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Biomedical subjects

W Likosky

Publications and source records attributed to W Likosky.

10 recordsLinked to original sources
PubMed2001

Injectable medication for the treatment of multiple sclerosis: the influence of self-efficacy expectations and injection anxiety on adherence and ability to self-inject.

The management of many chronic illnesses involves medications that must be injected on a frequent basis. With fewer support resources available, patients are increasingly being obliged to manage injectable medications themselves. Interferon beta-1a (IFNbeta-1a), recommended for the treatment of multiple sclerosis (MS), must be injected intramuscularly on a weekly basis. Patients are generally advised and taught to self-inject, if possible. This longitudinal study examined cognitive and affective contributions to the ability to self-inject and adherence to IFNbeta-1a over 6 months following initiation of medication. Participants were 101 patients with a relapsing form of MS. Injection self-efficacy expectations, injection anxiety, adherence expectations, method of injection administration, and 6-month adherence to IFNbeta-1a were fitted to a path analytic model. Pretreatment injection self-efficacy expectations were significantly related to 6-month adherence. This relation was mediated by the patient's ability to self-inject. Patients 'experienced level of injection anxiety was related to adherence but not to method of injection.

Adjuvants, Immunologic↗
PubMed2000

Telephone-administered cognitive-behavioral therapy for the treatment of depressive symptoms in multiple sclerosis.

This study examined the efficacy of an 8-week telephone-administered cognitive-behavioral therapy (CBT) for the treatment of depressive symptomatology in multiple sclerosis (MS) patients. The treatment, Coping with MS (CMS), included a patient workbook designed to structure the treatment, provide visual aids, and help with homework assignments. Thirty-two patients with MS, who scored at least 15 on the Profile of Mood States Depression-Dejection scale, were randomly assigned to either the telephone CMS or to a usual-care control (UCC) condition. Depressive symptomatology decreased significantly in the CMS condition compared with the UCC condition. Furthermore, adherence to interferon beta-1a, a disease-modifying medication for the treatment of MS, was significantly better at the 4-month follow-up among patients who received CMS as compared with those in the UCC condition.

Adaptation, Psychological↗
PubMed1999

Course of depression during the initiation of interferon beta-1a treatment for multiple sclerosis.

OBJECTIVE: To examine the hypothesis that increases in depression after initiation of treatment with interferon beta-1a for multiple sclerosis can be explained as representing a return to pretreatment levels of depression. DESIGN: Level of depression in patients with multiple sclerosis was assessed at 3 time points: 2 weeks before initiation of interferon beta-la treatment, at initiation of treatment, and at 2-month follow-up. SETTING: A health maintenance organization. PATIENTS: Fifty-six patients with confirmed relapsing forms of multiple sclerosis. MAIN OUTCOME MEASURE: The depression-dejection scale of the Profile of Mood States. RESULTS: Patients who scored high on the depression measure 2 weeks before the initiation of interferon beta-1a treatment showed significant reduction in depression at the initiation of treatment. However, depression returned nearly to initial levels within 2 months. CONCLUSIONS: These findings suggest that increases in depression after initiation of interferon beta-1a treatment are related to level of depression 2 weeks before initiation of treatment. Physicians should assess history of depression for all patients in whom interferon beta-1a treatment is initiated. Patients with a recent history of depression are at risk for increased depression within 2 months after starting interferon beta-1a treatment, even though they may not be depressed at the time of treatment initiation.

Adjuvants, Immunologic↗
PubMed1999

The psychosocial impact of multiple sclerosis: exploring the patient's perspective.

This study examined subjective patient experiences of the psychosocial consequences of multiple sclerosis (MS). Fifty patients were interviewed regarding the effects MS had on their lives and interpersonal relationships. These statements were collated and administered with a 5-point Likert scale to 94 MS patients. The responses were subjected to factor analysis. Three areas of subjective patient experience of the psychosocial consequences of MS emerged: demoralization, benefit-finding, and deteriorated relationships. Of particular interest was benefit-finding, which included a deepening of relationships, enhanced appreciation of life, and an increase in spiritual interests. Although benefit-finding was related to adaptive coping strategies such as positive reappraisal and seeking social support, it was unrelated to depression and was related to higher levels of anxiety and anger. These findings indicate that benefit-finding is a substantial and poorly understood part of the illness experience for MS patients.

Adaptation, Psychological↗
PubMed1998

Side effect profile and adherence to in the treatment of multiple sclerosis with interferon beta-1a.

