1 Psychosocial and socio-demographic correlates of medication compliance among people with schizophrenia Original Research Article Journal of Behavior

Therapy and Experimental Psychiatry, Volume 40, Issue 1, March 2009, Pages 3-14 Hector W.H. Tsang, Kelvin M.T. Fung, Patrick W. Corrigan Close preview | PDF (405 K) | Related articles | Related reference work articles Abstract | Figures/Tables | References Abstract This study examined the medication compliance of people with schizophrenia in relation to their self-stigma, insight, attitude towards medication, and socio-demographic status via a crosssectional observational design. Eighty-six Chinese adults with schizophrenia were recruited from the psychiatric hospitals and community settings for this study. The findings suggested that stereotype agreement of self-stigmatization and attitude towards medication were moderately correlated with medication compliance. Poor insight and living alone were found to be significant predictors of medication compliance based on regression analysis. Insight was identified to be the strongest predictor on compliance which accounted for 68.35% of the total variance. Although self-stigma is only moderately linked with medication compliance, its effects on medicationinduced stigma cannot be ignored. 2 Fewer symptoms vs. more side-effects in schizophrenia? Opposing pathways between antipsychotic medication compliance and quality of life Original Research Article Schizophrenia Research, Volume 113, Issue 1, August 2009, Pages 27-33 A.B.P. Staring, C.L. Mulder, H.J. Duivenvoorden, L. De Haan, M. Van der Gaag

Close preview | PDF (277 K) | Related articles | Related reference work articles Abstract Background Non-compliance with medication often has long-term detrimental effects in patients with schizophrenia. However, when patients are compliant, it is not certain whether they experience short-term improved quality of life. By simultaneously reducing symptoms and increasing side-effects, compliance with antipsychotics may have opposing effects on a patient's perceived quality of life. Aim This study aimed to identify any clinicalempirical evidence for two pathways between compliance and quality of life. Method To evaluate various pathways between compliance (Service Engagement Scale plus a one-item rating), psychotic symptoms (Positive and Negative Syndromes Scale), adverse medication effects (Subjective Wellbeing under Neuroleptics scale), and quality of life (EQ-5D), we used Structural Equation Modeling on cross-sectional data of 114 patients with a psychotic disorder. Results Compliance was not directly related to quality of life (r = 0.004). The best-fitting model (2 = 1.08; df = 1) indicated that high compliance was associated with fewer psychotic symptoms ( = 0.23) and more adverse medication effects ( = 0.22). Symptoms ( = 0.17) and adverse medication effects ( = 0.48) were both related to lower quality of life. Discussion Our results suggest that compliance with antipsychotics has two opposing pathways towards quality of life, albeit indirect ones. While compliance was associated with less severe psychotic symptoms, and was thus related to higher quality of life, it was also associated with more adverse medication effects, and was thus related to lower quality of life. However, due to our study design, we cannot draw firm conclusions on causality. Two possible clinical implications of the results for compliance and interventions are discussed. 5

The use of electronic monitoring (MEMS) to evaluate antipsychotic compliance in outpatients with schizophrenia Original Research Article Schizophrenia Research, Volume 90, Issues 1-3, February 2007, Pages 229-237 Gary Remington, Jean Kwon, April Collins, Dan Laporte, Steve Mann, Bruce Christensen Close preview | PDF (187 K) | Related articles | Related reference work articles Abstract Compliance with antipsychotic treatment is a well-recognized concern in the ongoing management of individuals with schizophrenia. The present investigation incorporated the Medication Event Monitoring System (MEMS) to evaluate compliance in a group of outpatients (N = 52) with schizophrenia or schizoaffective disorder. Evaluating compliance as a dichotomous variable and using a threshold of 80%, the rate of noncompliance as measured by MEMS was 52%, considerably higher than self-report (3%), clinician rating (24%) and pill count (25%). The ability of treating clinicians to predict compliance/noncompliance was limited: 13 of 31 (42%) subjects they rated as compliant were noncompliant while 4 of 9 (44%) rated as noncompliant were actually compliant according to MEMS. Factors most consistently associated with noncompliance were higher total symptom scores and dosing complexity i.e., greater than once daily. Based on MEMS data, the overall mean level of compliance was 66%; however, it remains unclear as to what threshold is associated with a compromise in clinical response. More sophisticated measurement tools such as MEMS may assist us in better understanding how level and pattern of antipsychotic noncompliance, factors that at present remain poorly understood, impact on symptom exacerbation.

