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1.
Psychiatr Serv ; 71(2): 192-195, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31615365

RESUMO

OBJECTIVE: This study examined whether serious mental illness is associated with initiating and with completing sofosbuvir-based treatment for hepatitis C virus (HCV) among veterans who started treatment after the Veterans Health Administration (VHA) received expanded funding for HCV care. METHODS: Administrative health care data from fiscal years 2016-2017 revealed 4,288 treatment-naïve patients with HCV, of whom 1,311 had initiated sofosbuvir-based treatment. Dependent variables were initiation and completion of ≥8 weeks of sofosbuvir treatment. Associations with serious mental illness were estimated with adjusted odds ratios from multivariable logistic regression analyses. RESULTS: No statistically significant differences were found in the proportion of veterans with and veterans without serious mental illness who initiated (p=0.628) or completed ≥8 weeks (p=0.301) of sofosbuvir treatment. CONCLUSIONS: Veterans with and without serious mental illness initiated and completed sofosbuvir treatment at similar rates. The VA should continue to provide equitable access to HCV treatments and support medication adherence.

2.
J Behav Med ; 2019 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-31741204

RESUMO

Adults with serious mental illness have high rates of obesity, with associated negative impacts on health-related quality of life. The present study utilized data from a randomized controlled trial (N = 276) to examine the effectiveness of in-person and online-delivered weight management interventions, compared to usual care, for improving health-related quality of life in this population. Participants completed quality of life assessments at baseline, 3 months, and 6 months. Mixed effects models examined group by time interactions. Compared to usual care, in-person MOVE was associated with improvements in loneliness (t = - 2.76, p = .006) and mental health related quality of life (t = 1.99, p = 0.048) at 6 months, and webMOVE was associated with improvements in weight-related self-esteem at 6 months (t = 2.23, p = .026) and mental health-related quality of life at 3 months (t = 2.17, p = 0.031) and 6 months (t = 2.38, p = .018). Web-based and in-person weight management led to improvements in health-related quality of life for adults with serious mental illness.ClinicalTrials.gov Identifier: NCT00983476.

3.
Psychiatr Rehabil J ; 42(3): 238-245, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30920258

RESUMO

OBJECTIVE: More women veterans than men use Veterans Health Administration (VHA) mental health services. Some psychiatric medications are associated with weight gain and other metabolic side effects, with women more susceptible and reporting more distress than men. We sought to explore how women experience and manage medication-induced weight gain to identify strategies for improving its prevention and management in women. METHOD: We completed semistructured, qualitative interviews with 30 female veterans with serious mental illnesses prescribed antipsychotic or mood stabilizer medications and 18 mental health prescribers. Interview transcripts were summarized and coded via principles of phenomenological inquiry to develop themes reflecting the study purpose. RESULTS: We identified 5 themes related to females' experiences with medication-induced weight gain. Female veterans described considerable psychological and physical distress associated with weight gain. However, many expressed a willingness to accept weight gain as a trade-off for medications' therapeutic effects, a theme echoed by prescribers. Both described primarily using reactive rather than proactive or preventative weight management approaches and described the limited effectiveness of reactive approaches. Other contributing factors, including the multiple and uncertain causes of weight gain, uneven quality and quantity of weight loss information, lack of social support, and environmental barriers, add to the difficulty and complexity of their struggles. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These findings improve our understanding of numerous veteran-, prescriber-, and environmental-level factors in the management of medication-associated weight gain in women that may be useful in designing gender-specific interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos Mentais/tratamento farmacológico , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Satisfação do Paciente , Estresse Psicológico/etiologia , Tranquilizantes/efeitos adversos , Veteranos/psicologia , Ganho de Peso/efeitos dos fármacos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estados Unidos
4.
Clin Schizophr Relat Psychoses ; 12(4): 152-167, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-27454213

