scholarly journals M120. IMPAIRED CLINICAL INSIGHT AS A PREDICTOR OF RELAPSE IN SCHIZOPHRENIA

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S180-S181
Author(s):  
Jean-Pierre Lindenmayer ◽  
Anzalee Khan ◽  
Philip Harvey ◽  
Richard Keefe ◽  
Lora Liharska ◽  
...  
Keyword(s):  
Substance Use ◽  
Age At Onset ◽  
Treatment Compliance ◽  
Chronic Schizophrenia ◽  
Negative Consequences ◽  
Care Providers ◽  
Psychiatric Facility ◽  
Inpatient Hospitalization ◽  
Clinical Prognosis

Abstract Background Many individuals with chronic or treatment resistant schizophrenia experience multiple relapses or treatment failures during the course of the illness. Some of these relapses are due to poor treatment compliance that is inherent to schizophrenia. Poor insight may be a leading cause for partial- or non-adherence to treatment as a high proportion of individuals with schizophrenia are partially or completely unaware of their mental disorder. The first two years after stabilization are thought to be key for long-term functional and clinical prognosis. In the present study, we first estimated the rate of treatment failure or relapse following clinical stability at one and two years, investigate the time to occurrence of relapse among individuals with chronic schizophrenia and the association between baseline clinical features recorded during the inpatient hospitalization and relapse at one- and two-year time points. We hypothesized that lack of insight, as measured by the PANSS item G12, would be a greater predictor of relapse than other characteristics previously suggested as possible predictors, including other symptoms from the PANSS, age, duration of illness, age at onset of illness, substance use, number of prior hospitalizations, and length of stay of the pre-discharge hospitalization. Methods A total of 138 participants diagnosed with schizophrenia or schizo-affective disorder were assessed with a comprehensive assessment at one year and two-year following discharge from a long-term psychiatric facility. Regression models were used to determine factors predicting time to relapse and other elements of functioning. Baseline factors examined included PANSS, MCCB, PSP, demographics and treatment variables. Results Relapse rates were 56.52% (n=78 of 138) by Year 1, and 69.56% (n=96 of 138) by end of Year 2. The estimated relapse-free period for all individuals at the end of the study was 8.78 months. The backward elimination (–2 log likelihood=189.59, χ2=9.01, df=2, p=.021) showed that the best predictive variables for relapse were lack of insight/judgment as assessed by PANSS item G12 at baseline (B=.20, SE=.09, df=1, p=.011, Exp[B]=1.36), lifetime years of substance use (B=.16, SE=.11, df=1, p=.029, Exp[B]=1.33), PANSS Factor baseline score on Disorganization (B=.15, SE=.12, df=1, p=.031, Exp[B]=1.56), and number of previous hospitalizations (B=.13, SE=.11, df=1, p=.048, Exp[B]=1.23). No other baseline variables were found to be significant. Discussion Poor insight is a fundamental symptom of schizophrenia that, while not entirely and uniformly expressed in all individuals, is among the most common symptoms across subjects. Our study shows that the numerous negative consequences of lack of insight should lead clinicians and researchers to make insight a high priority for allocation of clinical resources. Effective approaches to managing these predictive characteristics will allow affected individuals and their families and care providers to take part in collaborative treatment and relapse risk-management paradigms.

scholarly journals Persistent negative illness perceptions despite long-term biochemical control of acromegaly: novel application of the drawing test

2015 ◽  
Vol 172 (5) ◽  
pp. 583-593 ◽  
Author(s):  
Jitske Tiemensma ◽  
Alberto M Pereira ◽  
Johannes A Romijn ◽  
Elizabeth Broadbent ◽  
Nienke R Biermasz ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Illness Perceptions ◽  
Illness Perception ◽  
Active Phase ◽  
Negative Consequences ◽  
Care Providers ◽  
Biochemical Control ◽  
Cross Sectional ◽  
Drawing Test

