Compliance as a stable function in the treatment course of bipolar disorder in patients stabilized on olanzapine: results from a 24-month observational study.

Compliance is a key factor in the maintenance treatment of bipolar disorder. This noninterventional study was conducted to explore factors associated with higher levels of compliance in bipolar patients, all treated in routine clinical settings. Bipolar outpatients (Clinical Global Impression of Severity score ≤3) who had been stabilized with olanzapine mono- or combination therapy for ≥4 weeks were enrolled in the study. Compliance to medication was assessed at baseline and after 3, 6, 9, 12, 18, and 24 months by a physician-rated, 4-point categorical scale using the following classification: noncompliant (patients being compliant to treatment schedule less than 20% of the time) and low (20% to 59% of the time), moderate (60% to 79% of the time), and high (≥80% of the time) levels of compliance. Both baseline and post-baseline factors were used in a generalized estimating equations (GEE) model to predict the likelihood of high compliance. Of 891 eligible patients, 657 patients completed the 24-month observation period. High levels of compliance (≥80%) were observed in 67% of patients at baseline, increasing to 80% in study completers. High compliance at baseline was identified as a strong predictor of compliance during study participation (odds ratio (OR) = 6.9, 95% confidence interval (CI) = 5.0 to 9.5, p < 0.001). Factors associated with high compliance during the study (GEE model) included greater life satisfaction (p = 0.002), better insight into illness (p < 0.001), less work impairment (p = 0.007), and fewer days of inpatient care (p = 0.002). Compliance ratings varied by country (p < 0.001) and duration of post-baseline treatment (p = 0.014). In conclusion, a number of clinical, functional, and social factors were identified as predictors of compliance in patients with bipolar disorder. As compliance is crucial for the long-term management of these patients, more attention should be directed towards compliance itself and factors associated with compliance levels in everyday treatment settings.

[Risks for Burden among Relatives Caring for Schizophrenia Patients]. / Prädiktoren für die Belastung von Angehörigen Schizophreniekranker.

OBJECTIVE: Relatives of persons with schizophrenia have an essential role in informal caregiving. This may result in a high level of burden. Aim of the study was to investigate, if the frequency of unmet needs among relatives caring for schizophrenia patients increases the risk for burden among these relatives. METHODS: 135 relatives of patients with schizophrenia or schizoaffective disorder were investigated by means of the "Involvement Evaluation Questionnaire" (IEQ) and the "Carer's Needs Assessment for Schizophrenia" (CNA-S). RESULTS: Multiple linear regression analyses showed positive associations between the frequency of caregivers' unmet needs and the IEQ-subscores "tension" and "worrying". Further, the IEQ-subscore "worrying" was significantly lower among caregivers of outpatients than among caregivers of inpatients or day hospital patients. The IEQ-subscore "urging" was significantly associated with patient's negative symptoms. CONCLUSION: Unmet needs among caring relatives have negative effects on their burden. Further, the patients' type of treatment setting (inpatient, outpatient, day hospital) seems to predict caregivers' burden.

[Minor relatives of schizophrenia patients: burden and needs]. / Minderjährige Angehörige von Schizophrenie-Kranken: Belastungen und Unterstützungsbedarf.

OBJECTIVES: The aim of the present study was to investigate the burden of minor relatives of schizophrenia patients and of the needs for support for the relatives. METHODS: 135 relatives of patients with schizophrenia or schizoaffective disorders were assessed by using the "Involvement Evaluation Questionnaire" and the "Carers' Needs Assessment for Schizophrenia". RESULTS: 24.4% of the total sample (N=33) had minor (i.e. below 18 years) siblings (N=18) or children (N=15). If the patient had minor siblings, almost the half of the adult relatives reported moderate or severe problems. However, among those patients who had to take care for minor children, only a fifth reported moderate or severe problems. Among the patients' offsprings being under the age of 16 behavioural disturbances, reduced appetite and other consequences of the disease were reported frequently. CONCLUSIONS: These results indicate that patients with schizophrenia or schizoaffective disorders often have minor relatives in their family frequently suffering from marked burden.

Impaired conditional discrimination learning in social phobia.

Eyelid conditional discrimination learning (ECDL) is a test of discriminative aversive conditioning. It places minimal demands on motivation and was shown to selectively test temporal lobe function. Twenty-five unmedicated social phobia (SP) patients (mean age 29.5 +/- 7.0 years), diagnosed according to DSM-IV criteria, and 25 age- and gender-matched healthy controls (HC, mean age 34.0 +/- 8.6 years) were examined with an ECDL paradigm. In the experiment two differently colored stimuli are randomly presented. Only one of the stimuli (reinforced trial) is followed by an aversive airpuff to the cornea, as opposed to unreinforced trials not followed by an airpuff. Conditioned responses (CRs) consist of reflex eyelid closures already upon light presentation. HC as well as SP patients showed a significant difference between reinforced and unreinforced trials. In SP patients, CR frequency did not increase during the ECDL task, while HCs showed appropriate conditional discrimination ability. Thus the results indicate an impairment of adequate behavior modification in an aversive conditioning task in SP.