10 Partial compliance in schizophrenia and the impact on patient outcomes Review Article Psychiatry Research, Volume 161, Issue 2, 30 November 2008, Pages 235-247 Pierre-Michel Llorca Close preview | PDF (258 K) | Related articles | Related reference work articles Abstract This review evaluates the impact of partial compliance on treatment outcomes in schizophrenia and discusses strategies that may be implemented to enhance compliance. As such, a search of English language articles evaluating compliance in schizophrenia was performed using Medline and EMBASE, with no time limits. Abstracts and posters presented at key psychiatry congresses were also reviewed. Results demonstrated that partial compliance with antipsychotic medication is a significant barrier to achieving optimal outcomes in schizophrenia. The problem increases with the duration of treatment, and is difficult to monitor. The impact of partial compliance is significant, leading to increases in psychotic symptoms, the risk of relapse and rehospitalization, and even suicide. Compliance is a complex phenomenon, influenced by aspects of the illness itself such as cognitive impairment and patients' health beliefs. The patient's environment and therapeutic alliance also influence medication compliance. Behavioural and pharmacological measures should be used together to improve compliance. While atypical antipsychotics have demonstrated improvements in psychotic symptoms, insight and cognition, these may not be enough to ensure compliance with oral daily medication. Long-acting risperidone may therefore bring together the benefits of the atypical antipsychotics with the long-acting injection delivery system required to build a platform for improved outcomes. 19 A framework for planning and critiquing medication compliance and persistence research using prospective

study designs Original Research Article Clinical Therapeutics, Volume 31, Issue 2, February 2009, Pages 421-435 Femida H. Gwadry-Sridhar, Elizabeth Manias, Ying Zhang, Anuja Roy, Kristina Yu-Isenberg, Dyfrig A. Hughes, Michael B. Nichol Show preview | PDF (1582 K) | Related articles | Related reference work articles Abstract Background: Medication compliance and persistence are important determinants of clinical outcomes. With the application of evidence-based therapy, it is increasingly important to ensure that studies that use compliance or persistence as a primary or secondary outcome are designed suitably and employ appropriate analyses to support the inferences made. Objective: The aim of this work was to describe the designs of medication compliance/persistence studies and provide guidance on appropriate analyses, with the ultimate goal of helping health providers and payers of health care understand the impact of compliance and persistence on health outcomes. Methods: MEDLINE, CINAHL, EMBASE, and all EBM Reviews databases were searched to locate key research articles about prospective medication compliance and persistence studies. Articles published between 1978 and 2008 were included in the search. Inclusion criteria included a focus on medication compliance and persistence, and prospective research designs. Articles that largely focused on retrospective study designs or were based on opinion rather than evidence were excluded. Results: A systematic framework was developed that comprised a prospective checklist and a quantitative tool to assess the quality of studies. The key elements of the checklist included the following: title and abstract, introduction or background, objectives, methods and study design, statistical analysis and results, discussion, conclusions, and disclosure of conflicts of interest. For each element, examples are provided to help readers make an informed decision about the design, value, and quality of a particular prospective study. Conclusions: The checklist and quantitative tool can be used to provide objective validation of the rigor of prospective research designs. It is anticipated that future research will follow a uniform approach to presentation and evaluation of

data, thereby facilitating a clear understanding of the impact of compliance and persistence on health outcomes. 36 Insight et interventions psychoducationnelles dans la schizophrnie Original Research Article Annales Mdico-psychologiques, revue psychiatrique, Volume 167, Issue 10, December 2009, Pages 745-752 C. Billiet, P. Antoine, R. Lesage, M.-L. Sangare Close preview | PDF (202 K) | Related articles | Related reference work articles Abstract Poor insight is consistently present in schizophrenia and is among the most discriminating symptoms for differentiating schizophrenia from other mental disorders. Patients are unable to see the most obvious symptoms of their illness, despite the fact that their family members can recognize thought disorder, mania or hallucinations. Results suggest that lack of insight is a part of the disorder itself, rather than an adaptive strategy. Poor insight in schizophrenia has been described as a lack of awareness of suffering from an illness, of the symptoms of the illness, of the consequences of the disorder, and of the need for treatment. Similarly to some negative symptoms lack of insight predisposes to an increased number of relapses and hospitalizations, to deteriorating social skills and quality of social relationships, and to a worsening course of illness. Unawareness is among the best predictions of non-adherence to treatment. Patients do not want to take medicine for an illness they do not think they have. The ways in which patients think about their illness experiences have been associated with a variety of behaviours and emotional responses. In schizophrenia, the study of beliefs about mental illness has generally been centered on people's interpretations of experiences and how these interpretations contribute to the development and maintenance of symptoms. There are less studies of other beliefs such as the causes of the experience, beliefs about treatment, consequences, and how long the illness is likely to last. The need to understand the way in which a patient appraises his/her own experiences has been recognized. People who integrated their experiences more fully,

