Attitudes of European physicians towards the use of long-acting injectable antipsychotics.

BACKGROUND: Prescription rates for long-acting injectable (LAI) antipsychotic formulations remain relatively low in Europe despite improved adherence over alternative oral antipsychotic treatments. This apparent under-prescription of LAI antipsychotics may have multiple contributing factors, including negative mental health practitioner attitudes towards the use of LAIs. METHODS: The Antipsychotic Long acTing injection in schizOphrenia (ALTO) non-interventional study (NIS), conducted across several European countries, utilised a questionnaire that was specifically designed to address physicians' attitudes and beliefs towards the treatment of schizophrenia with LAI antipsychotics. Exploratory principal component analysis (PCA) of feedback from the questionnaire aimed to identify and characterize the factors that best explained the physicians' attitudes towards prescription of LAIs. RESULTS: Overall, 136/234 solicited physicians returned fully completed questionnaires. Physicians' mean age was 48.5 years, with mean psychiatric experience of 20.0 years; 69.9% were male, 84.6% held a consultant position, and 91.9% had a clinical specialty in general adult care. Most physicians considered themselves to have a high level of clinical experience with LAI antipsychotics (77.2%), with an increased rate of LAI antipsychotics prescription over the last 5 years (59.6%). Although the majority of physicians (69.9%) declared feeling no difference in stress levels when offering LAI compared to oral antipsychotics, feelings of 'no/more stress' versus 'less stress' was found to influence prescription patterns. PCA identified six factors which collectively explained 66.1% of the variance in physician feedback. Multivariate analysis identified a positive correlation between physicians willing to accept usage of LAI antipsychotics and the positive attitude of colleagues (co-efficient 3.67; p = 0.016). CONCLUSIONS: The physician questionnaire in the ALTO study is the first to evaluate the attitudes around LAI antipsychotics across several European countries, on a larger scale. Findings from this study offer an important insight into how physician attitudes can influence the acceptance and usage of LAI antipsychotics to treat patients with schizophrenia.

Functional impairment in patients with major depressive disorder: the 2-year PERFORM study.

BACKGROUND: The Prospective Epidemiological Research on Functioning Outcomes Related to Major depressive disorder (PERFORM) study describes the course of depressive symptoms, perceived cognitive symptoms, and functional impairment over 2 years in outpatients with major depressive disorder (MDD) and investigates the patient-related factors associated with functional impairment. METHODS: This was a 2-year observational study in 1,159 outpatients with MDD aged 18-65 years who were either initiating antidepressant monotherapy or undergoing their first switch of antidepressant. Functional impairment was assessed by the Sheehan Disability Scale and the Work Productivity and Activity Impairment questionnaire. Patients assessed depression severity using the nine-item Patient Health Questionnaire and severity of perceived cognitive symptoms using the five-item Perceived Deficit Questionnaire. To investigate which patient-related factors were associated with functional impairment, univariate analyses of variance were performed to identify relevant factors that were then included in multivariate analyses of covariance at baseline, month 2, months 6 and 12 combined, and months 18 and 24 combined. RESULTS: The greatest improvement in depressive symptoms, perceived cognitive symptoms, and functional impairment was seen immediately (within 2 months) following initiation or switch of antidepressant therapy, followed by more gradual improvement and long-term stabilization. Improvement in perceived cognitive symptoms was less marked than improvement in depressive symptoms during the acute treatment phase. Functional impairment in patients with MDD was not only associated with severity of depressive symptoms but also independently associated with severity of perceived cognitive symptoms when adjusted for depression severity throughout the 2 years of follow-up. CONCLUSION: These findings highlight the burden of functional impairment in MDD and the importance of recognizing and managing cognitive symptoms in daily practice.

Physical activity in patients with type 2 diabetes and hypertension--insights into motivations and barriers from the MOBILE study.

