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Biomedical subjects

Jan Scott

Publications and source records attributed to Jan Scott.

35 records · Page 2Linked to original sources
PubMed2004

The sleep of remitted bipolar outpatients: a controlled naturalistic study using actigraphy.

BACKGROUND: Several sleep laboratory studies suggest sleep abnormalities in bipolar disorder. However, this is the first study to compare remitted bipolar subjects with controls on actigraphic and subjective sleep parameters in a naturalistic setting over 5 nights. METHODS: Nineteen subjects with Bipolar I Disorder and 19 age- and gender-matched healthy controls were included. Objective sleep parameters were estimated using wrist actigraphs. Subject-rated sleep diaries and mood ratings were also completed. Sleep data were averaged for each subject across nights, and raw score standard deviations were calculated as a measure of within-subject variability. RESULTS: Multivariate analyses of variance found significant group differences for both actigraphic (F(4,33)=3.80, P=0.012) and subjective measures (F(4,31)=3.18, P=0.027). Univariate analyses identified reliable differences in sleep onset latency (subjective), sleep duration (subjective), and variability of sleep duration and night wake time (actigraphic). Binary backward stepwise logistic regression demonstrated that a combination of three sleep measures correctly predicted disorder status in 84% of cases. LIMITATIONS: Failure to match on sociodemographic and employment status is a limitation that may provide an alternative explanation for some findings. Furthermore, in the bipolar group 18 of 19 subjects were in receipt of psychotropic medication, compared to none of the healthy control group. Also, no information was recorded about family history of mental disorders in the control group. CONCLUSIONS: The study suggests that the sleep of remitted bipolar outpatients measured in naturalistic settings is characteristically different from controls: bipolar subjects sleep longer, report longer onset latencies, and display greater variability across nights.

Adult↗
PubMed2004

The current status of psychological treatments in bipolar disorders: a systematic review of relapse prevention.

OBJECTIVE: This paper reviews published randomized-controlled treatment trials of psychological therapies added to standard psychiatric treatment versus medication and standard psychiatric treatment alone to explore whether adjunctive psychotherapy reduces relapse rates in individuals with bipolar disorders (BDs). METHOD: Relapse rates were calculated for individual trials that met inclusion criteria and then pooled odds ratios were calculated using meta-analytic techniques. RESULTS: The majority of studies quoted demonstrate that individuals receiving psychological treatments had significantly fewer relapses. The length of therapy required was between 10 and 20 h over 6-9 months and the models of effective therapies had many shared characteristics in terms of style and content. CONCLUSIONS: Adjunctive psychological treatments for individuals with BDs are acceptable and feasible and reduce relapse risk. There are relatively few differences in the benefits that accrue from the different therapy models. It is now important to explore whether they have added value in terms of additional health gains and social functioning compared with standard treatment approaches.

Bipolar Disorder↗
PubMed2003

A systematic review of manic and depressive prodromes.

BACKGROUND: This paper explores whether individuals with a mood disorder can identify the nature and duration of depressive and manic prodromes. METHODS: Seventy-three publications of prodromal symptoms in bipolar and unipolar disorders were identified by computer searches of seven databases (including MEDLINE and PsycLIT) supplemented by hand searches of journals. Seventeen studies (total sample=1191 subjects) met criteria for inclusion in a systematic review. RESULTS: At least 80% of individuals with a mood disorder can identify one or more prodromal symptoms. There are limited data about unipolar disorders. In bipolar disorders, early symptoms of mania are identified more frequently than early symptoms of depression. The most robust early symptom of mania is sleep disturbance (median prevalence 77%). Early symptoms of depression are inconsistent. The mean length of manic prodromes (>20 days) was consistently reported to be longer than depressive prodromes (<19 days). However, depressive prodromes showed greater inter-individual variation (ranging from 2 to 365 days) in duration than manic prodromes (1-120 days). LIMITATIONS: Few prospective studies of bipolar, and particularly unipolar disorders have been reported. CONCLUSIONS: Early symptoms of relapse in affective disorders can be identified. Explanations of the apparent differences in the recognition and length of prodromes between mania and bipolar depression are explored. Further research on duration, sequence of symptom appearance and characteristics of prodromes is warranted to clarify the clinical usefulness of early symptom monitoring.