Context and objectivePatients with acromegaly have persistent complaints despite long-term biochemical control. Drawings can be used to assess patients' perceptions about their disease. We aimed to explore the utility of the drawing test and its relation to illness perceptions and quality of life (QoL) in patients after long-term remission of acromegaly.DesignA cross-sectional study was conducted to evaluate the utility of the drawing test.MethodsA total of 50 patients after long-term remission (mean±s.e.m., 16±1.2 years) of acromegaly were included in this study. Patients completed the drawing test (two retrospective drawings of their body perception before acromegaly and during the active phase of acromegaly, and one drawing on the current condition after long-term remission), Illness Perception Questionnaire-Revised, Physical Symptom Checklist, EuroQoL-5D, and AcroQoL.ResultsPatients perceived a dramatic change in body size during the active state of the disease compared with the healthy state before the awareness of acromegaly. Patients reported that their body did not completely return to the original proportions after long-term remission. In addition, larger drawings indicated more negative consequences (P<0.05), a higher score on emotional representations (P<0.05), and more perceived symptoms that were attributed to acromegaly (P<0.01). Larger drawings also indicated more impaired QoL, especially disease-specific QoL (all P<0.05).ConclusionThere are strong correlations among the drawing test, illness perceptions, and QoL. The drawing test appears to be a novel and relatively easy tool to assess the perception of patients after long-term remission of acromegaly. The assessment of drawings may enable health care providers to appreciate the perceptions of patients with long-term remission of acromegaly, and enable discussion of symptoms and remission.

Screening for bipolar disorder among outpatients with substance use disorders

2011 ◽  
Vol 28 (3) ◽  
pp. 147-153 ◽  
Author(s):  
A. Nallet ◽  
B. Weber ◽  
S. Favre ◽  
M. Gex-Fabry ◽  
R. Voide ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Bipolar Disorders ◽  
Treatment Compliance ◽  
Opiate Dependence ◽  
Negative Consequences ◽  
Not Otherwise Specified ◽  
Mood Disorder Questionnaire ◽  
Axis I

AbstractBackgroundComorbidity of bipolar disorder and alcohol or substance abuse/dependence is frequent and has marked negative consequences on the course of the illness and treatment compliance. The objective of this study was to compare the validity of two short instruments aimed at screening bipolar disorders among patients treated for substance use disorders.MethodsThe Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist-32 (HCL-32) were tested with reference to the mood section of the Structured Clinical Interview for DSM-IV axis I disorders (SCID) in 152 patients, recruited in two outpatient clinics providing specialized treatment for alcohol and opiate dependence.ResultsAccording to the SCID, 33 patients (21.7%) had a diagnosis within the bipolar spectrum (two bipolar I, 21 bipolar II and 10 bipolar not otherwise specified). The HCL-32 was more sensitive (90.9% vs. 66.7%) and the MDQ more specific (38.7% vs. 77.3%) for the whole sample. The MDQ displayed higher sensitivity and specificity in patients treated for alcohol than for opiate dependence, whereas the HCL-32 was highly sensitive but poorly specific in both samples. Both instruments had a positive predictive value under 50%.ConclusionsCaution is needed when using the MDQ and HCL-32 in patients treated for substance use disorders.

Substance Use Disorders

2021 ◽  
pp. 353-358
Author(s):  
Bhanuprakash Kolla ◽  
Sara E. Hocker
Keyword(s):  
Substance Use ◽  
Environmental Factors ◽  
Substance Use Disorders ◽  
Withdrawal Syndrome ◽  
Social Consequences ◽  
Negative Consequences ◽  
Amount Of Substance ◽  
Abrupt Cessation ◽  
Continued Use

Substance use disorders are chronic, relapsing illnesses that are associated with serious medical, economic, and social consequences. Substance use disorders are associated with loss of control over the amount of substance used, continued use despite negative consequences, preoccupation with use, and dysphoria during abstinence. In heavy and long-term users, abrupt cessation or reduction in substance use results in substance-specific withdrawal syndrome. Risk of substance use disorders is influenced by genetic, psychosocial, and environmental factors.

scholarly journals New Access Routes to Undertreated Populations; How Do Problem Substance Users Recruited from an Unemployment Office Differ from Detoxification Treatment Inpatients?

