Factors Associated With Pharmacological and Non-pharmacological Treatments Adherence in Patients With Borderline Personality Disorder in Iran

BackgroundBorderline personality disorder is a major mental illness characterized by a sustained relationship instability, impulsive behavior and intense affects. Adherence is a complex behavior, from minor refusals of treatment to inappropriate use of health services or even abandonment of treatment, which can be affected by various factors. Therefore, the present study aimed to investigate the factors affecting pharmacological and non-pharmacological adherence in patients with borderline personality disorder referred to an outpatient referral clinic in Tehran, Iran.MethodsThe study was a retrospective cohort. The files of patients with borderline personality disorder referred to the outpatient clinic of the Tehran Psychiatric Institute were reviewed as the first step. In the next step, we contacted the patients and asked them to fill out the questionnaires. Data were collected using the Drug Attitude Inventory (DAI) questionnaire and a researcher made questionnaire to determine the attitude of patients toward pharmacological and non-pharmacological treatment and therapeutic adherence. After collecting data, patients’ therapeutic acceptance was divided into three groups: poor, partial, good compliance. The data were analyzed by SPSS software version-22.Results Ninety-four patients were involved in the study and fifty four of them were women. In terms of psychotherapy adherence, patients with higher education and hospital admission history have better compliance. Medication attitudes were negative in 54 patients (57.4%), while 40.4% of them stated that psychotherapy or counselling did not help their condition and showed a negative attitude toward non-pharmacological treatment. Additionally, psychotherapy good adherence of the patients (44.7%) was higher than medication good adherence (31.9%). The most common reasons for discontinuation of treatment were medication side effects (53.1%), dissatisfaction with the therapist (40.3%) and then fear of medication dependence (40%). The results showed no relationship between other demographic factors and treatment adherence.ConclusionsResults of the current study show that attitude toward psychotherapy is more positive than pharmacotherapy. In addition, according to the results, working on changeable factors such as patients’ fear of dependence to medication, dissatisfaction with the therapist, and medication side effects may improve patients' treatment adherence.

Belief in Brua among psychiatric patients from Aruba, Bonaire, and Curaçao: Results from an explorative study in the Netherlands

Brua is an Afro-Caribbean religion and healing tradition predominantly practised on the ABC islands of the former Netherlands Antilles. It is grounded in oral tradition and shrouded in strict social taboos. Existing literature suggests that the majority of people on and from the islands are familiar with Brua and that it plays a substantial role in shaping their illness conception and idioms of distress. A lack of knowledge of Brua may therefore lead biomedically trained health professionals to misdiagnose these patients. This article discusses how religious beliefs related to Brua influence the illness concepts and idioms of distress of psychiatric patients originating from the ABC Islands, based on semi-structured interviews with former islanders receiving treatment at a psychiatric institute in the Netherlands. We found that of the 29 interviewees, 93.1% knew what Brua involved, 72.4% believed in it, 48.2% had first-hand experience with Brua practices, and 34.5% attributed their mental illness to Brua with greater or lesser certainty. However, only one patient had previously discussed her belief in Brua with her psychiatrist and only when asked to do so. The role of psychoactive substances in the context of Brua practices was negligible. Thus, the present study indicates that the majority of psychiatric patients from the ABC islands are familiar with Brua, but feel reluctant to discuss their concerns in this area with mental health professionals. Recommendations for clinical practice and further research are provided, including the need for a culture-sensitive approach and integrative care.

Physical Activity Monitoring Preferences in Adults With Bipolar Disorder

This report investigated physical activity (PA) monitoring preferences and problems among adults with bipolar disorder (BD).Methods: PARC2 study was conducted at the Western Psychiatric Institute and Clinic at the University of Pittsburgh. This secondary data analysis assessed three PA monitors; Body Media SW Pro Armband, Actigraph AM-7164, and Pedometer Omron HJ-720IT. PA monitors were worn simultaneously for 1 week. Participants reported preferences and problems (irritating, cumbersome, movement of the activity monitor, technical difficulties, and impaired functioning) encountered with each activity monitor.Results: Approximately 70% of the participants (n = 66) were middle-aged Caucasian women with a diagnosis of BD I and overweight. Sixty-six adults with BD wore all 3 monitors simultaneously. Twelve (18%) participants had no PA monitoring preference, 28 (42%) preferred the armband, 17 (26%) preferred the pedometer and 9 (14%) preferred the Actigraph. Activity monitoring preferences did not statistically differ by age, gender, race, BMI, diagnosis, or depressive and mania symptoms (p > 0.25). Two-thirds of the participants (64%) had at least one problem with at least one activity monitor. As far as problem categories, more than a quarter of participants reported irritation with the Armband (26%, n = 17) and movement of the pedometer (32%, n = 21). No statistically significant association was observed between activity monitoring preferences and problems (p = 0.72).Discussion: Adults with BD were willing to wear activity monitors even though problems were reported. Preference of physical activity monitors, in descending order, was the armband, pedometer, and Actigraph. One fifth of the adults with BD reported no preferences in activity monitors. The activity monitors selected for investigation included the “gold standard” in activity monitoring (Actigraph) worn at the waist as well as a research grade pedometer that is considerably more affordable, provides activity feedback in real-time, and may be a more feasible option for large scale studies.