Bipolar Disorder↗
PubMed2003

Do clinicians understand why individuals stop taking lithium?

BACKGROUND: Previous research highlights that, over a 2-year period, up to 50% of individuals receiving lithium prophylaxis are non-adherent with medication against medical advice. The main reasons identified by clinicians only partially reflect the reasons given by patients. METHODS: Seventy-two subjects who were identified from biochemistry laboratory data as receiving lithium for an affective disorder and who gave written informed consent, completed the 'Reasons for Stopping Medication' questionnaire. Forty-one clinicians involved in treating these 72 patients also completed the same questionnaire. Ratings on the 'Reasons for Stopping Medication' questionnaire were compared between adherent and non-adherent patients and between patients and their clinicians. RESULTS: Adherent (n=39) and previously non-adherent patients (n=33) showed a high level of concordance in their rank ordering of reasons for considering stopping taking lithium (Kendall's W=0.059; P=0.001), with 'bothered by the idea that moods were controlled by medication', 'bothered by the idea of a chronic illness' and 'felt depressed' being the most commonly endorsed items. Clinicians and patients views showed low levels of concordance (Kendall's W=0.019; P=0.32). Clinicians identified 'missing highs', and 'felt well, saw no need to take medication' as the most likely reasons for non-adherence. The differences in the primary reasons for stopping lithium identified by clinicians and patients were statistically significant (chi(2)=61.1; df 40, P=0.005). CONCLUSIONS: Patients' reasons for stopping lithium appear to be influenced by concerns about what having an affective disorder and taking medication says about them. Clinicians are not fully aware of the main reasons patients would stop prophylactic treatment.

Adult↗
PubMed2003

Cognitive styles in individuals with bipolar disorders.

BACKGROUND: Published studies of emotional processing and cognitive style in bipolar disorders tend to have small sample sizes or use non-clinical samples. Larger clinically representative studies are needed. METHOD: Self-esteem, dysfunctional attitudes and personality style were compared in unipolar (N=16) and bipolar disorder (N=77); and then investigated in the different phases of bipolar disorder (remitted=26; depressed=38; hypomanic=13). One-year outcome was assessed in 36 bipolar subjects. RESULTS: Unipolar subjects and bipolar subjects differed significantly in their mean levels of negative self-esteem (unipolar=15.5; bipolar=12.7; P<0.05). Bipolar subjects with hypomania reported mean levels of dysfunctional beliefs that were higher than individuals in remission but lower than depressed subjects (remitted=136.7; depressed=153.8; hypomanic=144.8; P<0.05). Hypomanic subjects recorded the highest levels of negative as well as positive self-esteem. In the exploratory analysis of outcome, negative self-esteem (Exp [B] 1.91; 95% CI 1.11 to 3.32; P<0.05) was the most robust predictor of relapse. CONCLUSIONS: There are similarities in the cognitive style of individuals with unipolar as compared to bipolar disorders. Cognitive style in hypomania represents a phase between remission and depression rather than the polar opposite of depression. The implications of these findings are considered for psychological and neural network models.

Adolescent↗
PubMed2003

Use of cognitive therapy for relapse prevention in chronic depression. Cost-effectiveness study.

BACKGROUND: There is a lack of data on the cost-effectiveness of relapse prevention in depression. METHOD: A total of 158 subjects with partially remitted major depression despite adequate clinical treatment were randomly allocated to cognitive therapy in addition to antidepressants and clinical management v. antidepressants and clinical management alone. Relapse rates and health care resource utilisation were measured prospectively over 17 months. RESULTS: Cumulative relapse rates in the cognitive therapy group were significantly lower than in the control group (29% v. 47%). The incremental cost incurred in subjects receiving cognitive therapy over 17 months (pound sterling 779; 95% CI pound sterling 387- pound sterling 1170) was significantly lower than the overall mean costs of cognitive therapy (pound sterling 1164; 95% CI pound sterling 1084- pound sterling 1244). The incremental cost-effectiveness ratio ranged from pound sterling 4328 to pound sterling 5027 per additional relapse prevented. CONCLUSIONS: In individuals with depressive symptoms that are resistant to standard treatment, adjunctive cognitive therapy is more costly but more effective than intensive clinical treatment alone.