2021 ◽  
Vol 18 (24) ◽  
pp. 13014
Author(s):  
Norbert Scherbaum ◽  
Thomas Mikoteit ◽  
Lilia Witkowski ◽  
Udo Bonnet ◽  
Michael Specka ◽  
...  
Keyword(s):  
Substance Use ◽  
Mental Disorders ◽  
Treatment Options ◽  
Age At Onset ◽  
Specific Treatment ◽  
Treatment Gap ◽  
Client Group ◽  
Problematic Substance ◽  
Employment Rates

Background: Only a minority of subjects with substance use disorders (SUDs) are in addiction-specific treatment (treatment gap). Co-operation between an unemployment office and a psychiatric hospital was established for the assessment and counseling of long-term unemployed clients with SUD. We aim at validating whether such a treatment gap exists in that group, and whether clients from an unemployment office differed from a matched group of inpatient detoxification patients with regard to socio-economic characteristics, substance use and treatment history, and the prevalence of mental disorders Methods: Unemployment office clients (n = 166) with an SUD were assessed using a standardized sociodemographic and clinical interview. They were compared with 83 inpatients from a local detoxification ward, matched for age, sex, and primary addictive disorder (matching ratio 2:1). Results: Most (75.9%) subjects were males, with an average age of 36.7 years. The SUDs mostly related to alcohol (63.9%) and cannabis (27.7%). Although most unemployment office clients had a long SUD history, only half of them had ever been in addiction-specific treatment during their lifetime, and only one in four during the last year. There were no statistically significant differences between the groups regarding age at onset of problematic substance use, the proportion of migrants, and prevalence of comorbid mental disorders. The unemployment office sample showed lower levels of education (p < 0.001), job experience (p = 0.009), and current employment rates (p < 0.001). Conversely, inpatients showed lower rates of imprisonment (p < 0.001), more inpatient detoxification episodes (p < 0.03); and longer abstinence periods (p < 0.005). Conclusions: There was a lifetime and recent treatment gap in the group of long-term unemployed subjects with alcohol and cannabis dependence. The markedly lower educational attainment, chronic employment problems and higher degree of legal conflicts in the client group, as compared with patients in detoxification treatment, might require specific access and treatment options. The co-operation between the psychiatric unit and the unemployment office facilitated access to that group.

Informal Caregivers As Long-Term Care Providers: Differential Experiences By Gender

2002 ◽  
Author(s):  
Maryam Navaie-Waliser ◽  
Aubrey L. Spriggs ◽  
Penny H. Feldman
Keyword(s):  
Long Term Care ◽  
Informal Caregivers ◽  
Care Providers ◽  
Term Care

Predicting attrition in long-term residential substance use disorder treatment: A modifiable risk factors perspective.

2020 ◽  
Vol 17 (4) ◽  
pp. 472-482
Author(s):  
Danielle E. Baker ◽  
Keith A. Edmonds ◽  
Maegan L. Calvert ◽  
Sarah M. Sanders ◽  
Ana J. Bridges ◽  
...  
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Modifiable Risk Factors ◽  
Substance Use Disorder Treatment ◽  
Disorder Treatment

Barriers and Facilitators of Using Telehealth to Identify and Manage Behavioral Health and Substance Use Disorder Conditions in Rural Areas: An Environmental Scan (Preprint)

2020 ◽  
Author(s):  
Naim Naim ◽  
Laura Dunlap
Keyword(s):  
Substance Use ◽  
Behavioral Health ◽  
Substance Use Disorder ◽  
Rural Areas ◽  
Primary Care Providers ◽  
Care Patient ◽  
Direct Patient Care ◽  
Care Providers ◽  
Provider Education ◽  
Opioid Use

