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PubMed2006

Compliance therapy for schizophrenia.

BACKGROUND: Schizophrenia is a severe mental illness characterised by delusions and hallucinations. Antipsychotic drugs does reduce these symptoms, but at least half of people given these drugs do not comply with the treatment regimen prescribed. OBJECTIVES: To assess the effects of compliance therapy on antipsychotic medication adherence for people with schizophrenia. SEARCH STRATEGY: Cochrane Schizophrenia Group Trials Register (June 2005). SELECTION CRITERIA: We included all randomised controlled trials of 'compliance therapy' for people with schizophrenia or related severe mental disorders. DATA COLLECTION AND ANALYSIS: We independently extracted data and, for dichotomous data, calculated the relative risk (RR), its 95% confidence interval (CI) on an intention to treat basis. We present continuous data using the weighted mean difference statistic. MAIN RESULTS: We included one trial with relevant and available data (n=56, duration 2 years) comparing compliance therapy with non-specific counseling. The primary outcome 'non-compliance with treatment' showed no significant difference between compliance therapy and non-specific counseling (n=56, RR 1.23 CI 0.74 to 2.05). The compliance therapy did not substantially effect attitudes to treatment (n=50, WMD DAI score -2.10 CI -6.11 to 1.91). Very few people (~10%) left the study by one year (n=56, RR 0.5 CI 0.1 to 2.51). Mental state seemed unaffected by the therapy (n=50, WMD PANSS score 6.1 CI -4.54 to 16.74) as was insight (n=50, WMD SAI -0.5 CI -2.43 to 1.43), global functioning (n=50, WMD GAF -4.20 CI -16.42 to 8.02) and quality of life (n=50, WMD QLS -3.40 CI -16.25 to 9.45). At both one and two years the average number of days in hospital was non-significantly reduced for those allocated to the compliance therapy. AUTHORS' CONCLUSIONS: There is no clear evidence to suggest that compliance therapy is beneficial for people with schizophrenia and related syndromes but more randomised studies are justified and needed in order for this intervention to be fully examined.

Antipsychotic Agents↗

PubMed2002

Olanzapine in the treatment of anorexia nervosa: an open label trial.

OBJECTIVE: The primary goal of the study was to determine if olanzapine is effective in producing weight gain in patients with anorexia nervosa. METHOD: Twenty patients with anorexia nervosa (restricting or binge/purge subtype) without schizophrenia, schizoaffective disorder, or bipolar disorder enrolled in an open label study of olanzapine 10 mg. Patients attended weekly drug monitoring sessions and weekly group medication adherence sessions that provided psychoeducation. RESULTS: Eighteen patients received the drug and 14 patients completed the 10-week study. The four drop-outs had gained a mean of 3.25 lb at their last visit. Of the 14 patients who completed the study, 10 gained an average of 8.75 lb and 3 of these patients attained their ideal body weight. The remaining four patients who completed the study lost a mean of 2.25 lb. DISCUSSION: These findings are promising with clinically significant weight gain in an outpatient setting during a brief 10-week period.

Adolescent↗

PubMed2000

An integrated program for comprehensive HIV care.

HIV-AIDS medical care systems that do not have full integration of mental health, alcohol, and substance use services--including the key components of prophylaxis, medication adherence, and outpatient symptom management--risk less-than-optimal outcomes. This chapter provides a model for integrated treatment.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Perceived need for alcohol, drug, and mental health treatment.

BACKGROUND: To investigate determinants of perceived need for alcohol, drug, and mental (ADM) health treatment and differences in ADM treatment patterns between individuals with perceived need and those without. METHODS: We used data from a nationally representative telephone survey of 9585 adults conducted in 1997-1998. Logistic regression was used to study the determinants of perceived need and the correlation between perceived need and any ADM treatment, specialty ADM treatment, appropriate care, and medication adherence. RESULTS: Just fewer than 37% of individuals with an ADM disorder perceived a need for treatment, while 4.6% of those without an ADM disorder perceived a need for treatment. Women, the young and middle aged, the better educated, those with greater emotional support, and those with greater psychiatric morbidity were more likely to perceive need for ADM services. Perceived need was strongly correlated with receiving ADM treatment, although almost 44% of individuals in ADM treatment did not perceive a need for treatment. Among individuals in ADM treatment, those with perceived need were significantly more likely to receive specialty ADM treatment, but not more likely to be treatment adherent, or to receive appropriate care. CONCLUSION: Substantial levels of unmet need are likely to persist as long as perceived levels of need remain low. Interventions targeting perceived need may hold promise for decreasing unmet need.