accepting that they had experienced a psychotic episode, actually showed higher levels of depression. This may reflect the demoralization and stigma that patients associate with mental illness. Many clinicians believe that lack of insight is very often a consequence of denial, a defensive mechanism. Terms such as defensive denial, and lack of insight often reflect underlying conceptual differences. Psychoeducational interventions were developed to increase patients knowledge of, and awareness about their illness, there is a focus on knowledge. Education is a process by which a patient gains understanding through learning. Patients have a right to an accurate and complete knowledge regarding their illness and treatment. The assumption is that this increased knowledge and insight will enable patients to cope in a more effective way. Learning implies changes in behaviour, skill or attitude. There is some suggestion that psychoeducation may improve compliance with medication and have a positive effect on a patients quality of life. Psychoeducational approaches involve interaction between the caregiver and the mentally ill person. Patient education can take a variety of forms and objectives. It may take place in groups or on a one-to-one basis and it may involve the use of videotapes, self-help or other media. The goal may be to better manage the patient's treatment, illness or condition to help him/her attain an improved level of health. Psychoeducational interventions address the illness from a multidimensional viewpoint, including familial, social and pharmacological information. Patients are provided with support, information and management strategies. Interventions may include elements of behavioural training, social and life skills training, or education performed by professional caregivers. This review studies the links between insight and various psychoeducational interventions: health and treatment education, psychosocial skills training, familial intervention, and intervention focused on subjective illness experience. 38 Management of Schizophrenia with Obesity, Metabolic, and Endocrinological Disorders Review Article Psychiatric Clinics of North America, Volume 32, Issue 4, December 2009, Pages 775-794 Palmiero Monteleone, Vassilis Martiadis, Mario Maj

Close preview | Related articles | Related reference work articles Abstract | Figures/Tables | References No abstract is available for this article.

46 Impact of antipsychotic medication on family burden in schizophrenia: Longitudinal results of CATIE trial Original Research Article Schizophrenia Research, Volume 116, Issues 2-3, February 2010, Pages 118-125 Deborah A. Perlick, Robert A. Rosenheck, Richard Kaczynski, Marvin S. Swartz, Jose M. Canive, Jeffrey A. Lieberman Close preview | PDF (175 K) | Related articles | Related reference work articles Abstract Background This study evaluated the effectiveness of first- and secondgeneration antipsychotics in reducing family burden associated with schizophrenia. Methods The family caregivers of 623 SCID-diagnosed patients enrolled in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) randomly assigned to a first-generation antipsychotic (perphenazine) or one of four second-generation drugs (olanzapine, quetiapine, risperidone or ziprasidone) were interviewed about resources provided and stresses experienced at baseline and followed for 18 months. Patient symptoms, side effects and service use were assessed as well. Hierarchical regression analyses evaluated the effect of treatment assignment on four burden factors: problem behavior, resource demands and disruption, impairment in activities of daily living and patient helpfulness. Intention-to-treat analyses with all available observations classified based on initial treatment assignment, including observations after medications changed were followed by secondary analyses excluding observations

after the first medication change, i.e. only considering initial medication. Results Despite significant reductions on the problem behavior and resource demands/disruption factors, there were no significant differences between perphenazine and any of the secondgeneration medications. When only initial treatment period observations were included, patients were perceived as more helpful when medicated with perphenazine as compared to risperidone. In comparisons between second-generation drugs, patients on quetiapine were perceived as more helpful than those on risperidone (p = 0.004). Conclusion In this 18-month randomized trial, there was no evidence of superiority of second-generation antipsychotics in relieving family burden. 65 PMH1 COMPLIANCE WITH ANTIPSYCHOTIC DRUGS AND HOSPITALIZATION: A NESTED CASE-CONTROL ANALYSIS IN A COHORT OF PEOPLE WITH SCHIZOPHRENIA Value in Health, Volume 12, Issue 7, October 2009, Page A350 J Moisan, JP Grgoire Close preview | PDF (79 K) | Related articles | Related reference work articles Abstract No abstract is available for this article. 70 Neuroleptic Compliance Among Chronic Schizophrenic Outpatients: An Intervention Outcome Report Original Research Article Journal of Consulting and Clinical Psychology, Volume 53, Issue 5, October 1985, Pages 666-671 Judith A. Boczkowski, Amos Zeichner, Niki DeSanto Close preview | PDF (516 K) | Related articles | Related reference work articles

