体重超重/肥胖的双相情感障碍青少年服用第二代抗精神病药物的依从率和障碍。

IF 1.5 4区 医学 Q2 PEDIATRICS
Christina C Klein, Avani C Modi, Jeffrey A Welge, Victor M Fornari, Brian Kurtz, Thomas J Blom, Claudine Higdon, Christoph U Correll, Melissa P DelBello
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引用次数: 0

摘要

目的:患有双相情感谱系障碍(BSD)的青少年经常服用第二代抗精神病药物(SGAs)。不坚持治疗往往会导致情绪症状加重和生活质量下降。我们研究了参加多地点实用临床试验的超重/肥胖并被诊断为 BSD 的青少年的 SGA 依从率和依从障碍。方法:通过患者和护理人员的报告对基线时的 SGA 依从性和依从性障碍进行评估。依从性的定义是在过去一周内服用≥70%的处方SGA剂量。加权卡帕统计量用于衡量儿童和护理人员在依从率、障碍和护理人员协助方面的一致性。回归分析用于研究护理人员协助、年龄、性别、种族、保险状况、用药频率和同时用药的数量与依从性之间的关系。使用逻辑回归法分别分析了青少年及其照顾者在坚持服药方面遇到的障碍,以评估知情者报告的障碍与知情者报告的坚持服药情况之间的关联。结果参与者包括 1485 名患者和/或护理人员。基线时,88.6%的患者自我报告坚持用药;92.0%的照护者报告其子女坚持用药。患者和护理人员之间的一致性适中(k = 0.42)。约有 50% 的样本表示在坚持治疗方面没有障碍。经常提到的障碍包括忘记、副作用、不好意思服药以及喜欢做其他事情。告知者之间在依从性障碍方面的一致性较弱(k = 0.05-0.36)。与认可存在障碍的患者和护理人员相比,不认可存在坚持用药障碍的患者和护理人员的坚持用药率更高。男性和每日服药一次与依从性较低有关。讨论在该样本中,患者和护理人员报告的一周依从性较高。半数样本报告了依从性障碍。最常见的障碍是忘记、副作用、尴尬和喜欢做其他事情。护理人员和患者对坚持治疗的障碍有着独特的看法。在临床实践中了解并解决治疗障碍可促进坚持治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Adherence Rates and Barriers to Second-Generation Antipsychotic Medication Use in Youth with Bipolar Spectrum Disorders Who Have Overweight/Obesity.

Objective: Youth with bipolar spectrum disorders (BSD) are frequently prescribed second-generation antipsychotics (SGAs). Nonadherence to treatment often results in increased mood symptoms and diminished quality of life. We examined SGA adherence rates and adherence barriers among youth who have overweight/obesity and are diagnosed with BSD enrolled in a multisite pragmatic clinical trial. Methods: SGA adherence and adherence barriers at baseline via patient- and caregiver report was assessed. Adherence was defined as taking ≥70% of prescribed SGA doses in the past week. The weighted Kappa statistic was used to measure child-caregiver agreement about adherence rates, barriers, and caregiver assistance. Regression analyses were used to examine associations of caregiver assistance, age, sex, race, insurance status, dosing frequency, and number of concomitant medications with adherence. Barriers to adherence were analyzed separately for youth and their caregivers, using logistic regression to assess associations between informant-reported barriers and informant-reported adherence. Results: Participants included 1485 patients and/or caregivers. At baseline, 88.6% of patients self-reported as adherent; 92.0% of caregivers reported their child was adherent. Concordance between patients and caregivers was moderate (k = 0.42). Approximately, 50% of the sample reported no adherence barriers. Frequently endorsed barriers included forgetting, side effects, being embarrassed to take medications, and preferring to do something else. Concordance between informants regarding adherence barriers was weak (k = 0.05-0.36). Patients and caregivers who did not endorse adherence barriers reported higher adherence than those who endorsed barriers. Male sex and having once daily dosing of medications were associated with lower adherence. Discussion: One-week patient- and caregiver-reported adherence was high in this sample. Half of the sample reported adherence barriers. Most commonly endorsed barriers were forgetting, side effects, being embarrassed, and preferring to do something else. Caregivers and patients have unique perspectives regarding adherence barriers. Understanding and addressing treatment barriers in clinical practice may facilitate adherence.

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来源期刊
CiteScore
3.60
自引率
5.30%
发文量
61
审稿时长
>12 weeks
期刊介绍: Journal of Child and Adolescent Psychopharmacology (JCAP) is the premier peer-reviewed journal covering the clinical aspects of treating this patient population with psychotropic medications including side effects and interactions, standard doses, and research on new and existing medications. The Journal includes information on related areas of medical sciences such as advances in developmental pharmacokinetics, developmental neuroscience, metabolism, nutrition, molecular genetics, and more. Journal of Child and Adolescent Psychopharmacology coverage includes: New drugs and treatment strategies including the use of psycho-stimulants, selective serotonin reuptake inhibitors, mood stabilizers, and atypical antipsychotics New developments in the diagnosis and treatment of ADHD, anxiety disorders, schizophrenia, autism spectrum disorders, bipolar disorder, eating disorders, along with other disorders Reports of common and rare Treatment Emergent Adverse Events (TEAEs) including: hyperprolactinemia, galactorrhea, weight gain/loss, metabolic syndrome, dyslipidemia, switching phenomena, sudden death, and the potential increase of suicide. Outcomes research.
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