Alcoholism↗

PubMed2006

Domains of life satisfaction among patients living with HIV: A factor analytic study of the quality of life inventory.

This study sought to identify multidimensional factors of life satisfaction in individuals with HIV through a factor analysis of the Quality of Life Inventory (QOLI), and to examine the relationship of these factors to health-related quality of life, depression, and medication adherence. Four quality of life domains emerged: Achievement, Self-Expression, Environment, and Interpersonal Relationships. QOLI means were substantially lower than the normative means and were significantly related to the SF-12 mental (but not the physical) component summary. Multidimensional assessments of quality of life in HIV may help specify targets sensitive to psychosocial interventions.

Achievement↗

PubMed2007

A social cognitive model of health for HIV-positive adults receiving care in India.

In-depth interviews were conducted with 50 HIV-positive adults (23 women, 27 men) with access to care at a non-governmental organization in Chennai, India to gain a broad understanding of how they managed their HIV infection. Using a Social Cognitive Model of Health, we identified factors within the model's three domains--Personal, Environmental, and Behavioral--that are applicable to this socio-cultural context. The Personal domain's factors were a positive self-concept, family-focused goals, and treatment optimism; the Environmental domain comprised family-based support, treatment availability, access and quality, and HIV stigma and discrimination; and the Behavior domain's factors were medication adherence and health habits, sexual behavior, and social relationships and emotional well-being. Significant differences for many of the factors within the three domains were observed across married men and women, widowed women, unmarried men, and female sex workers. Implications for an enhanced intervention for HIV-infected individuals in similar treatment settings are discussed.

Adult↗

PubMed2006

HIV/AIDS patients who move to urban Florida counties following a diagnosis of HIV: predictors and implications for HIV prevention.

We characterized patients at publicly funded HIV/AIDS patient treatment sites who moved ("migrated") post-diagnosis of HIV to five urban Florida counties, by geographic, demographic, socioeconomic and risk variables. Each patient who came for services at the sites in a 2-3 week sampling period was asked to complete a brief, self-administered questionnaire. We compared migrant with non-migrant patients to disclose characteristics predictive of migration and help plan for continuity of HIV care, future funding, and HIV prevention. Overall, 25% (range by site, 20%-38%) of the 1,286 patients in the study migrated to the counties from a non-contiguous Florida county, another state, or another country. In a multivariate model comparing interstate migrants with non-migrants, white and Hispanic race/ethnicity, age 9-29 years at first HIV diagnosis compared with older age, increasing education, highest current income and exposure category (men having sex with men and injection drug users) were independently associated with migration (all p < 0.05). In a similar model for international migrants, the independently associated variables included Hispanic ethnicity, education, and younger age at first HIV diagnosis. Although migrating can bring benefits to a patient such as improved access to health care or a new employment opportunity, it is stressful because it can result in changes in a person's social network, employment, and health care providers. Thus, moving could create unique patient needs concerning medication adherence, risk-taking, and other psychosocial needs. Given the high percentage of migrants in these urban Florida county clinics, these needs should be further examined and addressed.

Adolescent↗

PubMed2005

The methamphetamine epidemic: implications for HIV prevention and treatment.

Methamphetamine and related amphetamine compounds are among the most commonly used illicit drugs, with over 35 million users worldwide. In the United States, admissions for methamphetamine treatment have increased dramatically over the past 10 years. Methamphetamine use is prevalent among persons with HIV infection and persons at risk for HIV, particularly among men who have sex with men. In addition to being associated with increased sexual risk behavior, methamphetamine causes significant medical morbidity, including neurologic deficits, cardiovascular compromise, dental decay, and skin infections, all of which may be worsened in the presence of HIV/AIDS. Methamphetamine use may also result in decreased medication adherence, particularly during "binging" episodes. Behavioral counseling remains the standard of treatment for methamphetamine dependence, although the effectiveness of most counseling interventions has not been rigorously tested. Pharmacologic and structural interventions may prove valuable additional interventions to reduce methamphetamine use.

Amphetamine-Related Disorders↗

PubMed2006

Contingency management interventions for HIV-related behaviors.

