Medication Adherence Among Children and Adolescents with Severe Mental Illness: A Systematic Review and Meta-Analysis.

Medication Adherence Among Children and Adolescents with Severe Mental Illness: A Systematic Review and Meta-Analysis.

J Child Adolesc Psychopharmacol. 2018 Jul 24;:

Authors: Edgcomb JB, Zima B

Abstract
OBJECTIVE: To perform a systematic review and meta-analysis of studies investigating predictors of medication adherence in children and adolescents with severe mental illness (SMI).
METHOD: A systematic literature search was conducted in PubMed/MEDLINE, Web of Science, and PsycINFO from 1980 through October 1st, 2017, for original peer-reviewed articles that investigated predictors of adherence to psychopharmacologic treatment among children (≤18-years-old) with a primary psychotic disorder, bipolar disorder, depression, recent suicide attempt, or psychiatric hospitalization. Effect sizes (ESs) for individual predictors were extracted and combined using DerSimonian-Laird random-effects meta-analysis. Meta-regression and moderator analyses were conducted to investigate subgroups. This review complied with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.
RESULTS: A total of 28 studies (n = 180,870) met inclusion criteria; 65.9% (±20.9%) of children and adolescents with SMI were medication adherent. Adherence was associated with patient and family attitudes toward care, adherence to psychotherapy, and insight. Nonadherence was associated with illness severity, substance use, and attention-deficit/hyperactivity disorder. Heterogeneity was moderate-to-large for most ES estimates (I2 > 50%). Age, sex, underlying diagnosis, and study methodology emerged as significant moderators.
CONCLUSION: Medication nonadherence among youth with SMI is highly prevalent. Children and adolescents with more severe illness and higher comorbidity burden are at greater risk for nonadherence. Positive interpersonal care processes and adherence to nonpharmacological treatment may be protective. These findings inform development of a risk profile for nonadherence among youth with SMI. Future prospective research is needed to address the shortcomings in the existing literature and inform interventions to improve adherence.

PMID: 30040434 [PubMed – as supplied by publisher]

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Medication Adherence Among Children and Adolescents with Severe Mental Illness: A Systematic Review and Meta-Analysis.

Medication Adherence Among Children and Adolescents with Severe Mental Illness: A Systematic Review and Meta-Analysis.

J Child Adolesc Psychopharmacol. 2018 Jul 24;:

Authors: Edgcomb JB, Zima B

Abstract
OBJECTIVE: To perform a systematic review and meta-analysis of studies investigating predictors of medication adherence in children and adolescents with severe mental illness (SMI).
METHOD: A systematic literature search was conducted in PubMed/MEDLINE, Web of Science, and PsycINFO from 1980 through October 1st, 2017, for original peer-reviewed articles that investigated predictors of adherence to psychopharmacologic treatment among children (≤18-years-old) with a primary psychotic disorder, bipolar disorder, depression, recent suicide attempt, or psychiatric hospitalization. Effect sizes (ESs) for individual predictors were extracted and combined using DerSimonian-Laird random-effects meta-analysis. Meta-regression and moderator analyses were conducted to investigate subgroups. This review complied with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.
RESULTS: A total of 28 studies (n = 180,870) met inclusion criteria; 65.9% (±20.9%) of children and adolescents with SMI were medication adherent. Adherence was associated with patient and family attitudes toward care, adherence to psychotherapy, and insight. Nonadherence was associated with illness severity, substance use, and attention-deficit/hyperactivity disorder. Heterogeneity was moderate-to-large for most ES estimates (I2 > 50%). Age, sex, underlying diagnosis, and study methodology emerged as significant moderators.
CONCLUSION: Medication nonadherence among youth with SMI is highly prevalent. Children and adolescents with more severe illness and higher comorbidity burden are at greater risk for nonadherence. Positive interpersonal care processes and adherence to nonpharmacological treatment may be protective. These findings inform development of a risk profile for nonadherence among youth with SMI. Future prospective research is needed to address the shortcomings in the existing literature and inform interventions to improve adherence.

PMID: 30040434 [PubMed – as supplied by publisher]

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Aripiprazole Lauroxil NanoCrystal® Dispersion Technology (Aristada Initio®).

Aripiprazole Lauroxil NanoCrystal® Dispersion Technology (Aristada Initio®).