RESUMO

Approximately 60% of individuals with schizophrenia do not take their antipsychotic medications as prescribed, and nonadherence is associated with exacerbation of psychotic symptoms, increased hospital and emergency room use, and increased healthcare costs. Behavioral-tailoring strategies that incorporate medication taking into the daily routine and use environmental supports have shown promise as adherence-enhancing interventions. Informed by the Information-Motivation-Behavioral (IMB) Skills Model and using the iterative process of user-centered design, we collaborated with individuals with schizophrenia and psychiatrists to develop an interactive smartphone application and web-based clinician interface, MedActive, for improving adherence to oral antipsychotic treatment. MedActive facilitates the active involvement of individuals with schizophrenia in managing their antipsychotic medication regimen by providing automated reminders for medication administration and tailored motivational feedback to encourage adherence, and by displaying user-friendly results of daily ecological momentary assessments (EMAs) of medication adherence, positive psychotic symptoms, and medication side effects for individuals and their psychiatrists. In a 2-week open trial completed by 7 individuals with schizophrenia and their psychiatrists, MedActive was determined to be both feasible and acceptable, with patient participants responding to 80% of all scheduled EMAs and providing positive evaluations of their use of the application. Psychiatrist participants were interested in viewing the information provided on the MedActive clinician interface, but cited practical barriers to regularly accessing it and integrating into their daily practice.


Assuntos
Antipsicóticos , Transtornos Psicóticos , Esquizofrenia , Smartphone , Adolescente , Adulto , Idoso , Antipsicóticos/uso terapêutico , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Projetos Piloto , Transtornos Psicóticos/tratamento farmacológico , Adulto Jovem
5.
Psychiatr Serv ; 69(10): 1062-1068, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30041588

RESUMO

OBJECTIVE: Many adults with serious mental illness are sedentary and experience significant medical illness burden. This study examined the effectiveness of online weight management with peer coaching (WebMOVE) for increasing general physical activity among adults with serious mental illness. METHODS: Using quantitative and qualitative data from a randomized controlled trial (N=276), this study compared WebMOVE, in-person weight management for adults with serious mental illness (MOVE SMI), and usual care. Participants completed assessments of general physical activity (baseline, three months, and six months) and a qualitative assessment (six months). Mixed-effects models examined group × time interactions on general physical activity. RESULTS: There were significant differences between MOVE SMI and usual care for total physical activity at three (t=3.06, p=.002) and six (t=3.12, p=.002) months, walking at six months (t=1.99, p=.048), and moderate (t=2.12, p=.035) and vigorous (t=2.34, p=.020) physical activity at six months. There was a significant difference between WebMOVE and usual care for total physical activity at six months (t=2.02, p=.044) and a trend for a group difference in walking at six months (t=1.78, p=.076). These findings reflected a decline in physical activity among participants in usual care and an increase in physical activity among participants in MOVE SMI or WebMOVE. CONCLUSIONS: In-person weight management counseling increased total physical activity and led to initiation of moderate and vigorous physical activity among adults with serious mental illness. Computerized weight management counseling with peer support led to more gradual increases in total physical activity.


Assuntos
Aconselhamento/métodos , Exercício , Comportamentos Relacionados com a Saúde , Transtornos Mentais/reabilitação , Grupo Associado , Terapia Assistida por Computador/métodos , Programas de Redução de Peso/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
6.
BMC Psychiatry ; 18(1): 142, 2018 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-29788933

RESUMO

BACKGROUND: People with psychosis struggle with decisions about their use of antipsychotics. They often want to reduce the dose or stop, while facing uncertainty regarding the effects these decisions will have on their treatment and recovery. They may also fear raising this issue with clinicians. The purpose of this study was to develop and test a shared decision making (SDM) tool to support patients and clinicians in making decisions about antipsychotics. METHODS: A diverse editorial research team developed an Encounter Decision Aid (EDA) for patients and clinicians to use as part of the psychiatric consultation. The EDA was tested using 24 semistructured interviews with participants representing six stakeholder groups: patients with first-episode psychosis, patients with long-term psychosis, family members, psychiatrists, mental health counselors, and administrators. We used inductive and deductive coding of interview transcripts to identify points to revise within three domains: general impression and purpose of the EDA; suggested changes to the content, wording, and appearance; and usability and potential contribution to the psychiatric consultation. RESULTS: An EDA was developed in an iterative process that yielded evidence-based answers to five frequently asked questions about antipsychotic medications. Patients with long-term psychosis and mental health counselors suggested more changes and revisions than patients with first-episode psychosis and psychiatrists. Family members suggested more revisions to the answers about potential risks of stopping or adjusting antipsychotics than other respondents. CONCLUSIONS: The EDA was perceived as potentially useful and feasible in psychiatric routine care, especially if presented during the consultation.