Adult↗
PubMed2002

Quality improvement report: Effect of a multifaceted approach to detecting and managing depression in primary care.

PROBLEM: Need to improve the detection and management of depression in primary care. DESIGN: Prospective, before and after study of changes in detection and management following attempts to introduce a chronic disease management approach. BACKGROUND AND SETTING: Two representative general practices in the north east of England that differed markedly in resources available and populations served. KEY MEASURES OF IMPROVEMENT: Number of cases on a depression register, number of cases accurately diagnosed, adherence to own clinical management guidelines. STRATEGIES FOR CHANGE: Multifaceted intervention to meet the needs of each practice modified by in-house steering group, including resources to develop a case register, an education and training programme on detection and management agreed by consensus, facilitation of meetings with secondary care staff, and support in developing a practice guideline. EFFECTS OF CHANGE: Practice A (with six partners and serving a predominantly affluent white British population) improved case detection rate by 23%, reduced prescribing of sub-therapeutic doses of antidepressants by 36%, and adhered to the preferred treatment regimens. At Practice B (with three partners and two surgeries located in deprived urban inner city areas with high levels of unemployment and large ethnic minority populations) improvement in the sensitivity of case detection was accompanied by a reduction in specificity. The practice did not reach consensus on its own guideline and was unable to sustain the model. LESSONS LEARNT: A simple practice based approach improved the detection and management of depression in a team familiar with the philosophy of chronic disease management, with the capacity to commit to the programme, and with a critical mass of team members being open to change. This model failed to affect depression management when staff engagement with the project was passive rather than active and the practice was less well resourced and served an economically deprived and ethnically diverse population.

Adult↗
PubMed2002

Using homework in therapy for depression.

There is a growing body of research evidence that demonstrates that completion of homework assignments is significantly correlated with outcome in cognitive therapy. The cognitive model of depression sees homework as an intrinsic aspect of the therapy process. Homework serves a number of purposes, including generalizing learning from the session into everyday life and fostering the independent practice of skills acquired during treatment. We review a number of commonly occurring problems that arise when seeking to engage the client in homework. The negotiation and implementation of homework assignments is a core clinical skill, and we present a range of strategies the clinician can use to optimize its effectiveness. It is vital that practitioners have an awareness of their own role and expectations in developing homework assignments.

Cognitive Behavioral Therapy↗
PubMed2002

A pilot study of concordance therapy for individuals with bipolar disorders who are non-adherent with lithium prophylaxis.

OBJECTIVES: To assess the acceptability and feasibility of concordance therapy (CCT) in improving adherence with lithium prophylaxis in individuals with bipolar disorder. METHODS: Ten subjects with bipolar I disorder and self-reported problems with lithium adherence were recruited. Eight participated in a 6-month study of CCT delivered by an expert in cognitive therapy. Reliable and valid assessments of self-reported adherence with lithium, attitudes towards, and knowledge of lithium and serum plasma lithium levels were measured pre- and post-intervention. Subjects' views of CCT were also recorded. RESULTS: Statistically significant improvements in attitudes towards lithium (mean score baseline = 6.8; follow up = 4.1; Effect size = 1.6) were associated with improvements in self-reported adherence. Laboratory results demonstrated statistically significant increases in serum plasma lithium levels (mean increased from 0.41 to 0.6; effect size 1.7). Subjects viewed CCT as an acceptable intervention. However, only four of the 10 subjects completed all seven half-hour therapy sessions and homework tasks. CONCLUSIONS: This small open study suggests that CCT may represent a useful addition to the 'stepped care' package of treatment for individuals with bipolar disorders. Research is underway to assess its efficacy and to establish whether novice therapists can also apply the model effectively.

Adult↗
PubMed2002

Treatment non-adherence in affective disorders.