This study examines the course of patient-reported side effects during the first 4 months of treatment for multiple sclerosis (MS) with interferon beta-1a (IFN beta-1a), and the relationship of those side effects to discontinuation of medication. Flu-like symptoms, muscle aches and chills decreased over the first 2 months of treatment but did not change over the second 2 months. Loss of feeling or numbness, tingling and depression increased over 4 months, however these side effects were generally mild. Loss of feeling or numbness and tingling at 2 month follow-up were significantly related to discontinuation of IFN beta-1a by 4 month follow-up.

Adolescent↗
PubMed1997

Treatment of depression improves adherence to interferon beta-1b therapy for multiple sclerosis.

OBJECTIVES: To examine the relationship between patient-reported depression and adherence to therapy with interferon beta-1b (IFN beta-1b) and to test the hypothesis that treatment of depression is associated with improved adherence. DESIGN: Patients with multiple sclerosis were followed up 6 months after initiating therapy with IFN beta-1b. SETTING: A university outpatient multiple sclerosis center, an academic group practice, and a health maintenance organization. PATIENTS: Eighty-five patients with clinically evident multiple sclerosis taking IFN beta-1b. MAIN OUTCOME MEASURE: Follow-up questionnaire. RESULTS: Thirty-five (41%) of the 85 patients reported new or increased depression within 6 months of initiating therapy with IFN beta-1b. Patients experiencing symptoms of depression were more likely to discontinue therapy. Among the patients reporting new or increased depression, 86% who received psychotherapy or antidepressant medication and 38% of the patients who received no therapy for depression continued the IFN beta-1b therapy (P = .003). Although psychotherapy was used as a treatment option more frequently in university and academic group practice-based multiple sclerosis clinics than in the health maintenance organization (P = .02), the treatment adherence patterns were similar across sites. CONCLUSIONS: These findings support previous findings that patients report increased depression after initiating therapy with IFN beta-1b. Although the source of this depression is unclear, these findings suggest that treating patient-reported depression increases adherence to treatment.

Adjuvants, Immunologic↗
PubMed1997

Identification of Beck Depression Inventory items related to multiple sclerosis.

The percentage contribution of each item on the Beck Depression Inventory (BDI) to the total BDI score was compared across patients with multiple sclerosis (MS), patients diagnosed with major depressive disorder, and normal college students. We considered an item to be confounded by MS-related symptoms if its percentage contribution to the total BDI score was significantly greater in the MS group than the major depression and control groups. Items measuring work difficulty, fatigue, and concerns about health met this criterion. These items accounted for 34, 17, and 19% of the total BDI score in the MS, major depression, and control groups, respectively. Using the 18-item BDI (BDI-18) which resulted from excluding the 3 confounded items, MS patients found to be were more depressed than controls but less depressed than the major depression group. The identification of signs of depression not confounded with MS which could be substituted for confounded signs was also discussed.

Adult↗
PubMed1996

Therapeutic expectations of patients with multiple sclerosis upon initiating interferon beta-1b: relationship to adherence to treatment.

This study, conducted in three separate outpatient health care delivery settings, examined the therapeutic expectations of patients with multiple sclerosis (MS) before they initiated interferon beta-1b therapy, the results of current educational procedures to correct unrealistic expectations, and the relationship between post-education expectations and discontinuing therapy. Ninety-nine consecutive patients were seen in a university based outpatient MS clinic, an academic group practice outpatient MS clinic, or a health maintenance organization outpatient neurology clinic. Before the educational sessions, 57% of the patients expressed unrealistically optimistic expectations regarding reduction in attack rate and 34% expressed unrealistically optimistic expectations regarding improvement in functional status. Educational procedures significantly altered unrealistic expectations but the results were sub-optimal since 33% of the patients maintained overly optimistic expectations regarding reduction in attack rate. Post-education unrealistic expectations of improvement in functional status were significantly related to discontinuing therapy within 6 months. Three adverse effects of therapy also were related independently to adherence to treatment: depression and flu-like symptoms were related to discontinuing therapy while soreness at injection site was related to continuing therapy.

Adjuvants, Immunologic↗
PubMed1982

Exacerbation detection in multiple sclerosis by clinical and evoked potential techniques: a preliminary report.

The EP is well demonstrated as a useful indicator of subclinical demyelinating disease. Our study performed on patients well defined as MS and monitored closely for clinical exacerbations demonstrated an unexpectedly high occurrence of significant worsening in EP parameters. These changes occurred in the presence or absence of clinical worsening. The parameter changes may represent new demyelination or other pathologic or neurophysiologic changes in neuropathologically static lesions.

Adult↗