Assuntos
Antipsicóticos/administração & dosagem , Tomada de Decisões , Técnicas de Apoio para a Decisão , Psiquiatria/métodos , Transtornos Psicóticos/tratamento farmacológico , Adulto , Família , Feminino , Humanos , Masculino , Transtornos Psicóticos/psicologia , Suspensão de Tratamento
7.
J Racial Ethn Health Disparities ; 5(2): 235-242, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28411327

RESUMO

Black consumers with serious mental illness (SMI) face significant challenges in obtaining quality mental health care and are at risk for experiencing significant disparities in mental health care outcomes, including recovery from mental illness. Patient-provider interactions may partly contribute to this disparity. The purpose of the current study was to understand the effects of race, psychosis, and therapeutic alliance on mental health recovery orientation among Veterans with SMI. Participants were Veterans who had an SMI being treated at two Veteran Affairs outpatient mental health clinics by a psychiatrist or nurse practitioner. Participants completed the Behavior and Symptom Identification Scale (BASIS-24), Mental Health Recovery Measure, and patient-report Scale to Assess the Therapeutic Relationship (STAR-P) which includes three subscales: positive collaboration, positive clinician input, and non-supportive clinician input. Regression analyses were used to determine interactive effects of race, psychosis severity, and therapeutic alliance variables. The sample was 226 Veterans (50% black, 50% white). Black participants were slightly older (p < .05), had higher baseline psychosis (p < .05), higher mental health recovery (p < .05), and perceived less non-supportive clinician input (p < .01) than white participants. Regression analyses indicated a significant three-way interaction among race, psychosis, and positive collaboration (p < .01). Greater positive collaboration attenuated the negative effect of higher levels of psychosis on mental health recovery orientation for black participants. Conversely, for white participants, positive collaboration had little effect on the negative relationship between psychosis severity and mental health recovery orientation. Increased levels of psychosis may inhibit patients' perceptions of their ability to recover from SMI. However, for black participants, positive collaboration with mental health providers may moderate the effects of psychotic symptomatology.


Assuntos
Transtorno Bipolar/reabilitação , Transtorno Depressivo Maior/reabilitação , Disparidades em Assistência à Saúde/etnologia , Recuperação da Saúde Mental , Transtornos Psicóticos/reabilitação , Qualidade da Assistência à Saúde , Transtornos de Estresse Pós-Traumáticos/reabilitação , Aliança Terapêutica , Adulto , Afro-Americanos , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Transtornos Mentais/reabilitação , Pessoa de Meia-Idade , Veteranos
8.
Int J Psychiatry Clin Pract ; 22(2): 89-94, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28920491

RESUMO

OBJECTIVE: The study was designed to explore patterns of prescriber communication behaviors as they relate to consumer satisfaction among a serious mental illness sample. METHODS: Recordings from 175 antipsychotic medication-monitoring appointments between veterans with psychiatric disorders and their prescribers were coded using the Roter Interaction Analysis System (RIAS) for communication behavioral patterns. RESULTS: The frequency of prescriber communication behaviors (i.e., facilitation, rapport, procedural, psychosocial, biomedical, and total utterances) did not reliably predict consumer satisfaction. The ratio of prescriber to consumer utterances did predict consumer satisfaction. CONCLUSIONS: Consistent with client-centered care theory, antipsychotic medication consumers were more satisfied with their encounters when their prescriber did not dominate the conversation. PRACTICE IMPLICATIONS: Therefore, one potential recommendation from these findings could be for medication prescribers to spend more of their time listening to, rather than speaking with, their SMI consumers.


