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Association of psychosocial factors with glycemic control and adherence in patients with type 2 diabetes and problem-solving intervention
Poster abstracts / Journal of Psychosomatic Research 55 (2003) 147–178 Recent evidence suggests that the popular illegal drug MDMA (ecstasy) may act as a serotonergic neurotoxin leading to memory deficits in human ecstasy users. The present report is from an ongoing investigation aiming to overcome limitations of previous research on this issue. Recently abstinent ecstasy users, former users, and ecstasy-naive cannabis/alcohol user controls were matched on age, gender, education, premorbid intelligence estimated by National Adult Reading Test, and alcohol use. Measures included the Wisconsin Card Sorting Test; Wechsler Memory Scale (WMS-III) immediate and delayed tests of visual and verbal memory; Brief Symptom Inventory; Impulsiveness Venturesomeness and Empathy Questionnaire; Everyday Memory Questionnaire; and the Prospective Memory Questionnaire. Preliminary findings indicate that memory scores were significantly worse in ecstasy users than controls. However, cannabis use was correlated with both memory scores and ecstasy use. When cannabis use was taken into account, the association of ecstasy use with memory impairment disappeared. The results reported here are preliminary (20 per group) and a larger sample is anticipated. Nevertheless, the findings are important because earlier work suggesting MDMA-related memory impairment did not take cannabis use into account; hence, memory deficits attributed to use of ecstasy may actually reflect residual effects of cannabis use.
Evaluation of depression in home carers using SDS-comparison with outpatients Otani J, Yoshida K Objective: When caring for the elderly, it is known that stress in caregivers, as well as in the patients themselves, is an important problem. It has been 3 years since the Long Term Care Insurance Law was put into practice, and a substantial change was seen in medical care for the elderly. We compared the depressive tendency between the family carers and outpatients and conducted an interview-style survey on the benefits of home service. Subjects and methods: We studied 2365 elderly who lived in local communities. Outpatients and family carers were evaluated using SDS. Also, 54 family carers were interviewed about their stress and the primary benefits of using home service. Results: The average SDS score of all outpatients was 35 (S.D. = 10.8). In contrast, the average SDS score of family carers was 44.5 (S.D. = 5.3), significantly higher than that of all outpatients ( P < .005). Discussion: It may be important to give careful attention to the home carer as well as the home care patients.
Association of psychosocial factors with glycemic control and adherence in patients with type 2 diabetes and problem-solving intervention Ando M, Ando S The objectives of this study are to clarify individual psychosocial factors in diabetic control and to implement intervention based on a problem-solving model. The group of subjects (n = 50) consisted of patients below the age of 65 who were diagnosed as having type 2 diabetes for the first time. They were divided into three groups by the state of their glycemic control 2 years after the first diagnosis and by the state of their adherence to the treatment within 2 years from the first diagnosis: well-controlled group, poorly controlled group, and a dropout group. Self-administered questionnaires (Yatabe-Guilford Personality Test and Taylor’s Manifest Anxiety Scale) and projective technique (Rorschach Test) were used within 2 months after the initial diagnosis. The results showed that patients in the well-controlled group tended to be extroverted, and those in the poorly controlled group tended to be less able to cope under stress. Those patients in the dropout group tended to be depressed and have more apathetic and pessimistic selfimages and thinking patterns. In conclusion, psychosocial factors were considered to be involved in glycemic control and in adherence to initial treatment in diabetic patients. For the next step, we have provided
157
psychological intervention based on a problem-solving model for some diabetic patients.
Measuring adherence to antidepressants. The value of electronic pill containers of computerized patients’ medication records and of patients’ self-reports for assessing adherence Brook OH, Hout HV, Stalman W, Nieuwenhuyse H, Haan MD Background: Several methods have been used to assess patients’ adherence. However, all available techniques have validity problems. Electronic pill containers (eDEMs) are regarded as the ‘‘gold’’ standard in measuring medication adherence. Objective: To assess how accurate patients’ adherence is measured by pharmacy medication records (PRMs) and patients’ self-reports (SRs). Methods: From 119 consecutive primary care patients with a first AD prescription adherence was registered by eDEMs over 6 months continuously. eDEMs were regarded as the reference standard. Adherence as assessed by PMRs and SRs was compared to the eDEM data (reference standard). Results: PRMs overestimated adherence by 5%. Patients’ self reports on forgetting AD intakes or extra intakes were not consistent with the eDEM data. Conclusions: PRMs are quite accurate for measuring overall medication adherence whereas SRs are not. However, for detailed intake patterns, eDEMs are superior. PMRs provide perhaps a more complete, practical, and less intrusive method for assessing adherence in clinical practice.