Standardization of the Persian Version of the Self-Report Personality Questionnaire (SCID-5-SPQ) in a Clinical Sample of Iranian Population

Background and Aim: This study was conducted to investigate the psychometric characteristics of the Persian version of the self-report personality questionnaire (SCID-5-SPQ) in the clinical sample in Tehran. Method: The present study is descriptive cross section type. The present study population includes outpatients and inpatients referred to three centers in Tehran, including Iran Psychiatric Medical Center, Hazrat Rasool Akram Educational and Medical Complex and the Clinic of the Faculty of Behavioral Sciences andMental Health (Tehran Psychiatric Institute). .The criteria for entering the study were the ages between of 18 and 65, conscious consent to enter the study and the ability to understand and speak Persian and no specific physical problems. Sampling in this study was performed in Convenience Sampling manner. In this study, in addition to the demographic questionnaire, the Persian version of the Structured clinical interview for the DSM-5 (SCID-5) and the self-report personality questionnaire (SCID-5-SPQ) were used. Finally, in order to evaluate the information, formal and convergent validity methods, internal reliability and comparative tests were used. Results: Based on the results, the SCID-5-SPQ has a good formal narrative. A study of the convergent validity of this questionnaire with SCID interview showed that all subscales had a significant positive correlation (P≥0.001). Also, the reliability of the questionnaire was 0.93, and therefore the Persian version of this questionnaire is considered a stable tool. Conclusion: According to the findings of the present study, SCID-5-SPQ is a more stable tool and can be used in psychiatric clinics and hospitals as a screening tool for personality disorders alone or in addition to interviews.

Knowledge, attitude, and practices towards COVID-19 among nurses, ward attendants, and housekeeping staff at a tertiary psychiatric institute in India

Background: The world health organization (WHO) declared COVID-19 a worldwide pandemic on 11th March 2020. As this is a novel illness, thus knowledge, attitude, and practice (KAP) related to the pandemic is a new area of research. KAP in a non-COVID facility, such as a psychiatric institution is rare.Methods: Cross-sectional survey with purposive sampling, conducted at central institute of psychiatry, Ranchi, India. A sample of 235 healthcare workers consisting of nurses, wards attendants, and housekeeping staff took part in the study. Participants completed a 36-item questionnaire assessing their KAP related to COVID-19.Results: 79.42% of healthcare workers in this study had adequate knowledge of COVID-19 symptomatology, transmission, management, and preventive measures. 89.79% were confident that India would win the battle against COVID-19. 35.32% fear to work in a hospital, but on the other hand, 80.85% of healthcare staff considered coming to work as part of their duty. Good practices like wearing a mask before leaving home and practicing proper cough hygiene were observed. The significant difference found in KAP among the three groups. Spearman’s correlation was significant between age, level of education of the participants with the KAP.Conclusions: The study suggests increased attention is required towards the training of the healthcare workers to enhance their knowledge and attitude so that the practices can be improved.

Roles, Facilitators and Challenges of Employment Support Specialists Assisting Young People with Mental Health Conditions

Purpose The present study aimed to understand the roles, effective strategies and facilitators, and challenges of employment support specialists (ESS) in assisting young people with mental health conditions (MHCs) gain and sustain employment in Singapore. Methods An interpretative qualitative design using an inductive approach was adopted for this study. Using a semi-structured interview guide, in-depth interviews were conducted with twenty ESS employed with mental health service providers or other community-based centers. Verbatim transcripts of the interviews were thematically analyzed using inductive methods. ESS were broadly classified as “any professionals providing employment-related support to people with MHCs”. Results Majority of the ESS were employed at a tertiary psychiatric institute. Participants included vocational and occupational specialists, case managers and other clinical professionals. Three key themes emerged from the data: (i) descriptions of roles undertaken by the ESS depicting a wide range of services and requisite skillsets; (ii) facilitators that benefit young people with MHCs’ in terms of job placement, for example, ESS’ attitudes and attributes, and their clients’ disposition; and (iii) challenges that deter effective job placements, such as factors pertaining to the ESS themselves, their clients, and clients’ employers. Under this theme, ESS also proposed ways to improve employment opportunities of people with MHCs. Conclusions This study provided insight into a range of tasks performed and challenges faced by ESS in Singapore while assisting their clients. There is a need to address ESS’ challenges and expectations in order to enhance their efficiency and aid reintegration of young people with MHCs into the workforce and the society.