Assuntos
Antipsicóticos/uso terapêutico , Comunicação , Comportamento do Consumidor , Prescrições de Medicamentos/normas , Transtornos Mentais/tratamento farmacológico , Satisfação do Paciente , Assistência Centrada no Paciente/normas , Relações Profissional-Paciente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veteranos
9.
J Gen Intern Med ; 32(Suppl 1): 48-55, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28271427

RESUMO

BACKGROUND: People with serious mental illness have high rates of obesity and related medical problems, and die years prematurely, most commonly from cardiovascular disease. Specialized, in-person weight management interventions result in weight loss in efficacy trials with highly motivated patients. In usual care, patient enrollment and retention are low with these interventions, and effectiveness has been inconsistent. OBJECTIVE: To determine whether computerized provision of weight management with peer coaching is feasible to deliver, is acceptable to patients, and is more effective than in-person delivery or usual care. DESIGN: Mixed-methods randomized controlled trial. PARTICIPANTS: Two hundred seventy-six overweight patients with serious mental illness receiving care at a Veterans Administration medical center. INTERVENTIONS: Patients were randomized to 1) computerized weight management with peer coaching (WebMOVE), 2) in-person clinician-led weight services, or 3) usual care. Both active interventions offered the same educational content. MAIN MEASURES: Body mass index; and feasibility and acceptability of the intervention. KEY RESULTS: At 6 months, in obese patients (n = 200), there was a significant condition by visit effect (F = 4.02, p = 0.02). The WebMOVE group had an average estimated BMI change from baseline to 6 months of 34.9 ± 0.4 to 34.1 ± 0.4. This corresponds to 2.8 kg (6.2 lbs) weight loss (t = 3.2, p = 0.001). No significant change in BMI was seen with either in-person services (t = 0.10, p = 0.92), or usual care (t = -0.25, p = 0.80). The average percentage of modules completed in the WebMOVE group was 49% and in the in-person group was 41% (t = 1.4, p = 0.17). When non-obese patients were included in the analyses, there was a trend towards a condition by visit effect (F = 2.8, p = 0.06). WebMOVE was well received, while the acceptability of in-person services was mixed. CONCLUSIONS: Computerized weight management with peer support results in lower weight, and can have greater effectiveness than clinician-led in-person services. This intervention is well received, and could be feasible to disseminate.


Assuntos
Transtornos Mentais/complicações , Manejo da Obesidade/métodos , Obesidade/terapia , Terapia Assistida por Computador/métodos , Adulto , Idoso , Terapia Comportamental/métodos , Peso Corporal , Aconselhamento/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Tutoria/métodos , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/fisiopatologia , Educação de Pacientes como Assunto/métodos , Grupo Associado , Veteranos/psicologia , Perda de Peso
10.
AIDS Care ; 29(7): 898-904, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28043176

RESUMO

BACKGROUND: Smartphones with programmable apps may offer innovative interactive interventions for improving adherence among people living with HIV with substance use problems. METHODS: This pilot randomized controlled trial sought to primarily determine the usability and feasibility of using a smartphone-based intervention called Heart2HAART as an adjunct to directly observed treatment with adherence counseling compared to directly observed treatment with adherence counseling alone among those with HIV and a history of substance use over a three-month time frame. Participants in the Heart2HAART condition completed an additional survey on usability and acceptability. Adherence was measured using unannounced pill counts assessed via a phone call. RESULTS: Twenty-eight participants were randomized to receive Heart2HAART (n = 19) or control (n = 9). All were receiving either weekly (n = 9) or daily (n = 19) observed treatment. Among those randomized to Heart2HAART, 63.2% reported no difficulty using the Heart2HAART smartphone application and 94.7% responded that the medication reminders did not interfere negatively with their activities. On average participants used Heart2HAART application 56.8 times over the three-month trial. In analyses adjusting for age, there was no difference in adherence to HAART medication between the Heart2HAART and control group as evaluated by the random pill count assessment (P = .29). CONCLUSIONS: Heart2HAART was feasible to use during a three-month pilot trial. Future studies may evaluate a more tailored approach, with more robust contingency management.


Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Sistemas de Alerta , Smartphone , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Aconselhamento , Estudos de Viabilidade , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/complicações , Mensagem de Texto
11.
Community Ment Health J ; 53(2): 163-175, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27061185

RESUMO

Adherence to recommendations for monitoring of metabolic side effects of antipsychotic medications has been historically low. This randomized controlled trial tested whether a computerized, patient-centered intervention that educated Veterans with serious mental illness about these side effects and encouraged them to advocate for receipt of monitoring would increase rates of monitoring compared to enhanced treatment as usual. The mean proportion of days adherent to monitoring guidelines over the 1-year study was similarly high and did not differ between the intervention (range 0.81-0.98) and comparison (range 0.76-0.96) groups. Many individuals in both groups had persistent abnormal metabolic parameter values despite high rates of monitoring, contact with medical providers, and receipt of cardiometabolic medications. Participants exposed to the intervention were interested in receiving personalized information about their cardiometabolic status, demonstrating the preliminary feasibility of brief interventions for enhancing involvement of individuals with serious mental illness in health care decision making.


Assuntos
Antipsicóticos/metabolismo , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/metabolismo , Programas de Rastreamento/normas , Assistência Centrada no Paciente , Melhoria de Qualidade , Adulto , Idoso , Feminino , Humanos , Masculino , Mid-Atlantic Region , Pessoa de Meia-Idade
12.
Am J Ophthalmol ; 173: 70-75, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27702620

RESUMO

PURPOSE: To assess trends in prevalence of diagnosed ocular disease and use of eye care services in the Veterans Affairs (VA) health care system. DESIGN: Prevalence study. METHODS: We performed a retrospective study of all eligible veterans in the VA Capitol Health Care Network from 2007 to 2011. The VA database was used to abstract demographic and socioeconomic variables, including age, race, sex, marital status, service connection, prescription copay, homelessness, and VA facility. Primary outcome measures were the prevalence of diagnosed ocular disease and use of eye care. Ocular diagnoses were determined by International Classification of Diseases, 9th revision codes and use by prescription medication fills, visits to eye care clinics, and cataract surgery frequency. RESULTS: The average age of veterans ranged from 59.8-60.9, most veterans were male (88.1-89.8%), and there was a high proportion of African Americans (29.5-30%). The prevalence of all ocular diagnoses increased from 20.5% in 2007 to 23.3% in 2011 (P < .01), a 13.7% increase. Similarly, the prevalence of diagnosed cataract increased by 35.7% (P = .02) from 7.1% in 2007 to 9.6% in 2011. Diagnosed glaucoma prevalence increased by 9.4% (P = .03) from 6.7 to 7.4%. The percent of patients seen in eye clinics increased 11.6%% in the 5-year study period to 24.0% in fiscal year 2011 (P = .05). The use of ophthalmic medications increased 20% (P < .01). The rate of cataract surgery did not change significantly during the study period. CONCLUSIONS: The prevalence of diagnosed eye conditions among American Veterans is increasing, as is the use of eye care services. Cataract surgery rates did not increase, which may indicate a need to increase availability of these services.


Assuntos
Grupos Étnicos , Oftalmopatias/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , United States Department of Veterans Affairs/estatística & dados numéricos , Veteranos , Estudos Transversais , Oftalmopatias/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
13.
Gen Hosp Psychiatry ; 43: 1-5, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27796250