BACKGROUND: Although physical activity (PA) is key in the management of type 2 diabetes (T2DM) and hypertension, it is difficult to implement in practice. METHODS: Cross-sectional, observational study. Participating physicians were asked to recruit two active and four inactive patients, screened with the Ricci-Gagnon (RG) self-questionnaire (active if score ≥16). Patients subsequently completed the International Physical Activity Questionnaire. The objective was to assess the achievement of individualized glycated hemoglobin and blood pressure goals (<140/90 mmHg) in the active vs inactive cohort, to explore the correlates for meeting both targets by multivariate analysis, and to examine the barriers and motivations to engage in PA. RESULTS: About 1,766 patients were analyzed. Active (n=628) vs. inactive (n=1,138) patients were more often male, younger, less obese, had shorter durations of diabetes, fewer complications and other health issues, such as osteoarticular disorders (P<0.001 for all). Their diabetes and hypertension control was better and obtained despite a lower treatment burden. The biggest difference in PA between the active vs inactive patients was the percentage who declared engaging in regular leisure-type PA (97.9% vs. 9.6%), also reflected in the percentage with vigorous activities in International Physical Activity Questionnaire (59.5% vs. 9.6%). Target control was achieved by 33% of active and 19% of inactive patients (P<0.001). Active patients, those with fewer barriers to PA, with lower treatment burden, and with an active physician, were more likely to reach targets. The physician's role emerged in the motivations (reassurance on health issues, training on hypoglycemia risk, and prescription/monitoring of the PA by the physician). A negative self-image was the highest ranked barrier for the inactive patients, followed by lack of support and medical concerns. CONCLUSION: Physicians should consider PA prescription as seriously as any drug prescription, and take into account motivations and barriers to PA to tailor advice to patients' specific needs and reduce their perceived constraints.

Self-reported sexual debut and behavior in young adults aged 18-24 years in seven European countries: implications for HPV vaccination programs.

OBJECTIVE: To generate country-specific data on age of sexual debut in young adults in 7 European countries with regard to the optimal age for prophylactic human papillomavirus (HPV) vaccination. METHODS: Survey of self-reported sexual debut and behavior in a sample of young adults aged 18-24 years in 7 European countries (Czech Republic, Ireland, Italy, Netherlands, Poland, Russia, France). Subjects (minimum of 500 males and 500 females per country) were recruited at public places using an in-street collecting approach in all countries except France, where the survey was conducted at home. Data were collected using a short, anonymous, self-administered questionnaire designed to gather information about any kind of sexual activity the subject might have engaged in with a partner, with standardized content to enable comparison between countries. RESULTS: Up to 14% of young men and 22% of young women aged 18-24 years had yet to experience sexual activity at the time of the survey. Median age of sexual debut calculated by survival analysis ranged between 16 and 17 years in boys and between 17 and 18 years in girls. The proportion of boys sexually active before the age of 15 years ranged from 5.0% (Poland) to 15.8% (Italy). The proportion of girls sexually active before the age of 15 years was lower compared with boys in all countries, ranging from 2.6% (Poland) to 11.9% (the Netherlands). The first sexual partner for girls was typically at least 1 year older, irrespective of the age of sexual debut. Almost one-third of young women did not use a condom at sexual debut. CONCLUSIONS: This survey provides an update on sexual debut and behavior in young adults in some European countries. Estimated age at sexual debut ranged between 16 and 18 years and appeared to be later in girls than in boys. The proportion of girls sexually active before the age of 15 years was low (

Fast and sustained efficacy of levetiracetam during titration and the first 3 months of treatment in refractory epilepsy.

PURPOSE: To investigate whether the efficacy of levetiracetam (LEV) is sustained in adult patients with refractory partial seizures over a 3-month period. METHODS: Treatment effect was assessed in a post hoc analysis by determining the proportion of seizure-free days during each week of a 3-month period after the initiation of treatment. Pooled data from three randomized, double-blind, placebo-controlled trials (n = 883) were analyzed. RESULTS: The mean proportion of seizure-free days was greater in the LEV group than in the placebo group. The difference, which was statistically significant, was observed as early as the first week after the initiation of treatment. It was higher in the first week of treatment and subsequently was maintained for each week over the 3-month period (p < 0.001 or p = 0.002 at each time point). Patients in the LEV group had on average 74% to 81% days each week without any seizure, compared with 69% to 72% in the placebo group. CONCLUSIONS: LEV is efficient in controlling seizures from the first week of drug initiation, during uptitration, and throughout the first 3 months of treatment. An interesting amplification of efficacy occurs in the first week of therapy, which is intriguing and warrants further investigation.