Short-acting antipsychotics or long-acting injectables? A treatment comparison in patients with schizophrenia

Aim This research aims to compare the efficacy and direct costs of short-acting oral antipsychotics and aripiprazole once-monthly (AOM) in the context of the treatment of patients with schizophrenia based on real-world data in Germany. Method Results are based on a single-armed, retrospective, non-interventional pre-post comparison study evaluating data from 132 patients with schizophrenia before and after switching from oral antipsychotics to AOM treatment (6 months each). Socio-demographics, as well as parameters of indication, efficacy and resource consumption were analyzed and statistically evaluated. Results The switch from an oral antipsychotic medication to AOM led to a distinct improvement in all clinically relevant parameters, including a reduction in hospitalization rates (55.1 % vs. 14.0 %), length of stay (43.5 d vs. 34.8 d) and percentage of patients with multiple hospitalizations (13.6 % vs. 3.8 %). There was also a reduction in schizophrenic episodes for patients with ≥ 1 episode (2.9 vs. 1.4) and of the percentage of patients with ≥ 1 (88.0 % vs. 29.3 %) as well as ≥ 2 (60.0 % vs. 8.1 %) schizophrenic episodes. The proportion of patients requiring a visit to day clinics or psychiatric institute outpatient clinics (PIA) decreased (39.5 % vs. 8.4 %) for patients with AOM treatment, as did the average length of stay in day clinics or PIAs (116.8 d vs. 86.4 d) for patients with ≥ 1 stay. The cost saving potential of AOM compared to the treatment with oral antipsychotics ranged between 1,729.32 € and 5,048.53 € per patient for a six-month observation period. Conclusion Our results suggest that AOM treatment of patients with schizophrenia is more effective (reduction in schizophrenic episodes, hospitalizations, stays in day clinics, psychiatrist visits, losses in productivity) and generates lower costs for the statutory health insurance (SHI) in Germany than treatment with oral antipsychotics and should therefore not be regarded as only a last-resort treatment option for schizophrenia.

Recovery in Psychosis: Perspectives of Clients with First Episode Psychosis

Introduction: Recovery from psychosis relates to connectedness, hope for the future, identity, meaning in life and empowerment. The process of recovery is often described as gradual and non-linear, with many stages and turning points, and without a definitive end point. This qualitative study aims to understand what recovery means to clients, to better understand their unique recovery process and what helps in recovery among clients with lived experience of first episode psychosis (FEP) in a developed Asian setting. Materials and Methods: The study design and interview guide development included inputs from persons with psychosis, following which 7 focus group discussions were conducted with 40 FEP clients of a tertiary care psychiatric institute. Results: Thematic qualitative analysis identified three themes: 1) meaning of recovery (where participants expressed their views on what recovery meant to them); 2) recovery as a journey (due to the constant ups and downs in the long process of recovery, it was often articulated as a “journey”); and 3) facilitators of recovery (related to resources, practices and experiences that supported their recovery). Conclusion: The emergent themes provide an understanding of the meaning of recovery to persons with FEP, their experiences as they proceed with their recovery journey and factors they found helpful. The importance of acceptance of the condition and the personal role the individual plays in his or her own recovery was evident in the narratives of the participants. The study suggests a need to incorporate recovery-relevant approaches right from the first episode of psychosis. Ann Acad Med Singapore 2020;49:186–98 Key words: Meaning of recovery, Qualitative, Thematic analysis

Antiviral therapy: Valacyclovir Treatment of Alzheimer’s Disease (VALAD) Trial: protocol for a randomised, double-blind,placebo-controlled, treatment trial

IntroductionAfter infection, herpes simplex virus-1 (HSV1) becomes latent in the trigeminal ganglion and can enter the brain via retrograde axonal transport. Recurrent reactivation of HSV1 may lead to neurodegeneration and Alzheimer’s disease (AD) pathology. HSV1 (oral herpes) and HSV2 (genital herpes) can trigger amyloid beta-protein (Aβ) aggregation and HSV1 DNA is common in amyloid plaques. Anti-HSV drugs reduce Aβ and phosphorylated tau accumulation in cell-culture models. Cognitive impairment is greater in patients with HSV seropositive, and antiviral drugs show robust efficacy against peripheral HSV infection. Recent studies of electronic health records databases demonstrate that HSV infections increase dementia risk, and that antiviral medication treatment reduces this risk. The generic antiviral drug valacyclovir was superior to placebo in improving memory in a schizophrenia pilot trial but has not been tested in AD.Methods and analysisIn patients with mild AD who test positive for HSV1 or HSV2 serum antibodies, valacyclovir, repurposed as an anti-AD drug, will be compared with placebo (lactose pills) in 130 patients (65 valacyclovir and 65 placebo) in a randomised, double-blind, 78-week phase II proof-of-concept trial. Patients on valacyclovir, dose-titrated from 2 g to a targeted oral dose of 4 g daily, compared with placebo, are hypothesised to show smaller cognitive and functional decline, and, using18F-Florbetapir positron emission tomography (PET) and18F-MK-6240 PET imaging, to show less amyloid and tau accumulation, respectively. In the lumbar puncture subsample, cerebrospinal fluid acyclovir will be assayed to assess central nervous system valacyclovir penetration.Ethics and disseminationThe trial is being overseen by the New York State Psychiatric Institute Institutional Review Board (protocol 7537), the National Institute on Ageing, and the Data Safety Monitoring Board. Written informed consent is obtained for all subjects. Results will be disseminated via publication, clinicaltrials.gov, media and conferences.Trial registration numberClinicalTrials.gov identifier (NCT03282916) Pre-results.