.09), and time to relapse (R(2) = 0.07) and had the best sensitivity for relapse (63.6%) as well as admission (87.5%). The MAQ and CRS were both moderate predictive for admission (Nagelkerke R(2) = 0.21, and R(2) = 0.29). We conclude that the validity of the instruments studied here is questionable and have limited clinical relevance. Given the feasibility and ease of most subjective instruments, researchers may be tempted to use them but should be aware of the serious drawbacks of these instruments
Assessment of medication adherence in patients with schizophrenia. The Achilles heal of adherence research
No full textShared decision-making in the treatment of people with severe mental illness: a focus group study.
No full textEffect of medication-related factors on adherence in people with schizophrenia: A European multi-centre study
No full textAim - To investigate the relation between medication-related factors and adherence in people with schizophrenia in outpatient treatment Methods - The sample comprised 409 outpatients (ICD- 10 diagnosis of schizophrenia) with clinician-rated instability in four European cities (Amsterdam, The Netherlands, Verona. Italy, Leipzig, Germany; London, Great Britain) Adherence was assessed using the Medication Adherence Questionnaire (patient perspective), and the Clinician Rating Scale (clinician perspective). Examined medication-related factors were type (atypical vs typical), application (oral vs. depot), daily dose frequency of antipsychotic medication (Medication History Scale), number of side effects (Liverpool University Neuroleptic Side Effect Rating Scale), and patient attitudes toward medication (Drug Attitude Inventory) Multiple regression analysis was used to identify predictors of adherence by medication-related factors Results - Adherence, as rated by patient and clinician, was predicted by patient attitude towards medication, but was unrelated to type of drug. formulation or side effects of antipsychotic medication A high daily dose frequency was associated with better adherence. but only when rated by the patient. Conclusions - In order to improve adherence there is a need to seriously consider and attempt to improve patient attitude toward medication. However, type of antipsychotic and other medication-related factors may not be as closely related to adherence as it has often been suggeste
Peer support and global mental health
No full textPeer support, i.e. persons with a lived experience of mental illness and recovery supporting others living
with mental health problems, is an empirically validated resource-oriented therapeutic promoting recovery (Priebe et al. 2014; Slade et al. 2014). During the last decades, peer support has been implemented to
varying degrees in mental health services of many high income countries (Mahlke et al. 2014). At the
same time, the burden of mental disorders and the treatment gap between those in need and those actually receiving formal mental health care is especially prominent in low and middle income countries
(Kohn et al. 2004; Patel et al. 2007). The knowledge of people with a lived experience of mental illness who de-stigmatise mental illness, offer alternative viewpoints in understanding clients and strengthen a
person-focused (rather than a pathological-focused) discourse is an untapped resource in global mental
health
A comparison of SF-6D and EQ-5D utility scores in a study of patients with schizophrenia
No full textEconomic evaluations of healthcare interventions increasingly measure outcomes using quality-adjusted life years (QALYs). The SF-6D and the EQ-5D are alternative ways of generating utility scores for use in QALY estimations, but it is unclear which is most sensitive to change in psychiatric symptom severity. There are also limited data on the sensitivity of these measures to changes in existing clinical indicators in long-term mental health conditions like schizophrenia. To: (i) assess the relationship between SF-6D and EQ-5D utility scores for patients with schizophrenia at two points in time, (ii) assess the relationship in the change scores of these two measures, (iii) measure the sensitivity of these measures to changes in an established measure of symptomatology. Patients with schizophrenia were recruited and the SF-36 and EQ-5D were administered at baseline and one-year follow-up and utility scores were computed and compared. Standardized response mean (SMR) scores were calculated for the SF-6D and EQ-5D and compared for patients who improved or deteriorated by at least 25% on the Brief Psychiatric Rating Scale. EQ-5D ratings were available for 394 patients at baseline, 368 at follow-up and 358 at both time points. The respective figures for the SF-6D were 383, 367 and 345. Mean utility scores were very similar at baseline (EQ-5D 0.68, SF-6D 0.67) and follow-up (EQ-5D 0.71, SF-6D 0.68). Median scores were markedly higher for the EQ-5D (0.76 v 0.66 at baseline, 0.80 v 0.68 at follow-up). The SF-6D scores followed a normal distribution whilst the EQ-5D scores were negatively skewed with a clustering at 1.00. There were few differences in sensitivity to change between the EQ-5D and SF-6D. From an analytical perspective the SF-6D has advantages over the EQ-5D due to its normal distribution and lack of ceiling effect. However, both measures produce similar mean utility scores. Overall the SF-6D appears more suitable as a measure of utility in this patient group. Decisions made on the basis of cost-effectiveness results need to consider the method by which QALYs have been calculated. Further comparisons of the EQ-5D and SF-6D are require
Course of adherence to medication and quality of life in people with schizophrenia
No full textThis study examined the relationship over time of adherence to anti-psychotic medication and quality of life in people with schizophrenia, taking into account effects of mediating variables. Data on on adherence, quality of life, attitude towards medication, side effects, symptom severity, and level of functioning at baseline and 1-year follow-up were obtained from 373 participants in a multi-centre trial. Participants randomised to the intervention group were offered eight sessions of adherence therapy. Data were analysed via block recursive graphical modelling. Direct links between adherence and quality of life and effects across time were scarce and weak if present. However, indirect effects could be identified, i.e. adherence at baseline affected quality of life at follow-up via symptom severity and medication side effects. These findings underline associations between "traditional" clinical outcome parameters and quality of life. Adherence might have an impact on some of these clinical outcome dimensions, and this might indirectly affect quality of life across time. Overall, findings indicate that at present, there is no plausible explanatory model of adherence. This also has consequences for clinical practice since there is no compelling evidence on how to intervene effectively to improve adherence in people with schizophrenia. (C) 2007 Elsevier Ireland Ltd. All rights reserve
Adherence to medication and quality of life in people with schizophrenia: results of a European multicenter study.
No full textQuality of life is often severely impaired in people with schizophrenia, and adherence to antipsychotic medication has been consistently found to be low in this population. Although there is a considerable amount of evidence on these two variables in schizophrenia research, there is only limited knowledge on how they relate to one another. The aim of this study is to develop a meaningful model of the relationship between quality of life and adherence that includes mediating variables. A multicenter randomized controlled trial recruited 409 subjects in London, Verona, Amsterdam, and Leipzig. Baseline interviews obtained data on adherence, quality of life, and other variables. We used graphical modeling to investigate the relationships between the variables. No direct relation could be discerned between subjective quality of life and adherence to medication. Mediating variables, most importantly symptomatic impairment, global functioning, and medication side effects, were identified by the model. It can be concluded that, when aiming at the improvement of quality of life in people with schizophrenia, variables other than adherence, i.e., symptomatic impairment, global functioning, and medication side effects, should be targeted
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