RESUMO

OBJECTIVE: To compare the prevalence of diagnosed ocular disease and eye disease treatment between Veteran's Administration (VA) patients with and without serious mental illness (SMI). METHODS: Retrospective comparison of diagnosed ocular disease and treatment prevalence among patients with and without diagnosed SMI in fiscal year 2011 in the VA Capitol Health Care System (VISN 5). RESULTS: We identified 6462 VA patients with SMI and 137,933 without SMI. The prevalence of diagnosed ocular disease was 22.7% in SMI patients and 35.4% in non-SMI patients (P<.001). Those with SMI had a higher prevalence of glaucoma (10.2% vs. 7.1%, P<.0001), cataract (12.6% vs. 9.2%, P<.0001) and dry eye (4.0% vs. 2.7%, P<.0001). Less than half (34.3%) of SMI subjects had been seen in ophthalmology or optometry vs. 23.0% of controls (P<.0001). CONCLUSION: VA patients with SMI have a greater prevalence of diagnosed ocular disease, particularly cataract, glaucoma and dry eye. While SMI patients utilize eye care services at a higher rate than the general VA population, the majority of subjects with SMI do not get recommended annual eye examinations. More consistent annual ocular screening among VA patients with SMI may be indicated.


Assuntos
Transtorno Bipolar/epidemiologia , Catarata/epidemiologia , Síndromes do Olho Seco/epidemiologia , Glaucoma/epidemiologia , Transtornos Psicóticos/epidemiologia , Esquizofrenia/epidemiologia , Veteranos/estatística & dados numéricos , Adulto , Idoso , Comorbidade , District of Columbia/epidemiologia , Feminino , Humanos , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Prevalência , Virginia/epidemiologia , West Virginia/epidemiologia
14.
Dialogues Clin Neurosci ; 18(2): 191-201, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27489459

RESUMO

Nonadherence to psychopharmacological treatments poses a significant challenge to treatment success in individuals with serious mental illness, with upwards of 60% of people not taking their psychiatric medications as prescribed. Nonadherence is associated with adverse outcomes, including exacerbation of psychiatric symptoms, impaired functioning, increased hospitalizations and emergency room use, and increased health care costs. Whereas interventions using psychoeducation or cognitive approaches, such as motivational interviewing, have largely proven ineffective in improving adherence, approaches employing behavioral tailoring that incorporate medication taking into the daily routine and/or use environmental supports have shown promise. Recently, adherence-enhancing behavioral tailoring interventions that utilize novel technologies, such as electronic monitors and mobile phones, have been developed. Although interventions utilizing these platforms have the potential for widespread dissemination to a broad range of individuals, most require further empirical testing. This paper reviews selected behavioral tailoring strategies that aim to improve medication adherence and other functional outcomes among individuals with serious mental illness.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Adesão à Medicação/psicologia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Psicotrópicos/uso terapêutico , Smartphone , Comportamentos Relacionados com a Saúde , Humanos , Smartphone/tendências , Mensagem de Texto/tendências , Resultado do Tratamento
15.
Psychiatr Serv ; 67(12): 1300-1306, 2016 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-27364816

RESUMO

OBJECTIVE: This study examined the adherence of psychiatrists to the Schedule of Recommended First and Second Line Antipsychotic Medications ("Antipsychotic Schedule"), which was implemented in two Recovery After an Initial Schizophrenia Episode (RAISE) Connection Program Implementation and Evaluation Study clinics. METHODS: Sixty-five individuals with a first episode of psychosis were enrolled in the RAISE Connection Program clinics. Two psychiatrists received training and ongoing consultation on use of a shared decision-making approach to prescribing antipsychotic medications according to the Antipsychotic Schedule. Information about participants, prescribed antipsychotic medications, and completion of side-effect assessments were obtained from standardized research assessments and chart extractions. Descriptive statistics were used to characterize the extent to which patterns of antipsychotic prescribing and side-effect monitoring were consistent with the Antipsychotic Schedule. RESULTS: Ninety-two percent of participants were prescribed an antipsychotic medication and received the medication on 76%±35% of the days they were in treatment. Seventy-seven percent of participants were prescribed at least one Antipsychotic Schedule first-line antipsychotic, 20% were prescribed olanzapine, and 10% received a trial of clozapine. Regarding monitoring for metabolic side effects, 92% of participants had at least one weight recorded, 72% had at least one blood glucose measure recorded, and 62% had at least one lipid profile recorded. CONCLUSIONS: In the context of a study in which training and ongoing clinical supervision by experts was provided to psychiatrists and shared decision making was encouraged, antipsychotic prescribing patterns closely adhered to recommendations established by the RAISE Connection Program.