OBJECTIVE: The aim of this paper is to review the prevalence, predictors and methods for improving medication adherence in unipolar and bipolar affective disorders. METHOD: Studies were identified through Medline and PsycLit searches of English language publications between 1976 and 2001. This was supplemented by a hand search and the inclusion of selected descriptive articles on good clinical practice. RESULTS: Estimates of medication non-adherence for unipolar and bipolar disorders range from 10 to 60% (median 40%). This prevalence has not changed significantly with the introduction of new medications. There is evidence that attitudes and beliefs are at least as important as side-effects in predicting adherence. The limited number of empirical studies of how to reduce non-adherence offer encouraging evidence that, if recognized, the problem can be overcome. CONCLUSION: Only 1-2% of all publications on the treatment of affective disorders explore factors associated with medication non-adherence. This is disappointing as research and clinical data highlight the importance of extended courses of medication in improving the long-term prognosis of affective disorders.

Antidepressive Agents↗
PubMed2002

Using Health Belief Models to understand the efficacy-effectiveness gap for mood stabilizer treatments.

OBJECTIVE: This study explored the utility of Health Belief Models (HBM) in explaining medication adherence in subjects with severe affective disorders. METHOD: Well-established measuring instruments, with confirmed reliability and validity, were used to assess each component of two HBMs and adherence to mood-stabilising medication in 98 subjects with either bipolar (805 subjects) or unipolar disorders. RESULTS: About 30% of subjects met criteria for partial adherence to medication. Demographic and diagnostic variables did not predict adherence status. Subjects' beliefs about themselves and their control over the disorder were more important than side-effects in predicting medication adherence. Self-reported assessments were predictive of admission to hospital in the year after the interview. CONCLUSION: Although the study has a number of methodological limitations, the results suggest that clinical assessment of components of HBMs may improve the detection of patients at risk of non-adherence to mood-stabilising medication.

Adult↗
PubMed2002

Self-reported adherence to treatment with mood stabilizers, plasma levels, and psychiatric hospitalization.

OBJECTIVE: The authors explored the relationship of adherence to treatment with mood stabilizers (lithium, carbamazepine, and sodium valproate) and plasma levels of these drugs to future psychiatric hospitalizations. METHOD: They prospectively followed 98 patients with mood disorders who were prescribed mood stabilizers. These patients participated in an initial interview and completed a questionnaire regarding their adherence to the medications. Data on their plasma levels of these drugs were taken from assays done in the 3 months before the interview. RESULTS: Six of the 98 patients were not classified as to medication adherence or plasma levels. Twenty-nine (32%) of the remaining patients reported partial adherence to the medication regimen, and 33 (36%) had an index plasma level that was suboptimal. At 18 months, rates of admission to a psychiatric hospital were significantly higher in the 16 partially adherent patients with subtherapeutic plasma levels (N=13, 81%) than in the 46 adherent patients with therapeutic plasma levels (N=4, 9%). However, hospital admission was also more likely in partially adherent patients with therapeutic plasma levels than in adherent patients with subtherapeutic plasma levels. CONCLUSIONS: Adherence to medication regimens may be a proxy measure of other healthy behaviors.

Adolescent↗
PubMed2002

Nonadherence with mood stabilizers: prevalence and predictors.

BACKGROUND: The prevalence of nonadherence with mood stabilizers ranges from about 18% to 52%. Only 1% of publications on mood stabilizers address this issue. This study aimed to explore the prevalence and predictors of nonadherence in a cohort of individuals with affective disorders receiving long-term treatment with mood stabilizers. METHOD: Subjects receiving lithium, carbamazepine, and/or valproate were identified from biochemistry laboratory data. Ninety-eight of these subjects had major depressive disorder (N = 20) or bipolar disorder (N = 78) (DSM-IV) and gave informed consent to participate in a structured clinical interview to assess their medication adherence and the factors that influenced it. RESULTS: Just under 50% of subjects (46/98) acknowledged some degree of medication nonadherence in the previous 2 years, and 32% (29/92) reported only partial adherence in the last month (missing 30% or more of their prescribed medication). Backward stepwise logistic regression demonstrated that partially adherent subjects were best distinguished from adherent subjects by a more frequent past history of nonadherence, denial of severity of illness, and greater duration of being prescribed a mood stabilizer. CONCLUSION: Rates of mood stabilizer nonadherence are high. Attitudes and behaviors are better predictors of nonadherence than side effects from medication. Clinicians need to inquire routinely about problems with adherence.

Adult↗