This study investigated the effects of a behavioral-tailoring (BT) intervention and a psychoeducational (PE) intervention on neuroleptic medication compliance of chronic schizophrenic outpatients. Thirty-six schizophrenic participants were assigned to either a PE (n = 12), a BT (n = 12), or a control group (n = 12). Compliance was measured by self-report, significant others' ratings, and pill count at pretreatment and 1-month and 3-month follow-up contacts. Results indicated that BT participants were significantly more compliant, as measured by pill count following treatment than were the other groups. Additionally, low correlations were found between the three compliance measures. The results suggest that subjective ratings may have questionable validity and that behavioral techniques may be superior to other approaches in improving neuroleptic compliance among chronic schizophrenic outpatients. 76 Further evidence for the efficacy of a metacognitive group training in schizophrenia Original Research Article Behaviour Research and Therapy, Volume 49, Issue 3, March 2011, Pages 151-157 S. Moritz, A. Kerstan, R. Veckenstedt, S. Randjbar, F. Vitzthum, C. Schmidt, M. Heise, T.S. Woodward Close preview | PDF (231 K) | Related articles | Related reference work articles Abstract Metacognitive training (MCT) for patients with schizophrenia is a novel psychological group treatment targeting cognitive biases putatively involved in the pathogenesis of schizophrenia (e.g. jumping to conclusions, overconfidence in errors). Its eight modules are available cost-free online in many languages. In the present study, 36 subacute or remitted patients were randomly allocated to either the MCT or a wait-list group who received treatment-as-usual (TAU). Baseline and post assessments were 8 weeks apart and were performed blind to group status. MCT showed significantly greater improvement on the following parameters relative to the TAU group: delusion distress (PSYRATS), memory and social quality of life. In the MCT group, the rate of jumping to conclusions bias was reduced

after training. No differences occurred on the PANSS. The present study confirms prior reports that MCT exerts beneficial effects on some cognitive and symptomatic parameters. 123 Schizophrenia, drug companies and the internet Original Research Article Social Science & Medicine, Volume 66, Issue 1, January 2008, Pages 99-109 John Read Close preview | PDF (158 K) | Related articles | Related reference work articles Abstract To investigate differences in the content of websites funded, and not funded, by drug companies, the top 50 websites about schizophrenia in Google and Yahoo were analysed in relation to five variables: three scales relating to causes, treatments and violence, and two categorical variables about the condition being extremely severe and about linking coming off medication to violence. Fifty eight percent of the websites analysed received funding from drug companies. Drug company funded websites were significantly more likely to espouse bio-genetic rather than psycho-social causal explanations, to emphasise medication rather than psychosocial treatments, to portray schizophrenia as a debilitating, devastating and long-term illness, and to link violence to coming off medication. They were neither more nor less likely to describe schizophrenics as violent. These results suggest that the documented influence of the pharmaceutical industry over research, professional organisations, teaching institutions, clinical practice and regulatory bodies may now extend to public promotion, via the internet, of perspectives conducive to maximisation of sales.

137 Treatment of schizophrenia with paliperidone extendedrelease tablets: A 6-week placebo-controlled trial Original Research Article Schizophrenia Research, Volume 90, Issues 1-3, February 2007, Pages 147-161 J. Kane, F. Canas, M. Kramer, L. Ford, C. Gassmann-Mayer, P. Lim, M. Eerdekens Close preview | PDF (401 K) | Related articles | Related reference work articles Abstract Background Paliperidone extended-release tablet (paliperidone ER) is an investigational oral psychotropic developed for schizophrenia treatment. It utilizes OROS technology to provide a unique pharmacokinetic profile, eliminating the need for titration and potentially leading to improved tolerability. Furthermore, paliperidone undergoes limited hepatic metabolism. Methods The efficacy and safety of once-daily paliperidone ER (6 mg, 9 mg and 12 mg) were assessed versus placebo in 628 patients with acute schizophrenia in a 6-week, multicenter, double-blind, randomized, parallel-group study. Results All doses of paliperidone ER demonstrated significant improvement in PANSS score, all PANSS Marder factor scores (p < 0.001) and personal and social functioning versus placebo (p < 0.001). The PANSS total score also improved significantly in the olanzapine treatment arm. Significantly higher percentages of paliperidone ER patients demonstrated a 30% reduction in PANSS total score versus placebo (p < 0.001). The incidence of movement disorder-related AEs and rating scales measurements were similar to placebo for the paliperidone ER 6 mg group and higher in the 9 mg and 12 mg groups. In the paliperidone ER groups there were no reports of glucoserelated AEs or clinically relevant changes in plasma lipid levels and changes in mean bodyweight < 1 kg. Conclusion