Clin Schizophr Relat Psychoses. 2018;12(2):92-96

Authors: Ehret MJ, Davis E, Luttrell SE, Clark C

Abstract
Nonadherence to antipsychotic medications for the treatment of schizophrenia is a widely recognized concern, leading to poorer clinical outcomes and higher treatment costs. Long-acting injectable (LAI) antipsychotics offer an extended dosing interval option for patients, although the current options may require an oral overlap at initiation. Aripiprazole lauroxil is an LAI that offers multiple dosing options but requires oral treatment overlap during initiation for the first 21 consecutive days. As an alternative to oral overlap, a novel nano-crystalline milled dispersion delivery system of aripiprazole lauroxil was recently approved as a one-day regimen to be added to aripiprazole lauroxil treatment.

PMID: 30040476 [PubMed – in process]

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Aripiprazole Lauroxil NanoCrystal® Dispersion Technology (Aristada Initio®).

Aripiprazole Lauroxil NanoCrystal® Dispersion Technology (Aristada Initio®).

Clin Schizophr Relat Psychoses. 2018;12(2):92-96

Authors: Ehret MJ, Davis E, Luttrell SE, Clark C

Abstract
Nonadherence to antipsychotic medications for the treatment of schizophrenia is a widely recognized concern, leading to poorer clinical outcomes and higher treatment costs. Long-acting injectable (LAI) antipsychotics offer an extended dosing interval option for patients, although the current options may require an oral overlap at initiation. Aripiprazole lauroxil is an LAI that offers multiple dosing options but requires oral treatment overlap during initiation for the first 21 consecutive days. As an alternative to oral overlap, a novel nano-crystalline milled dispersion delivery system of aripiprazole lauroxil was recently approved as a one-day regimen to be added to aripiprazole lauroxil treatment.

PMID: 30040476 [PubMed – in process]

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Dose reduction of high-dose first-generation antipsychotics or switch to ziprasidone in long-stay patients with schizophrenia: A 1-year double-blind randomized clinical trial.

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Dose reduction of high-dose first-generation antipsychotics or switch to ziprasidone in long-stay patients with schizophrenia: A 1-year double-blind randomized clinical trial.

Eur Neuropsychopharmacol. 2018 Jul 16;:

Authors: Bogers JPAM, Schulte PFJ, Broekman TG, Moleman P, de Haan L

Abstract
Long-stay patients with severe schizophrenia are frequently treated with high doses of first-generation antipsychotics (FGA). Dose reduction or switching to ziprasidone may reduce the severity of negative symptoms and side effects. We investigated in a randomized double-blind trial whether a dose-reduction strategy to achieve an adequate dose of a FGA (5 mg/day haloperidol equivalents, n = 24) or switching to ziprasidone (160 mg/day, n = 24) in treatment resistant patients would decrease negative symptoms after 1 year of treatment. We found that negative symptoms did not change significantly in either condition. Positive symptoms, excited symptoms, and emotional distress worsened over time with ziprasidone, resulting in a significant difference between conditions in favour of FGA dose reduction. Relapse and treatment failure, defined as a prolonged or repeated relapse, occurred more often with ziprasidone than with FGA (45.8% versus 20.8%, and 25.0% versus 16.7%, respectively). Treatment with ziprasidone was superior for extrapyramidal symptoms. Our study establishes that lowering high FGA doses to an equivalent of 5 mg/day haloperidol or switching to ziprasidone is feasible in the vast majority of patients but does not improve negative or other symptoms. Neither FGA dose reduction nor switching to ziprasidone is an adequate alternative to clozapine for long-stay patients with severe treatment resistant schizophrenia.

PMID: 30025751 [PubMed – as supplied by publisher]

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Exploring predictors of medication adherence among inpatients with schizophrenia in Singapore’s mental health settings: A non-experimental study.

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Exploring predictors of medication adherence among inpatients with schizophrenia in Singapore’s mental health settings: A non-experimental study.
Arch Psychiatr Nurs. 2018 Aug;32(4):536-548
Authors: …

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How Do Patients With Schizophrenia and Their Families Learn About the Diagnosis?

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How Do Patients With Schizophrenia and Their Families Learn About the Diagnosis?
Psychiatry. 2018 Jul 18;:1-5
Authors: Amsalem D, Hasson-Ohayon I, Gothelf D, Roe D
Abstract
OBJECTIVE…

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Effects of Discontinuation of Paliperidone Long-Acting Injectable After Switching from Risperidone Long-Acting Injectable Switching.

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Effects of Discontinuation of Paliperidone Long-Acting Injectable After Switching from Risperidone Long-Acting Injectable Switching.

