THE ROLE OF DYSFUNCTIONAL BELIEFS IN INDIVIDUALS WHO EXPERIENCE PSYCHOSIS AND USE SUBSTANCES: IMPLICATIONS FOR COGNITIVE THERAPY AND MEDICATION ADHERENCE

1998 ◽  
Vol 26 (3) ◽  
pp. 193-208 ◽  
Author(s):  
Hermine L. Graham
Keyword(s):  
Substance Use ◽  
Medication Adherence ◽  
Subjective Experience ◽  
Cognitive Model ◽  
Developmental Model ◽  
Cognitive State ◽  
Case Formulation ◽  
Treatment Services ◽  
Adherence To Medication ◽  
Starting Point

It can be argued that an individual’s subjective experience and beliefs about a substance are important. Motives and expectancies regarding the use of alcohol and drugs are often that they are going to modify a cognitive state or help them cope with a particular situation. However, there are growing concerns in the U.S.A. and in the U.K. regarding individuals who experience psychosis and concurrently use substances. Correctly diagnosing individuals with dual presentation is said to be difficult, engagement in treatment is problematic, and medication adherence and prognosis poor. In this paper a cognitive-developmental model is proposed. I suggest that for individuals who experience psychosis and also use drugs or alcohol, the ability to identify the relationship between the substance use and the psychotic illness in terms of a case formulation/conceptualization would provide a good starting point for developing strategies and interventions that are most likely to succeed in treatment. Such an approach would explicitly address key cognitions. Unless the dysfunctional substance-related beliefs are addressed, adherence to medication and engagement with treatment services will be hindered and the possibility of relapsing to problematic substance use and acute psychosis remains. A cognitive treatment component, to target these beliefs, based on the cognitive model of substance misuse and the motivational interviewing approach will also be briefly outlined.

An institutional ethnography of prevention and treatment services for substance use disorders in the Dominican Republic

2019 ◽  
Vol 15 (5) ◽  
pp. 691-703
Author(s):  
Mark Padilla ◽  
José Félix Colón-Burgos ◽  
Caroline Mary Parker ◽  
Nelson Varas-Díaz ◽  
Armando Matiz-Reyes
Keyword(s):  
Substance Use ◽  
Dominican Republic ◽  
Substance Use Disorders ◽  
Institutional Ethnography ◽  
Treatment Services ◽  
Prevention And Treatment

scholarly journals Disclosure and health-related outcomes among children living with HIV and their caregivers

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Margaret Amankwah-Poku ◽  
Delight Abla Klutsey ◽  
Kwaku Oppong Asante
Keyword(s):  
Medication Adherence ◽  
Psychological Health ◽  
Positive Impact ◽  
Well Being ◽  
Demographic Variables ◽  
Hiv Status ◽  
African Countries ◽  
Psychological Well Being ◽  
Adherence To Medication ◽  
Living With Hiv

Abstract Background The prevalence of disclosure of status to children living with the Human Immunodeficiency Virus (HIV) is low in most sub-Saharan African countries, leading to poor compliance and adverse psychological outcomes in these children. This study examined the influence of disclosure on health outcomes in children living with HIV and their caregivers. Methods Using a cross-sectional design, 155 HIV-positive children between age 6–15 years and their caregivers were administered standardized questionnaires measuring adherence to medication, children's psychological well-being, caregiver burden, and caregivers’ psychological health. Results Results indicated that only 33.5% of the children sampled knew their status. Disclosure of HIV status was significantly related to medication adherence, psychological wellbeing, the burden of caregiving, and the length of the disclosure. A child’s age and level of education were the only demographic variables that significantly predicted disclosure of HIV status. In a hierarchical analysis, after controlling for all demographic variables medication adherence, psychological well-being and burden of caregiving were found to be significant predictors of disclosure of status in children living with HIV. Conclusions Findings suggest the need for disclosure of status among children living with HIV for a positive impact on their medication adherence and psychological health. These findings underscore the need for the development of context-specific interventions that will guide and encourage disclosure of status by caregivers to children living with HIV.

scholarly journals The 8-item Morisky medication adherence scale: validation of a Portuguese version in HIV patients

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Aguiar ◽  
C Piñeiro ◽  
R Serrão ◽  
R Duarte
Keyword(s):  
Medication Adherence ◽  
Psychometric Properties ◽  
Reliability Analysis ◽  
Cronbach’S Alpha ◽  
Portuguese Version ◽  
Cronbach's Alpha ◽  
Adherence To Medication ◽  
Morisky Medication Adherence Scale ◽  
Adherence Scale ◽  
The Mean

Abstract Background Antiretroviral therapy (ART) has the most effective treatment for people with HIV, but its effectiveness depends on the individual medication adherence. Morisky Medication Adherence Scale (MMAS-8) is one of the most widely used scales to assess patient adherence. Thus, we aimed to validate a Portuguese version of MMAS-8 and determine its psychometric properties in HIV positive patients. Methods A cross-sectional survey was conducted in Centro Hospitalar Universitário São João (Porto, northern Portugal) at the infectious diseases department. After authorization to use the scale - granted by the author - and, a standard forward-backwards procedure to translate MMAS-8 to Portuguese, the questionnaire was applied to 233 patients with HIV doing ART. Reliability was assessed using Cronbach's alpha and test-retest reliability. Three levels of adherence were considered: 0 to < 6 (low), 6 to < 8 (medium), 8 (high). Results In the studied sample, the mean age was 45.03 years (SD = 11.63), 80.3% men, 19.3% women and 1 transgender, and 53.8% had ≤9 years of education. The mean number of prescribed ART per patient was 1.76. The mean score for the medication adherence scale was 7.29 (SD = 6.74). For the reliability analysis, 12 patients were excluded due to missing data (n = 221). Regarding the level of adherence, 22.5% were low adhering, 71.6% medium and 5.9% high. Corrected item-total correlations showed that 1 item does not correlate very well with the overall scale and was dropped. Scale reliability analysis for the remaining 7 items revealed an overall Cronbach's alpha of 0.661. Women had a protective effect on adherence (OR = 0.31;95%CI:0.15-0.66). Number of years doing ART, age of participants, and type of residence didn't show to be correlated with adherence. Conclusions MMAS-8 is a reliable and valid measure to detect patients at risk of non-adherence. A satisfactory Cronbach's alfa (0.661) was obtained. In general, adherence to medication was medium or high. Key messages This scale can be applied nationwide in other different hospitals, as it could serve as a tool for measuring adherence to ART that can allow for better health care to the ones that are low adhering. A Portuguese version of the MMAS-8 was created for measuring adherence to ART that maintained a similar structure to the original MMAS-8 and good psychometric properties.