BACKGROUND Access to behavioral health services, particularly substance use disorder (SUD) treatment services, is challenging in rural and other underserved areas. Some of the reasons for these challenges include local primary care providers without experience in behavioral health treatment, few specialty providers, and concerns over stigma and lack of privacy for individuals from smaller communities. Telehealth can ease these challenges and support behavioral health, specifically SUD treatment, in a variety of ways, including direct patient care, patient engagement, and provider education. Telehealth is particularly relevant for the growing opioid epidemic, which has profoundly affected rural areas. OBJECTIVE We sought to understand how telehealth is used to support behavioral health and SUDs, with a particular focus on implications for medication-assisted treatment for opioid use disorders. The intent was to understand telehealth implementation and use, financing and sustainability, and impact in the field. The results of this work can be used to inform future policy and practice. METHODS We reviewed literature and interviewed telehealth stakeholders and end users in the field. The team identified a diverse set of participants, including clinical staff, administrators, telehealth coordinators, and information technology staff. We analyzed research notes to extract themes from participant experiences to answer the study questions. RESULTS Organizations varied in how they implemented telehealth services and the services they offered. Common themes arose in implementation, such as planning for technical and organizational impacts of telehealth, the importance of leadership support, and tailoring programs to community needs. CONCLUSIONS Telehealth is used in a variety of ways to expand access to services and extend service delivery. As the policy and reimbursement landscape continues to evolve, there may be corresponding changes in telehealth uptake and services provided. CLINICALTRIAL NA

scholarly journals Substance Use Among Older People Living With HIV: Challenges for Health Care Providers

2019 ◽  
Vol 7 ◽  
Author(s):  
Sherry Deren ◽  
Tara Cortes ◽  
Victoria Vaughan Dickson ◽  
Vincent Guilamo-Ramos ◽  
Benjamin H. Han ◽  
...  
Keyword(s):  
Health Care ◽  
Substance Use ◽  
Older People ◽  
Health Care Providers ◽  
People Living With Hiv ◽  
Care Providers ◽  
Living With Hiv

scholarly journals Alpha-Fetoprotein-Producing Lung Hepatoid Adenocarcinoma with Brain Metastasis Treated with S-1

2020 ◽  
Vol 13 (3) ◽  
pp. 1552-1559
Author(s):  
Yuki Muroyama ◽  
Hiroyuki Tamiya ◽  
Goh Tanaka ◽  
Wakae Tanaka ◽  
Alexander C. Huang ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Disease Control ◽  
Parietal Lobe ◽  
Laboratory Data ◽  
Stage Iv ◽  
Final Diagnosis ◽  
Alpha Fetoprotein ◽  
Hepatoid Adenocarcinoma ◽  
Clinical Prognosis

Lung hepatoid adenocarcinoma (HAC) is a rare primary lung carcinoma pathologically characterized by hepatocellular carcinoma-like tumor cells, the majority of which produce alpha-fetoprotein (AFP). The clinical prognosis of lung HAC is generally poor, and effective therapeutic regimens for inoperable or recurrent cases have not been established. Here, we report a case of AFP-producing lung HAC with brain metastasis with long-term disease control, treated with the 5-fluorouracil-derived regimen S-1. The patient was a 66-year-old male admitted to the hospital with alexia. Chest X-ray revealed a massive tumor in the left upper lobe, and a head CT scan revealed a metastasis in the left parietal lobe. The laboratory data showed a remarkably elevated AFP level (97,561 ng/mL). Pathological assessment of the resected brain tumor revealed HAC, which was compatible with the lung biopsies. Together with the absence of other metastatic lesions, a final diagnosis of primary lung HAC, stage IV T4N3M1b, was given. The patient first underwent non-small cell lung cancer chemotherapy regimens (carboplatin and paclitaxel as the first line, and pemetrexed as the second line), but had clinical progression. After third-line oral S-1 (tegafur/gimeracil/oteracil) administration, the serum AFP level significantly dropped and the patient achieved long-term disease control without relapse, surviving more than 19 months after disease presentation. The autopsy result was consistent with the diagnosis of primary lung HAC, and immunohistochemical staining was AFP+, glypican 3+, and spalt-like transcription factor 4+. Here, we report the case of a rare primary lung HAC with apparent disease control on S-1 therapy, together with a literature review.

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