Psychopharmacol Bull. 2016 Aug 15;46(2):42-52

Authors: Watanabe T, Yamada A

Abstract
BACKGROUND: Risperidone long-acting injection (RLAI) is increasingly being switched to paliperidone palmitate (PP) because of several benefits. However, this switching is not always successful.
METHODS: We examined patient profiles following discontinuation of PP after switching from RLAI. We collected the electronic records of 24 patients with schizophrenia who had switched from RLAI to PP treatment at our hospital between November 2013 and March 2014. Twelve patients continued PP injection for over 1 year (PP-continuers), the other 12 patients discontinued within 1 year (PP-discontinuers), and both groups were followed up until December 31, 2014.
RESULTS: PP-discontinuers had significantly shorter RLAI-administration period (mean 73.1 ± 59.0 weeks versus 148.5 ± 75.0 weeks), and lower chlorpromazine (CP) equivalent mean doses (mean 553.5 ± 251.0 mg versus 1002.5 ± 529.3 mg) compared with PP-continuers. The CP equivalent mean dose of PP-discontinuers had increased at the time of discontinuation and their social status became significantly worse. Six PP-discontinuers (50%) re-switched to RLAI, and their social status was not significantly worse at the end of the observation period.
CONCLUSIONS: On switching from RLAI to PP, we need to consider that some patients have had a shorter RLAI-administration period and may require lower amounts of antipsychotics.

PMID: 27738379 [PubMed – indexed for MEDLINE]

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Effects of Discontinuation of Paliperidone Long-Acting Injectable After Switching from Risperidone Long-Acting Injectable Switching.

Related Articles

Effects of Discontinuation of Paliperidone Long-Acting Injectable After Switching from Risperidone Long-Acting Injectable Switching.

Psychopharmacol Bull. 2016 Aug 15;46(2):42-52

Authors: Watanabe T, Yamada A

Abstract
BACKGROUND: Risperidone long-acting injection (RLAI) is increasingly being switched to paliperidone palmitate (PP) because of several benefits. However, this switching is not always successful.
METHODS: We examined patient profiles following discontinuation of PP after switching from RLAI. We collected the electronic records of 24 patients with schizophrenia who had switched from RLAI to PP treatment at our hospital between November 2013 and March 2014. Twelve patients continued PP injection for over 1 year (PP-continuers), the other 12 patients discontinued within 1 year (PP-discontinuers), and both groups were followed up until December 31, 2014.
RESULTS: PP-discontinuers had significantly shorter RLAI-administration period (mean 73.1 ± 59.0 weeks versus 148.5 ± 75.0 weeks), and lower chlorpromazine (CP) equivalent mean doses (mean 553.5 ± 251.0 mg versus 1002.5 ± 529.3 mg) compared with PP-continuers. The CP equivalent mean dose of PP-discontinuers had increased at the time of discontinuation and their social status became significantly worse. Six PP-discontinuers (50%) re-switched to RLAI, and their social status was not significantly worse at the end of the observation period.
CONCLUSIONS: On switching from RLAI to PP, we need to consider that some patients have had a shorter RLAI-administration period and may require lower amounts of antipsychotics.

PMID: 27738379 [PubMed – indexed for MEDLINE]

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Trajectories and changes in individual items of positive and negative syndrome scale among schizophrenia patients prior to impending relapse.

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Trajectories and changes in individual items of positive and negative syndrome scale among schizophrenia patients prior to impending relapse.

NPJ Schizophr. 2018 Jun 20;4(1):10

Authors: Wang D, Gopal S, Baker S, Narayan VA

Abstract
Effective early detection of impending relapse may offer opportunities for early interventions to prevent full relapse in schizophrenia patients. Previously reported early warning signs were not consistently validated by prospective studies. It remains unclear which symptoms are most predictive of relapse. To prioritize the symptoms to be captured by periodic self-report in technology-enabled remote assessment solutions for monitoring symptoms and detecting relapse early, we analyzed data from three relapse-prevention studies to identify individual items of the Positive and Negative Syndrome Scale (PANSS) that changed the most prior to relapse and to understand exactly when these symptoms manifested. Relapse was defined by a composite endpoint: hospitalization, suicidal/homicidal ideation, violent behavior, a 25% increase in the PANSS total score, or a significant increase in at least one of several pre-specified PANSS items. Longitudinal mixed effect models were applied to model the trajectories of individual PANSS items before relapse. Among 267 relapsed patients, the PANSS items that increased the most at relapse from randomization did not differ much by different relapse reasons or medications. A subset of seven PANSS items, including delusions, suspiciousness, hallucinations, anxiety, excitement, tension, and conceptual disorganization, had on average > 1-point of increase at relapse. The trajectories of these items suggested these items started to increase 7-10 days before relapse and reached on average 1-point of increase 0.3 ~ 1.2 days before relapse. Our results indicated that a subset of PANSS items could be leveraged to develop remote assessment solutions for monitoring symptoms and detecting relapse early in schizophrenia patients.

PMID: 29925851 [PubMed]

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