Contingency management (CM) is a scientifically based treatment approach typically employed in substance abuse treatment settings to reinforce drug abstinence, counseling attendance, completion of activities, or other treatment goals. Although the application of CM to HIV management has few published studies, it shows promise as an intervention for HIV-related behaviors. CM interventions such as voucher reinforcement, prize systems, and cash incentives can be used to reduce HIV risk behaviors and to improve HIV medication adherence. CM programs have wide applicability to HIV prevention and management in clinical and community settings and can be implemented as stand-alone techniques or in combination with other interventions.

Behavior Therapy↗

PubMed2006

An update on the role of psychotherapy in the management of bipolar disorder.

Recent studies have examined the value of combining structured forms of psychotherapy with medication maintenance for patients with bipolar disorder. These studies have been influenced by the growing body of literature on stress in the elicitation of manic and depressive episodes. Randomized trials published within the past 5 years indicate positive benefits of cognitive-behavioral therapy, interpersonal and social rhythm therapy, family-focused therapy, and group psychoeducation as adjuncts to mood stabilizers in delaying recurrences, stabilizing symptoms, and improving medication adherence. Open trials of family interventions for pediatric-onset bipolar patients also have yielded promising results. Questions remain about the relative advantages of one psychosocial approach over the others, whether there are subgroups of patients who respond to each type of intervention, the impact of psychotherapy on role functioning, mediators of treatment effects, and the potential utility of early intervention as a means of delaying the onset and/or severity of the disorder.

Antimanic Agents↗

PubMed2006

Quality of care in African-American patients admitted for congestive heart failure at a university teaching hospital.

Previous studies have shown that the quality of congestive heart failure (CHF) treatment for hospitalized patients varies. The goal of this study was to evaluate the compliance of physicians at a large, inner-city teaching hospital with current evidence-based guidelines. A retrospective review of the medical records of 104 patients admitted with CHF was conducted. Quality-of-care indicators were assessed, including the use of echocardiograms, the administration of angiotensin-converting enzyme (ACE) inhibitors and beta blockers to appropriate patients, and lifestyle and medication counseling at discharge. The assessment of left ventricular (LV) function was documented in 96.1% of patients (n = 100). A total of 65 patients (92.8%) with systolic dysfunction were considered to be ideal candidates for ACE inhibitor therapy. Of these 65 patients, 58 (89.2%) were discharged on ACE inhibitors. Of 41 patients with LV systolic dysfunction who were considered to be ideal candidates for beta-blocker therapy, only 10 (24.4%) were discharged on beta-blocker therapy. Of all patients with CHF, 50% received discharge counseling on medication compliance, 48% received counseling on a low-salt diet, and only 9% were told to monitor daily weight. This study shows that in a major academic teaching hospital, there is a need for improvement in the use of beta-blocker therapy as well as greater emphasis on patient education strategies regarding diet, medication adherence, and monitoring daily weight.

Adrenergic beta-Antagonists↗

PubMed2005

Biological properties and mechanism of action of ibandronate: application to the treatment of osteoporosis.

Bisphosphonates, with their proven efficacy and safety, are the most commonly prescribed treatment for women with postmenopausal osteoporosis; however, optimal efficacy is often not achieved due to poor patient adherence to medication. Poor adherence leads to an increased risk of fracture, which itself results in morbidity, elevated healthcare costs and potentially, mortality. Although weekly rather than daily dosing of bisphosphonates has improved adherence, there remains a significant problem, and dosing less frequently than weekly has been suggested as a possible means for further improving adherence. Ibandronate is a new bisphosphonate that has a specific structure and set of characteristics that enable less frequent dosing than currently available bisphosphonates. This review provides details of the general structural features of all bisphosphonates and how these are understood to contribute to their functions in osteoporosis treatment. From this, the unique structure of ibandronate is described, along with how this translates into the high antiresorptive potency, favorable bone-binding, persistence in bone, and good tolerability that permits less frequent dosing. Finally, the clinical evidence for ibandronate is briefly presented, demonstrating the viability of less frequent dosing, with its potential benefits for patient convenience and adherence to therapy.

Bone Resorption↗

PubMed2006

Difficulty taking medications, depression, and health status in heart failure patients.