In this study, all doses of paliperidone ER were effective in significantly improving the symptoms of schizophrenia and personal and social functioning and were generally well tolerated. Paliperidone ER offers a distinctive treatment profile and may provide a valuable new treatment option for patients with schizophrenia. 138 Therapeutic compliance methodologies in HIV-infection treatment: A comparative study Original Research Article Swiss Journal of Psychology, Volume 60, Issue 3, September 2001, Pages 136-160 Cyril Tarquinio, Gustave Nicolas Fischer Close preview | PDF (211 K) | Related articles | Related reference work articles Abstract | References Compliance with HIV treatment has been studied extensively. Following the introduction of tritherapy, its importance and implications have changed. Antiretroviral treatments entail taking up to 20 pills a day at set hours, for which there are often numerous undesirable and even toxic side effects. These therapeutic constraints lead to what is labeled greater or lesser compliance. Certain factors such as side effects, modes of contamination, and trust in physicians appear to be more closely linked to noncompliance than others. A recurring problem is how to assess this compliance. There are two types of measures that serve this purpose: direct (biological) or indirect (interviews, questionnaires). It is often very difficult to know how authors actually proceed in assessing their patients' compliance. To determine this, we analyzed 27 of the 310 studies published between 1990 and 2000 on therapeutic compliance in HIV-infected patients. These 27 studies were not chosen because they are a statistically representative sample of the related literature, but because they account quite well for the different types of methods used to measure compliance with HIV treatment. Our analysis shows that compliance measures are quite diverse and can be either a combination of direct and indirect measures, or consist of one or more direct measures or only indirect measures. These three methodological orientations are discussed first. The limits and

biases of self- and hetero-compliance assessment, so often neglected, are studied next. Finally, problems related to the temporal facet of compliance behavior are analyzed, namely definition of the concept, need for a more precise theoretical elaboration, and the place of health psychology in relation to the medical sciences. 169 Owner compliance and clinical outcome measures for domestic cats undergoing clinical behavior therapy Original Research Article Journal of Veterinary Behavior: Clinical Applications and Research, Volume 3, Issue 3, May-June 2008, Pages 114-124 Rachel A. Casey, John W.S. Bradshaw Close preview | PDF (274 K) | Related articles | Related reference work articles Abstract The importance of owner compliance in following treatment is recognized in all aspects of veterinary and human medicine. However, in veterinary behavioral medicine, where the majority of the treatment is conducted by the owners themselves after the consultation, compliance is fundamental to the successful outcome of the case. The owners of 85 cats with a range of different behavior problems were recruited to participate in this study. Each owner had 2 visits from a clinician: at the first background information was gathered, the owner and clinician assigned a subjective score of severity and a full behavior consultation was conducted. At a second visit 8 weeks later, owner and clinician rated the severity of the problem again, and the owner was asked questions that were designed to check their compliance to various aspects of the treatment program. The owners reported a decrease in severity after treatment in 92% of cases, and the clinician in 78% of cases. The average compliance of owners to programs was 61%. A strong positive correlation was found between change in severity score rated by the clinician, and compliance score (Spearman's = 0.718, P < 0.01), a weaker positive correlation was found between compliance and difference in owner severity scores between visits (Spearman's = 0.402, P < 0.01). There was no significant correlation found between

compliance score and the severity score on visit one, rated either by owner or clinician. The results of this study confirm that owner compliance is an important factor in treatment outcomes for behavior problems in domestic cats.

205 C.06.02 Predictors of individual response and long-term compliance in schizophrenia treatment European Neuropsychopharmacology, Volume 17, Supplement 4, October 2007, Page S601 C.A. Tamminga Close preview | PDF (54 K) | Related articles | Related reference work articles Abstract No abstract is available for this article. 221 Antipsychotic treatment patterns and hospitalizations among adults with schizophrenia Original Research Article Schizophrenia Research, Volume 101, Issues 1-3, April 2008, Pages 304-311 Susan dosReis, Elizabeth Johnson, Donald Steinwachs, Charles Rohde, Elizabeth A. Skinner, Maureen Fahey, Anthony F. Lehman Close preview | PDF (226 K) | Related articles | Related reference work articles bstract Objective(s) To characterize the longitudinal patterns of antipsychotic treatment and to investigate the relationship between antipsychotic treatment patterns and acute hospitalizations among adults with schizophrenia. We hypothesized that continuous antipsychotic treatment would be associated with fewer hospitalizations and shorter lengths of stay.

Method Seven years of retrospective Maryland Medicaid administrative data were used to examine inpatient medical encounters and outpatient psychotropic treatment in community-based settings from 1993 through 2000. The sample consisted of 1727 adults continuously enrolled in the Maryland Medicaid program from July 1992 through June 1994, and diagnosed with schizophrenia. The main outcome measures were a) any schizophrenia hospitalization; b) number of schizophrenia hospitalizations; and c) inpatient days associated with a primary diagnosis of schizophrenia. Results The average duration of antipsychotic use was six months in any single year and four and one-half years across the entire study period. Compared to individuals with a more continuous pattern of antipsychotic treatment, individuals with moderate or light use had odds of hospitalization for schizophrenia that were 52 or 72% greater (95%CI: 3075% greater, 49100% greater respectively). Light users of antipsychotics have an average length of stay per hospitalization that is approximately 20% longer than the average for continuous users (95%CI: 2 39% longer). Conclusions Findings emphasize the benefit of continuous antipsychotic treatment for individuals with schizophrenia.

