Enhancing Case Managers' Skills in the Assessment and Management of Antipsychotic Medication Side-Effects

2000 ◽  
Vol 34 (5) ◽  
pp. 814-821 ◽  
Author(s):  
Paul Morrison ◽  
Tom Meehan ◽  
Deanne Gaskill ◽  
Paul Lunney ◽  
Paul Collings
Keyword(s):  
Side Effects ◽  
Training Program ◽  
Antipsychotic Medication ◽  
Side Effect ◽  
Rating Scale ◽  
Intervention Group ◽  
Case Managers ◽  
Short Term ◽  
Medication Side Effects ◽  
Medication Side

Objective: Our goal was to reduce the prevalence of antipsychotic medication side-effects by providing a short-term training program on the assessment and management of side-effects to case managers. Method: Forty-four patients in receipt of community-based mental health services were allocated to comparison (n = 20) and intervention (n = 24) groups based on the health service district in which they resided. While case managers working with the intervention group attended a short-term training program to improve their assessment and management of neuroleptic side-effects, case managers providing services to the comparison group received no additional training. Side-effects were assessed pre- and postintervention using the Liverpool University Neuroleptic Side-effect Rating Scale (LUNSERS). Results: A reduction in the overall prevalence of side-effects in both groups was observed, however, only those patients in the intervention group reported a statistically significant reduction in mean side-effect scores between the pre- and post-measures (Wilcoxon Matched Pairs Signed-ranks Test, z = −2.8411, two-tailed, p < 0.01). In addition, qualitative data collected during the second survey revealed that patients in the intervention group had acquired some positive management strategies for dealing with unwanted side-effects. The strategies were elicited from eight different patients distributed across six of the 12 case managers who took part in the training program. Conclusions: Training cases managers in the assessment and management of side-effects may help to reduce their impact on the lives of people prescribed neuroleptic medication.

Beliefs about medications predict adherence to antidepressants in older adults

2011 ◽  
Vol 24 (1) ◽  
pp. 159-169 ◽  
Author(s):  
Waleed Fawzi ◽  
Mohamed Yousry Abdel Mohsen ◽  
Abdel Hamid Hashem ◽  
Suaad Moussa ◽  
Elizabeth Coker ◽  
...  
Keyword(s):  
Side Effects ◽  
Rating Scale ◽  
Poor Response ◽  
Self Report ◽  
Poor Adherence ◽  
Response To Treatment ◽  
Medication Side Effects ◽  
Beliefs About Medicines ◽  
Medication Side ◽  
Highly Correlated

ABSTRACTBackground: Adherence to treatment is a complex and poorly understood phenomenon. This study investigates the relationship between older depressed patients’ adherence to antidepressants and their beliefs about and knowledge of the medication.Methods: Assessment was undertaken of 108 outpatients over the age of 55 years diagnosed with depressive disorder and treated for at least four weeks with antidepressants. Adherence was assessed using two self-report measures: the Medication Adherence Rating Scale (MARS) and a Global Adherence Measure (GAM). Potential predictors of adherence investigated included sociodemographic, medication and illness variables. In addition, 33 carers were interviewed regarding general medication beliefs.Results: 56% of patients reported 80% or higher adherence on the GAM. Sociodemographic variables were not associated with adherence on the MARS. Specific beliefs about medicines, such as “my health depends on antidepressants” (necessity) and being less worried about becoming dependant on antidepressants (concern) were highly correlated with adherence. General beliefs about medicines causing harm or being overprescribed, experiencing medication side-effects and severity of depression also correlated with poor adherence. Linear regression with the MARS as the dependent variable explained 44.3% of the variance and showed adherence to be higher in subjects with healthy specific beliefs who received more information about antidepressants and worse with depression severity and autonomic side-effects.Conclusions: Our findings strongly support a role for specific beliefs about medicines in adherence. Challenging patients’ beliefs, providing information about treatment and discussing side-effects could improve adherence. Poor response to treatment and medication side-effects can indicate poor adherence and should be considered before switching medications.

scholarly journals Short-Term Effects of Thrust Versus Nonthrust Mobilization/Manipulation Directed at the Thoracic Spine in Patients With Neck Pain: A Randomized Clinical Trial

2007 ◽  
Vol 87 (4) ◽  
pp. 431-440 ◽  
Author(s):  
Joshua A Cleland ◽  
Paul Glynn ◽  
Julie M Whitman ◽  
Sarah L Eberhart ◽  
Cameron MacDonald ◽  
...  
Keyword(s):  
Side Effects ◽  
Neck Pain ◽  
Thoracic Spine ◽  
Repeated Measures ◽  
Rating Scale ◽  
Intervention Group ◽  
Neck Disability Index ◽  
Self Report ◽  
Global Rating ◽  
Short Term

Background and Purpose Evidence supports the use of manual physical therapy interventions directed at the thoracic spine in patients with neck pain. The purpose of this study was to compare the effectiveness of thoracic spine thrust mobilization/manipulation with that of nonthrust mobilization/manipulation in patients with a primary complaint of mechanical neck pain. The authors also sought to compare the frequencies, durations, and types of side effects between the groups. Subjects The subjects in this study were 60 patients who were 18 to 60 years of age and had a primary complaint of neck pain. Methods For all subjects, a standardized history and a physical examination were obtained. Self-report outcome measures included the Neck Disability Index (NDI), a pain diagram, the Numeric Pain Rating Scale (NPRS), and the Fear-Avoidance Beliefs Questionnaire. After the baseline evaluation, the subjects were randomly assigned to receive either thoracic spine thrust or nonthrust mobilization/manipulation. The subjects were reexamined 2 to 4 days after the initial examination, and they again completed the NDI and the NPRS, as well as the Global Rating of Change (GROC) Scale. The primary aim was examined with a 2-way repeated-measures analysis of variance (ANOVA), with intervention group (thrust versus nonthrust mobilization/manipulation) as the between-subjects variable and time (baseline and 48 hours) as the within-subject variable. Separate ANOVAs were performed for each dependent variable: disability (NDI) and pain (NPRS). For each ANOVA, the hypothesis of interest was the 2-way group × time interaction. Results Sixty patients with a mean age of 43.3 years (SD=12.7) (55% female) satisfied the eligibility criteria and agreed to participate in the study. Subjects who received thrust mobilization/manipulation experienced greater reductions in disability, with a between-group difference of 10% (95% confidence interval [CI]=5.3–14.7), and in pain, with a between-group difference of 2.0 (95% CI=1.4–2.7). Subjects in the thrust mobilization/manipulation group exhibited significantly higher scores on the GROC Scale at the time of follow-up. No differences in the frequencies, durations, and types of side effects existed between the groups. Discussion and Conclusion The results suggest that thoracic spine thrust mobilization/manipulation results in significantly greater short-term reductions in pain and disability than does thoracic nonthrust mobilization/manipulation in people with neck pain.

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