BACKGROUND: Little is known about medication nonadherence in heart failure populations. We evaluated the association between 1 aspect of medication nonadherence, patient-reported difficulty taking medications as directed, and health status among heart failure outpatients, and then examined whether this association was explained by depression. METHODS AND RESULTS: A total of 522 outpatients with left ventricular ejection fraction <0.40 completed clinical evaluation, Kansas City Cardiomyopathy Questionnaire (KCCQ), Medical Outcomes Study-Depression questionnaire, and categorized their difficulty taking medications (5-level Likert-scale question). Multivariable regression was used to evaluate the cross-sectional association between difficulty taking medications and health status, with incremental adjustment for medical history and depressive symptoms. Patients with difficulty taking medications (n = 64; 12.2%) had worse health status (8.2 +/- 2.7 point lower mean KCCQ summary scores; P = .008) and more depressive symptoms (43.8% versus 27.1%; P = .006). Adjusting for demographic and clinical factors had little effect on the association between difficulty taking medications and health status (8.0 +/- 3.2 point lower KCCQ scores; P = .01); however, the relationship was attenuated with adjustment for depressive symptoms (4.7 +/- 2.9 point lower KCCQ scores; P = .11). CONCLUSIONS: Among heart failure outpatients, difficulty taking medications is associated with worse health status. This association appears to be explained, in part, by coexistent depression. Future studies should evaluate interventions such as depression treatment to improve medication adherence and health status.

Aged↗

PubMed2005

The veterans' study to improve the control of hypertension (V-STITCH): design and methodology.

BACKGROUND: Among the 60 million Americans with hypertension, only approximately 31% have their blood pressure (BP) under control (<140/90 mm Hg). Despite the damaging impact of hypertension and the availability of evidence-based target values for BP, interventions to improve BP control have had limited success. OBJECTIVES: A randomized controlled health services intervention trial with a split-plot design is being conducted to improve BP control. This 4-year trial evaluates both a patient and a provider intervention in a primary care setting among diagnosed hypertensive veterans. METHODS: In a cluster-randomization, 30 primary care providers in the Durham VAMC Primary Care Clinic were randomly assigned to receive the provider intervention or control. The provider intervention is a patient-specific electronically generated hypertension decision support system (DSS) delivering guideline-based recommendations to the provider at each patient's visit, designed to improve guideline-concordant therapy. For these providers, a sample of their hypertensive patients (n=588) was randomly assigned to receive a telephone-administered patient intervention or usual care. The patient intervention incorporates patients' need assessments and involves tailored behavioral and education modules to promote medication adherence and improve specific health behaviors. All modules are delivered over the telephone bi-monthly for 24 months. In this trial, the primary outcome is the proportion of patients who achieve a BP < or =140/90 mm Hg at each outpatient clinic visit over 24 months. CONCLUSION: Despite the known risk of poor BP control, a majority of adults still do not have their BP controlled. This study is an important step in testing the effectiveness of a patient and provider intervention to improve BP control among veterans in the primary care setting.

Adult↗

PubMed2006

The Take Control of Your Blood pressure (TCYB) study: study design and methodology.

BACKGROUND: Among the 65 million Americans with hypertension, only approximately 31% have their blood pressure under control (<140/90 mm/Hg). Despite the damaging impact of hypertension and the availability of evidence-based target values for blood pressure, interventions to improve blood pressure control have had limited success. OBJECTIVES: A randomized controlled health services intervention trial with a two by two design is being conducted to improve blood pressure control. This five-year trial evaluates two patient-directed interventions designed to improve blood pressure control among patients diagnosed with hypertension in a community-based primary care setting. METHODS: Patients are randomized to one of four groups: usual care, home blood pressure monitoring, tailored behavioral self-management intervention that is administered via telephone by a nurse, or a combination of the home blood pressure monitoring and tailored behavioral intervention. Patients receiving the home blood pressure monitoring are trained in the use of an electronic blood pressure measurement device, are asked to measure their blood pressure 3 times/week, and send in two-month blood pressure recordings throughout the 24-month study duration. The behavioral intervention incorporates patients' need assessments and involves tailored behavioral and education modules to promote medication adherence and improve specific health behaviors. A nurse delivers all behavioral self-management modules over the telephone bi-monthly for 24 months. The primary outcome is the proportion of patients who achieve control of their blood pressure based on evidence-based guidelines (for patients without diabetes <140/90 mm/Hg, for patients with diabetes <130/80 mm/Hg) evaluated at six-month intervals over 24 months (five measurements) using a random-zero sphygmomanometer. CONCLUSION: Despite the known risk of poor blood pressure control, and the wide availability of effective treatment strategies, a majority of adults still do not have their blood pressure controlled. This study will be an important step in defining two explicit interventions to improve blood pressure control. To our knowledge, this study is the first to combine both a tailored behavioral self-management intervention and self-monitoring home blood pressure intervention to improve blood pressure control among patients in a primary care setting.