256 Informing patients about adverse effects did not reduce compliance with schizophrenia treatment Review Article Evidence-based Healthcare, Volume 2, Issue 4, December 1998, Pages 106-107 AS David, MV Lambert Close preview | PDF (115 K) | Related articles | Related reference work articles Abstract | References No abstract is available for this article.

75 Caregiver psychoeducation for first-episode psychosis Original Research Article European Psychiatry, Volume 25, Issue 1, January 2010, Pages 33-38 Stephen McWilliams, Patrick Egan, Deirdre Jackson, Laoise Renwick, Sharon Foley, Caragh Behan, Emma Fitzgerald, Alastair Fetherston, Niall Turner, Anthony Kinsella, Eadbhard OCallaghan Close preview | PDF (174 K) | Related articles | Related reference work articles bstract Introduction International best-practice guidelines for the management of first-episode psychosis have recommended the provision of psychoeducation for multifamily groups. While there is ample evidence of their efficacy in multiepisode psychosis, there is a paucity of evidence supporting this approach specifically for first-episode psychosis. We sought to determine whether a sixweek caregiver psychoeducation programme geared specifically at first-episode psychosis improves caregiver knowledge and attitudes. Methods Caregivers of people with first-episode psychosis completed a 23-item adapted version of the self-report Family Questionnaire (KQ) and a 17-item adapted version of the self-report Drug Attitudes Inventory (DAI) before and after the six-week DETECT Information and Support Course (DISC). Using a Generalised Linear Repeated Measures Model, we analyzed the differences in proportions of correct answers before and after the programme. Results Over a 24-month study period, 31 caregivers (13 higher socioeconomic; 13 lower socioeconomic; five unspecified socioeconomic; 19 female; 12 male) participated in the DISC programme and completed inventories before and after the course. Knowledge of psychosis and specific knowledge of medication treatment improved among caregivers overall (p < .01; effect sizes 0.78 and 0.94 respectively). There were

no significant gender or socioeconomic differences in any improvement. Discussion This study confirms that caregiver psychoeducation specifically for first-episode psychosis directly improves knowledge of the illness overall and, in particular, knowledge of medication. Gender is not a factor in this, while the lack of any socioeconomic differences dispels the myth that patients in lower socioeconomic groups are disadvantaged because their caregivers know less. 283 Effect of perospirone on P300 electrophysiological activity and social cognition in schizophrenia: A threedimensional analysis with sLORETA Original Research Article Psychiatry Research: Neuroimaging, Volume 172, Issue 3, 30 June 2009, Pages 180-183 Tomiki Sumiyoshi, Yuko Higuchi, Toru Itoh, Mie Matsui, Hirofumi Arai, Michio Suzuki, Masayoshi Kurachi, Chika Sumiyoshi, Yasuhiro Kawasaki Close preview | PDF (490 K) | Related articles | Related reference work articles Abstract The purpose of this study was to determine if perospirone, a second generation antipsychotic drug and partial agonist at serotonin-5-HT1A receptors, enhances electrophysiological activity, such as event-related potentials (ERPs), in frontal brain regions, as well as cognitive function in subjects with schizophrenia. P300 current source images were obtained by means of standardized low resolution brain electromagnetic tomography (sLORETA) before and after treatment with perospirone for 6 months. Perospirone significantly increased P300 current source density in the left superior frontal gyrus, and improved positive symptoms and performance on the script tasks, a measure of verbal social cognition, while verbal learning memory tended to be improved. There was a significant correlation between the changes in P300 amplitude on the left frontal lead and those in social cognition. These results suggest the changes in three-dimensional distribution of

cortical activity, as demonstrated by sLORETA, may mediate some of the actions of antipsychotic drugs. The distinct cognition-enhancing profile of perospirone in patients with schizophrenia may be related to its actions on 5-HT1A receptors. 301 COMPARING THE EFFICACY OF INTERVENTIONS THAT USE ENVIRONMENTAL SUPPORTS TO IMPROVE OUTCOMES IN PATIENTS WITH SCHIZOPHRENIA Schizophrenia Research, Volume 102, Issues 1-3, Supplement 2, June 2008, Page 260 Dawn Velligan, Pam Diamond Close preview | PDF (61 K) | Related articles | Related reference work articles Abstract No abstract is available for this article.