Assuntos
Antipsicóticos/administração & dosagem , Tomada de Decisões , Padrões de Prática Médica/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Adolescente , Adulto , Antipsicóticos/efeitos adversos , Benzodiazepinas/administração & dosagem , Clozapina/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Estudos Longitudinais , Masculino , Olanzapina , Estados Unidos , Adulto Jovem
16.
Psychiatr Rehabil J ; 39(2): 183-186, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27159111

RESUMO

OBJECTIVE: Person-centered psychiatric services rely on consumers actively sharing personal information, opinions, and preferences with their providers. This research examined predictors of consumer communication during appointments for psychiatric medication prescriptions. METHODS: The Roter Interaction Analysis System was used to code recorded Veterans Affairs psychiatric appointments with 175 consumers and 21 psychiatric medication prescribers and categorize communication by purpose: biomedical, psychosocial, facilitation, or rapport-building. RESULTS: Regression analyses found that greater provider communication, symptomology, orientation to psychiatric recovery, and functioning on the Repeatable Battery for the Assessment of Neuropsychological Status Attention and Language indices, as well as consumer diagnostic label, were positive predictors of consumer communication, though the types of communication impacted varied. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Provider communication is the easiest variable to intervene on to create changes in consumer communication. Future research should also consider how cognitive and symptom factors may impact specific types of consumer communication in order to identify subgroups for targeted interventions. (PsycINFO Database Record


Assuntos
Comunicação , Veteranos , Humanos , Transtornos Mentais/tratamento farmacológico , Assistência Centrada no Paciente , Relações Médico-Paciente , Psicotrópicos/uso terapêutico
17.
J Gambl Stud ; 32(1): 1-10, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25773867

RESUMO

This study sought to: (1) determine the prevalence of gambling disorder using the Diagnostic and Statistical Manual of Mental Disorders Version 5 (DSM-5; American Psychiatric Association in Diagnostic and statistical manual of mental disorders, American Psychiatric Publishing, Arlington, 2013) criteria; (2) identify the frequency and amount of money spent on gambling behaviors; and (3) determine demographic and treatment related predictors associated with gambling disorder in a substance using population. People receiving methadone maintenance treatment (N = 185) in an urban medical center consented to participate in the study. We used DSM-5 criteria to assess the 12-month prevalence of gambling disorder. Questions adapted from a previously developed measure were used to identify, describe and quantify the frequency of use and amount of money spent on gambling behaviors. Most participants were African-American (71.4 %), male (54.1 %), unmarried (76.8 %), unemployed (88.1 %) and had an income of <$20,000 (88.5 %). On average, participants were receiving 81.0 mg of methadone (SD: 22.8) daily. Nearly half (46.2 %) of participants met DSM-5 criteria for gambling disorder. Compared to those without gambling disorder, those with gambling disorder did not differ significantly with respect to demographic characteristics nor methadone dose. However, those with gambling disorder had been in methadone maintenance treatment for significantly less time. Those with gambling disorder were significantly more likely to report engaging in a variety of gambling behaviors. Given that the 12-month prevalence of DSM-5 defined gambling disorder was nearly 50 % future efforts to screen and treat gambling disorder in the context of methadone maintenance treatment are clearly warranted.


Assuntos
Jogo de Azar/tratamento farmacológico , Jogo de Azar/epidemiologia , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Grupos Étnicos/estatística & dados numéricos , Feminino , Jogo de Azar/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/psicologia
18.
Community Ment Health J ; 52(2): 136-41, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25821927

RESUMO

This study evaluated internet use among 239 veterans with serious mental illness who completed questionnaires assessing demographics and internet use in 2010-2011. The majority of individuals (70 %) reported having accessed the internet and among those, 79 % had accessed it within the previous 30 days. Those who were younger and more educated were more likely to have accessed the internet, as were those with a schizophrenia spectrum disorder, bipolar disorder, or major depressive disorder, compared to individuals with PTSD. Veterans with serious mental illness commonly use the internet, including to obtain health information, though use varies across demographic characteristics and clinical diagnosis.