Antihypertensive Agents↗

PubMed2006

Randomized, placebo-controlled trial of baclofen and gabapentin for the treatment of methamphetamine dependence.

OBJECTIVE: To conduct a 16-week, randomized, placebo-controlled, double-blind trial of two GABAergic medications, baclofen (20 mg tid) and gabapentin (800 mg tid), for the treatment of methamphetamine dependence. METHODS: Adults with methamphetamine dependence were randomized to one of three conditions for 16 weeks: baclofen (n = 25), gabapentin (n = 26) or placebo (n = 37). All participants attended clinic thrice weekly to receive study medication and psychosocial counseling, complete study assessments, and provide urine samples. RESULTS: No statistically significant main effects for baclofen or gabapentin in reducing methamphetamine use were observed using a generalized estimating equation (GEE). A significant treatment effect was found in post hoc analyses for baclofen, but not gabapentin, relative to placebo among participants who reported taking a higher percentage of study medication (significant treatment group and medication adherence interaction in GEE model of methamphetamine use). CONCLUSIONS: While gabapentin does not appear to be effective in treating methamphetamine dependence, baclofen may have a small treatment effect relative to placebo. Future studies evaluating the effectiveness of baclofen and other GABAergic agents for treatment of methamphetamine may be warranted.

Adult↗

PubMed2006

Safety, tolerability and efficacy of levodopa-carbidopa treatment for cocaine dependence: two double-blind, randomized, clinical trials.

RATIONALE: The role of dopamine in cocaine abuse has been long recognized. Cocaine use can profoundly alter dopaminergic functioning through depletion of this monoamine and changes in receptor functioning. Based on these facts, levodopa (L-dopa) pharmacotherapy may be helpful in reducing or abolishing cocaine use. OBJECTIVE: The current studies sought to evaluate the safety, tolerability and efficacy of L-dopa as a treatment for cocaine dependence. METHODS: In Study 1, 67 cocaine-dependent subjects were randomized in a 5-week, double-blind, placebo-controlled safety trial. Subjects received either placebo, or 400 mg L-dopa plus 100 mg of the peripheral decarboxylase inhibitor, carbidopa, in a sustained-release preparation (Sinemet CR). In Study 2, 122 cocaine-dependent subjects were enrolled in a 9-week, randomized, double-blind, placebo-controlled trial to compare placebo to 400/100 mg and 800/200 mg L-dopa/carbidopa treatments. Placebo or L-dopa were administered twice daily in both studies. RESULTS: L-dopa was well tolerated with similar retention and medication adherence rates compared to placebo. Only two side effects occurred more often in L-dopa-treated patients: nausea and dizziness. L-dopa lowered diastolic blood pressure in a dose-dependent fashion. In these trials, L-dopa had no effect on cocaine use, cocaine craving, or mood. CONCLUSION: These two studies demonstrate the safety and tolerability of L-dopa pharmacotherapy in cocaine-dependent patients. No evidence for greater efficacy of L-dopa compared to placebo was observed. The possibility of enhancing treatment effects by combining L-dopa with other behavioral or pharmacological interventions is discussed.

Adult↗

PubMed2006

Influence of viral chronic hepatitis co-infection on plasma drug concentrations and liver transaminase elevations upon therapy switch in HIV-positive patients.

It is still controversial whether viral hepatitis co-infection can influence antiretroviral plasma drug concentrations and whether drug concentrations are correlated with liver enzyme elevations during highly active antiretroviral therapy. An analysis of data from a cohort of 220 human immunodeficiency virus (HIV)-infected patients was conducted. Univariate and multivariate logistic analyses were performed to identify predictors of plasma drug concentrations. The association of transaminase elevation with higher plasma drug concentrations was explored following stratification of patients into HIV monoinfected and hepatitis C virus (HCV) and/or hepatitis B virus (HBV) co-infected groups. Hepatitis co-infections were independently correlated with drug concentrations above the therapeutic cut-offs at Week 1 (P=0.06), Week 4 (P=0.04) and Week 12 (P=0.005). The apparent effect was independent of the possible impact exerted by other variables such as demographics and medication adherence. The incidence of relevant hypertransaminasaemia was low. Patients with hepatitis co-infections had higher rates of transaminase elevation than monoinfected HIV patients; however, risk of transaminase elevation was not associated with drug concentrations. The presence of HCV and/or HBV co-infections correlated with higher plasma drug concentrations, although it did not appear to influence hepatotoxicity risk.

Adult↗