309 Self-efficacy and empowerment as outcomes of selfstigmatizing and coping in schizophrenia Original Research Article Psychiatry Research, Volume 150, Issue 1, 28 February 2007, Pages 71-80 Roland Vauth, Birgit Kleim, Markus Wirtz, Patrick W. Corrigan Close preview | PDF (379 K) | Related articles | Related reference work articles Abstract

The concept of internalized stigma or self-stigma is central to the understanding of the psychological harm caused by stigma. In this study, we aim to demonstrate how the evaluative dimension of self-concept (self-efficacy and empowerment) mediates the psychological effects of self-stigmatizing and coping with stigma. As important examples of psychological effects, depression and quality of life were focussed on. In 172 outpatients with DSM-IV schizophrenia, measures of self-stigma and devaluation, coping with stigma, self-efficacy, empowerment, quality of life and depression were assessed. It was hypothesized that withdrawal and secrecy as important coping strategies yielded to higher levels of anticipatory anxiety of future stigmatizing. Higher levels of perceived discrimination and devaluation were hypothesised to undermine self-efficacy and illness-related empowerment. Lowering of empowerment was supposed to enhance depression and reduce quality of life. This hypothesis was tested by Structural Equation Modeling as a method of data analysis. The results supported the hypothesized model; i.e., 46% of depression and 58% of quality of life reduction could be explained by eroded empowerment. Moreover, 51% of the empowerment reduction was explained by reduction in selfefficacy at a more general level by dysfunctional coping and higher levels of anticipated stigma. Taken together, our data suggest an avoidant coping style as a risk factor for anticipatory stigma, which erodes self-efficacy and empowerment. These data have implications for cognitive behavioral approaches, which should focus on anticipated stigma to improve recovery in schizophrenia. 429 Suicidality in first episode psychosis is associated with insight and negative beliefs about psychosis Original Research Article Schizophrenia Research, Volume 123, Issues 2-3, November 2010, Pages 257-262 Elizabeth A. Barrett, Kjetil Sundet, Ann Faerden, Ingrid Agartz, Unni Bratlien, Kristin Lie Romm, Erlend Mork, Jan Ivar Rossberg, Nils Eiel Steen, Ole A. Andreassen, Ingrid Melle

Close preview | PDF (167 K) | Related articles | Related reference work articles Abstract Introduction Suicidal behaviour is prevalent in psychotic disorders. Insight has been found to be associated with increased risk for suicidal behaviour, but not consistently. A possible explanation for this is that insight has different consequences for patients depending on their beliefs about psychosis. The present study investigated whether a relationship between insight, negative beliefs about psychosis and suicidality was mediated by depressive symptoms, and if negative beliefs about psychosis moderated the relationship between insight and suicidality in patients with a first episode of psychosis (FEP). Method One hundred ninety-four FEP-patients were assessed with a clinical interview for diagnosis, symptoms, functioning, substance use, suicidality, insight, and beliefs about psychosis. Results Nearly 46% of the patients were currently suicidal. Depressive symptoms, having a schizophrenia spectrum disorder, insight, and beliefs about negative outcomes for psychosis were independently associated with current suicidality; contradicting a mediating effect of depressive symptoms. Negative beliefs about psychosis did not moderate the effect of insight on current suicidality. Conclusion The results indicate that more depressive symptoms, higher insight, and negative beliefs about psychosis increase the risk for suicidality in FEP-patients. The findings imply that monitoring insight should be part of assessing the suicide risk in patients with FEP, and that treating depression and counteracting negative beliefs about psychosis may possibly reduce the risk for suicidality. 491 New clinical strategies of assessment of comorbidity associated with substance use disorders Review Article Clinical Psychology Review, Volume 31, Issue 3, April 2011,

Pages 418-427 F. Cosci, G.A. Fava Close preview | PDF (294 K) | Related articles | Related reference work articles Abstract The introduction of dual diagnosis had the merit of drawing attention on substance use among patients with mental illness. In due course, as what often happens with innovations, the concept of dual diagnosis displayed considerable limitations and was progressively replaced by comorbidity. This paper critically reviews the limitations of dual diagnosis and comorbidity and formulates an alternative proposal based on clinimetric methods. In many instances of diagnostic reasoning in psychiatry and in clinical psychology, the process ends with the identification of the disorders and their diagnoses. However, diagnostic endpoints, the customary guidance of diagnostic reasoning, should be replaced by the conceptualization of disorders as transfer stations, which are amenable to longitudinal verification and modification. Indeed, diagnoses might encompass a wide range of manifestations, seriousness, prognosis, and response to treatment that need to be evaluated. A new clinimetric approach which takes advantage of clinimetric methods (including macro-analysis, micro-analysis, staging, and evaluation of subclinical symptoms) is proposed. This approach may allow an accurate analysis of the different problem areas of each patient and their hierarchical organization and may yield important implications for mental health and substance abuse clinics. 894 Safety and compliance with an emergency medical service direct psychiatric center transport protocol Original Research Article The American Journal of Emergency Medicine, Volume 26, Issue 7, September 2008, Pages 750-756 Paul Cheney, Tiffany Haddock, Leslie Sanchez, Amy Ernst, Steven Weiss

