Non-adherence to Psychotropic Medication Among Adolescents - A Systematic Review of the Literature.

Introduction: Whether patients take their medication as prescribed is of increasing importance in adolescent psychiatry since both the number of efficacious pharmaceutical treatments and the rate of prescriptions of psychotropic compounds are on the rise. Previous research showed high rates of medication nonadherence among both adolescents with medical disorders and adult patients with psychiatric disorders. Methods: The present review was performed according to PRISMA guidelines and evaluates existing scientific literature concerning adherence to psychotropic medication among adolescents. The goal was to determine rates of nonadherence in this age group as well as the factors associated with it. Therefore, we conducted a comprehensive literature search of PubMed from its inception until 15 September 2015 using the keywords "adherence," "compliance," "adolescent," and "psychotropic medication." Results: A total of 607 pertinent articles were collected and screened; 15 publications were selected for detailed review. The studies differed, among other things, regarding sample characteristics, medication type, and indications. Furthermore, the definitions of what constitutes nonadherence and the methods used to assess it varied widely. Nonadherence rates ranged from 6 % to 62 % (median 33 %). Conclusions: Nonadherence to psychotropic medication is a clinically relevant problem among adolescents. Because of the methodological heterogeneity across studies and partially contradictory results, no conclusions could be drawn concerning the influence of factors such as psychopathology, medication type, side effects, the effectiveness of treatment, or family-related factors. Well-designed long-term studies of large patient samples and a consensus regarding definitions are therefore warranted. Such research would facilitate the design of tailored strategies to improve adherence in these patients.

Agreement of central venous saturation and mixed venous saturation in cardiac surgery patients.

OBJECTIVE: Comparison of the bias and the limits of agreement (LOA; 2 SD) of the central venous saturation (S(cv)O(2)) before, during and after coronary artery bypass graft surgery with a simultaneous measurement of the mixed venous saturation (S(v)O(2)). DESIGN AND SETTING: Prospective controlled study in a university hospital department of anaesthesiology. PATIENTS: 60 patients with coronary artery bypass surgery, 300 paired measurements of S(v)O(2) and S(cv)O(2). MEASUREMENTS AND RESULTS: S(cv)O(2) and S(v)O(2) were analysed after induction of anaesthesia 15 min after cardiopulmonary bypass and 1, 6 and 18 h after admission to the intensive care unit. Regression analysis for the pooled measurements of S(cv)O(2) and S(v)O(2) showed a correlation R (2) = 0.52. After induction of anaesthesia 15 min after weaning from cardiopulmonary bypass and 6 h after admission to the intensive care unit the correlation coefficient was R (2) = 0.46, on admission to the intensive care unit it was R (2) = 0.42, and at 18 h it was R (2) = 0.38. Bland-Altman analysis for the measurements of S(cv)O(2) and S(v)O(2) showed a mean bias and LOA of 0.3% and -11.9 to +12.4%. In patients with a low S(cv)O(2) there was a trend to overestimate the S(v)O(2) by using the S(cv)O(2). The only factor that influenced the DeltaS(v)O(2) - S(cv)O(2) was the oxygen extraction rate (R (2) = 0.16). In patients with S(cv)O(2) below 70% this association was more pronounced (R (2) = 0.60). CONCLUSIONS: Our findings demonstrate that oxygen extraction rate is the major factor in the difference between S(v)O(2) and S(cv)O(2). Under certain circumstances S(cv)O(2) differed substantially from S(v)O(2). Therefore in selected patients both parameters should be monitored to exclude general or focal hypoperfusion.