scholarly journals Chronic polytherapy after myocardial infarction: the trade-off between hospital and community-based providers in determining adherence to medication

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mirko Di Martino ◽  
Michela Alagna ◽  
Adele Lallo ◽  
Kendall Jamieson Gilmore ◽  
Paolo Francesconi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medication Adherence ◽  
Geographic Variation ◽  
Best Practice ◽  
Multilevel Models ◽  
Medication Possession Ratio ◽  
Coronary Intervention ◽  
Community Based ◽  
Optimal Care ◽  
Adherence To Medication

Abstract Background The benefits of chronic polytherapy in reducing readmissions and death after myocardial infarction (MI) have been clearly shown. However, real-world evidence shows poor medication adherence and large geographic variation, suggesting critical issues in access to optimal care. Our objectives were to measure adherence to polytherapy, to compare the amount of variation attributable to hospitals of discharge and to community-based providers, and to identify determinants of adherence to medications. Methods This is a population-based study. Data were obtained from the information systems of the Lazio and Tuscany Regions, Italy (9.5 million inhabitants). Patients hospitalized with incident MI in 2010–2014 were analyzed. The outcome measure was medication adherence, defined as a Medication Possession Ratio (MPR) ≥ 0.75 for at least 3 of the following drugs: antiplatelets, β-blockers, ACEI/ARBs, statins. A 2-year cohort-study was performed. Cross-classified multilevel models were applied to analyze geographic variation. The variance components attributable to hospitals of discharge and community-based providers were expressed as Median Odds Ratio (MOR). Results A total of 32,962 patients were enrolled. About 63% of patients in the Lazio cohort and 59% of the Tuscan cohort were adherent to chronic polytherapy. Women and patients aged 85 years and over were most at risk of non-adherence. In both regions, adherence was higher for patients discharged from cardiology wards (Lazio: OR = 1.58, p < 0.001, Tuscany: OR = 1.59, p < 0.001) and for patients with a percutaneous coronary intervention during the index admission. Relevant variation between community-based providers was observed, though when the hospital of discharge was included as a cross-classified level, in both Lazio and Tuscany regions the variation attributable to hospitals of discharge was the only significant component (Lazio: MOR = 1.30, p = 0.001; Tuscany: MOR = 1.31, p = 0.001). Conclusion Adherence to best practice treatments after MI is not consistent with clinical guidelines, and varies between patient groups as well as within and between regions. The variation attributable to providers is affected by the hospital of discharge, up to two years from the acute episode. This variation is likely to be attributable to hospital discharge processes, and could be reduced through appropriate policy levers.

scholarly journals The association between hypertension self-management and stroke event in male patients at the Badung District Hospital, Bali

2018 ◽  
Vol 6 (2) ◽  
pp. 82
Author(s):  
Ni Kadek Sutini ◽  
Ni Wayan Septarini ◽  
I Made Ady Wirawan ◽  
Anak Agung Sagung Sawitri
Keyword(s):  
Medication Adherence ◽  
Stress Management ◽  
Self Management ◽  
Stroke Event ◽  
Adherence To Medication ◽  
History Of ◽  
Male Patients ◽  
Main Components ◽  
Self Administered Questionnaire ◽  
Poor Management

Background and purpose: Hypertension is a major risk factor for stroke. Despite efforts to control hypertension with pharmacological and non-pharmacological therapies, the prevalence of and death from stroke is reported to be increasing. This study aims to determine the association of hypertension self-management with the incidence of stroke in patients with hypertension.Methods: A case-control study was conducted involving 44 patients suffering from hypertension and who had suffered a stroke as a case, as well as 44 patients with hypertension and no stroke as a control. Data on self-management of diet, physical activity, stress mitigation efforts, alcohol consumption, and medication adherence were collected using self administered questionnaire. Data on the diagnosis of hypertension, stroke and history of comorbidities were obtained from the patient's medical records. Multivariatee analysis using logistic regression was employed to assess the association between hypertension self-management with the incidence of stroke in patients with hypertension.Results: Characteristics of cases and controls did not differ in education, marital and socioeconomic status, but differed in age and employment. Multivariate analysis showed that there were three components of hypertension self-management associated with the incidence of stroke, namely poor adherence to medication (AOR=7.28; 95%CI: 2.19-24.17), poor self-management of stress (AOR=5.45; 95%CI: 1.56-18.99), and poor management of self-regulated diet (AOR=5.28; 95%CI: 1.31-21.32).Conclusions: Medication adherence, diet and stress management are the three main components of self-management that are associated with stroke events among hypertension patients. Efforts to increase medication adherence, diet and stress management should be enhanced.

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