Assuntos
Acesso à Informação , Internet/estatística & dados numéricos , Transtornos Mentais/psicologia , Veteranos/psicologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Antipsicóticos , Feminino , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Serviços de Saúde Mental , Mid-Atlantic Region , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos , United States Department of Veterans Affairs , Veteranos/estatística & dados numéricos , Adulto Jovem
19.
J Affect Disord ; 188: 112-7, 2015 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-26361066

RESUMO

BACKGROUND: Mood stabilizer medications (MSMs) can induce significant weight gain and other metabolic side effects. Research suggests that women are more susceptible to psychotropic medication-induced metabolic side effects than men. We examined gender differences in the likelihood of receiving an MSM with a lower liability for weight gain using data from the U.S. Department of Veterans Affairs (VA) healthcare system. METHODS: We identified 3823 VA patients with a schizophrenia or bipolar disorder diagnosis who initiated treatment with a MSM between 10/2006 and 9/2011. We used multivariable logistic regression analysis to examine gender differences in the likelihood of incident prescription of MSMs with low versus medium/high metabolic risk, adjusting for fiscal year of prescribing and demographic, mental health, and physical health characteristics. RESULTS: Overall, 47% of women were prescribed a low metabolic risk MSM compared to 26% of men (p<0.0001). In multivariable analysis, women were 2.19 times as likely as men to be prescribed a low metabolic risk MSM (95% CI: 1.84-2.60, p<0.0001). Several demographic and clinical covariates were also independently related to prescribing of MSMs by level of metabolic risk. LIMITATIONS: This study used retrospective administrative data collected from a VA healthcare system database, which does not allow us to understand the context in which MSM treatment decisions were made. CONCLUSIONS: Prescribing choices for MSMs by VA mental health prescribers and female Veterans may reflect a growing awareness of the potential adverse health consequences of these treatments in women.


Assuntos
Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Veteranos/estatística & dados numéricos , Ganho de Peso/efeitos dos fármacos , Adulto , Antipsicóticos/efeitos adversos , Feminino , Humanos , Hiperlipidemias/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Obesidade/induzido quimicamente , Obesidade/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Caracteres Sexuais , Estados Unidos , United States Department of Veterans Affairs , Veteranos/psicologia
20.
J Dual Diagn ; 11(2): 145-50, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25985201

RESUMO

OBJECTIVE: Consumers with serious mental illness smoke more and are at higher risk for smoking-related illness. We examined provider and consumer factors influencing the implementation of the evidence-based "5 A's" (ask, advise, assess, assist, arrange) in six community mental health centers in greater Baltimore. METHODS: Data collected as part of a larger study examining the effectiveness of delivery of the 5 A's at patient visits. First, we examined responses to a survey administered to 49 clinicians on barriers and attitudes toward delivering the 5 A's. Second, we used multilevel models to examine variance between patients (n = 228), patient factors, and variance between their psychiatrists (n = 28) in the delivery of the 5 A's (and first 3 A's). RESULTS: The most strongly endorsed barrier was perceived lack of patient interest in smoking cessation. Psychiatrists and patients both accounted for significant variance in the delivery of the 5 A's and 3 A's. Patient "readiness to change" predicted delivery of the full 5 A's, while smoking severity predicted delivery of the first 3 A's. CONCLUSIONS: There is a critical need for creative and collaborative solutions, policies, and clinician training to address actual and perceived obstacles to the delivery of evidence-based smoking cessation treatment in the mental health care setting.


Assuntos
Centros Comunitários de Saúde Mental , Transtornos Mentais/complicações , Abandono do Hábito de Fumar/métodos , Tabagismo/terapia , Adulto , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Cooperação do Paciente , Abandono do Hábito de Fumar/psicologia , Tabagismo/complicações
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