Close preview | PDF (144 K) | Related articles | Related reference work articles Abstract Objectives To evaluate compliance and safety of an emergency medical service (EMS) triage protocol that allows paramedics to transport patients directly to psychiatric emergency services. Methods A psychiatric patient diversion protocol was developed for our system. Protocol compliance was evaluated the following 3 ways: (1) psychiatric facility intake forms completed by mental health workers on patients transported by EMS directly to a psychiatric emergency service (PES) bypassing the ED, (2) hospital records for patients who were redirected from PES to the ED for medical evaluation, (3) retrospective analysis of ambulance charts. Study outcomes included protocol noncompliance rate, protocol failure rate, and any morbidity associated with either noncompliance or protocol failure. Data were analyzed using proportions and 95% confidence intervals (CI). Results A total of 174 patients were directly transported to PES bypassing ED medical clearance. The protocol effectively screened for medical issues in 96% of cases. Protocol noncompliance occurred in 51 cases for a frequency of 29% (CI, 22%-36%). One patient in the paramedic noncompliance group required hospital admission. There was protocol failure in 5 (2.9%; 95% CI, 0.9-6.6) of the patients who fit all protocol requirements for transport to PES but required secondary transport to the ED. All were subsequently transferred back to PES. Nine patients (5.2%; CI, 2.7%-9.5%) required secondary transfer to the ED. No patient had critical or life-threatening problems. Conclusions Emergency medical service providers showed a poor level of compliance with vital sign criteria, but the protocol provided a high level of safety. 916

Medical Complications of Mothers Breastfeeding (Seventh Edition), 2011, Pages 550-613 Ruth A. Lawrence MD,, Robert M. Lawrence MD Close preview | Related articles | Related reference work articles DRUGS FOR PRETERM LABOR Breast engorgement and galactorrhea have been reported to be associated with the use of ritodrine for tocolysis.177 Evaluation was done in 11 women with measurements of serum prolactin, progesterone, estradiol, and estriol excretion. No differences were noted in association of the ritodrine. Apparently the affect is unrelated to hormone changes.251 Reports of breast engorgement and galactorrhea have also been reported with other tocolytics. One case was associated with the use of intravenous (IV) magnesium sulfate in a 24-year-old woman at 30 weeks gestation.185 Plasma magnesium levels ranged between 4.1 and 6.4 mg/mL. On day 4 of treatment, engorgement and dripping of milk developed. Prolactin level was 83.6 ng; normal range in pregnancy is up to 200 ng/L. Magnesium was replaced with nifedipine, and the symptoms gradually subsided. Another case report describes tocolysis in which thyrotropin-releasing hormone 400 mcg every 8 hours for four doses was used with corticosteroids to enhance fetal lung maturity. This has been associated with an increase in prolactin. The patient also received magnesium sulfate initially, followed by oral terbutaline; 36 hours after the last dose of thyrotropin-releasing hormone the patient experienced painful bilateral engorgement, tender masses in both axillae, and lactation. Prolactin level was 55.4 ng/mL. Symptoms subsided in 96 hours.112 CESAREAN DELIVERY When birth takes place by cesarean delivery, a mother becomes a surgical patient with all the inherent risks and problems. If the procedure is anticipated because of a previous cesarean delivery, cephalopelvic disproportion, or some other identifiable reason, a mother can prepare herself psychologically

for the event and usually tolerates the process better. When the procedure is unplanned and done during the process of labor, it is psychologically more traumatic, and the mother tends to feel as if she has failed in her role. In addition to this unexpected disappointment, medical emergencies may also have an impact on the mothers well-being, such as a long, difficult labor, abruptio placentae, blood loss, toxemia, or infection. A mother who plans to breastfeed after cesarean delivery should be able to do so if the infant is well enough. The method of delivery makes no significant difference to the timing of the milk coming in or the changes in the concentration of the major milk constituents in the first 7 days postpartum.164 Depending on the type of anesthesia and the associated circumstances, the mother may feel alert enough to put the infant to breast within the first hour. The obstetrician, surgeon, and the operating room nurses are key in making it happen. Bupivacaine is being used as an epidural block for cesarean or vaginal delivery because it does not result in the decrease in muscle tone and strength reported in neonates whose mothers have received lidocaine or mepivacaine.188,244 Bupivacaine and tetracaine are highly protein bound and appear 923 S.2.05 Psychoeducation and shared decision making as a way to reduce non-compliance in mental disorders European Neuropsychopharmacology, Volume 21, Supplement 2, 1 April 2011, Pages S109-S110 S. Leucht Close preview | PDF (52 K) | Related articles | Related reference work articles Abstract No abstract is available for this article.