The efficacy of duloxetine (60 mg qd) in the treatment of painful physical symptoms in patients with major depressive disorder Wohlreich MM, Mallinckrodt CH, Lu Y, Detke MJ Introduction: Physical symptoms are common in depressed patients. We report the efficacy of duloxetine, a dual reuptake inhibitor of both serotonin and norepinephrine, in alleviating painful physical symptoms in depressed patients. Methods: Efficacy data were pooled from 2 identical, 9-week randomized, double-blind trials of duloxetine 60 mg qd (N = 244) and placebo (N = 251). Efficacy measures included Visual Analog Scales (VAS) for pain. Patients were not screened for pain. The average baseline score for overall pain was 26 on the 0 (no pain) to 100 (as severe as I can imagine) scale. Results: Pooled over all visits, mean changes for duloxetine-treated patients corresponded to improvements of 22 – 41% compared with 5 – 18% mean improvements for placebo. Differences were significant for all outcomes except headache ( P = .051). In visitwise results, significant improvements for duloxetine over placebo were observed as early as Week 1 (back pain, shoulder pain) or Week 2 (overall pain, headache, pain while awake, daily activities). Path analyses demonstrated that over half the improvement in back, shoulder, and overall pain associated with duloxetine was independent of improvements in HAMD17. Conclusion: In these studies, duloxetine (60 mg qd) demonstrated robust efficacy in treating painful physical symptoms in depressed patients.
Does the alleviation of painful physical symptoms associated with depression lead to higher remission rates? Wohlreich MM, Fava M, Mallinckrodt CH, Watkin JG, Detke MJ Introduction: While psychological symptoms of depression have been shown to respond to current antidepressants, physical symptoms may be less responsive. Treating both may lead to a higher percentage of patients achieving remission. Methods: Efficacy data were pooled from 2 identical, 9-week randomized, double-blind trials of duloxetine 60 mg qd (N = 244) and placebo (N = 251).
Evaluation of depression in home carers using SDS-comparison with outpatients Otani J, Yoshida K Objective: When caring for the elderly, it is known that stress in caregivers, as well as in the patients themselves, is an important problem. It has been 3 years since the Long Term Care Insurance Law was put into practice, and a substantial change was seen in medical care for the elderly. We compared the depressive tendency between the family carers and outpatients and conducted an interview-style survey on the benefits of home service. Subjects and methods: We studied 2365 elderly who lived in local communities. Outpatients and family carers were evaluated using SDS. Also, 54 family carers were interviewed about their stress and the primary benefits of using home service. Results: The average SDS score of all outpatients was 35 (S.D. = 10.8). In contrast, the average SDS score of family carers was 44.5 (S.D. = 5.3), significantly higher than that of all outpatients ( P < .005). Discussion: It may be important to give careful attention to the home carer as well as the home care patients.
Association of psychosocial factors with glycemic control and adherence in patients with type 2 diabetes and problem-solving intervention Ando M, Ando S The objectives of this study are to clarify individual psychosocial factors in diabetic control and to implement intervention based on a problem-solving model. The group of subjects (n = 50) consisted of patients below the age of 65 who were diagnosed as having type 2 diabetes for the first time. They were divided into three groups by the state of their glycemic control 2 years after the first diagnosis and by the state of their adherence to the treatment within 2 years from the first diagnosis: well-controlled group, poorly controlled group, and a dropout group. Self-administered questionnaires (Yatabe-Guilford Personality Test and Taylor’s Manifest Anxiety Scale) and projective technique (Rorschach Test) were used within 2 months after the initial diagnosis. The results showed that patients in the well-controlled group tended to be extroverted, and those in the poorly controlled group tended to be less able to cope under stress. Those patients in the dropout group tended to be depressed and have more apathetic and pessimistic selfimages and thinking patterns. In conclusion, psychosocial factors were considered to be involved in glycemic control and in adherence to initial treatment in diabetic patients. For the next step, we have provided
157
psychological intervention based on a problem-solving model for some diabetic patients.
Measuring adherence to antidepressants. The value of electronic pill containers of computerized patients’ medication records and of patients’ self-reports for assessing adherence Brook OH, Hout HV, Stalman W, Nieuwenhuyse H, Haan MD Background: Several methods have been used to assess patients’ adherence. However, all available techniques have validity problems. Electronic pill containers (eDEMs) are regarded as the ‘‘gold’’ standard in measuring medication adherence. Objective: To assess how accurate patients’ adherence is measured by pharmacy medication records (PRMs) and patients’ self-reports (SRs). Methods: From 119 consecutive primary care patients with a first AD prescription adherence was registered by eDEMs over 6 months continuously. eDEMs were regarded as the reference standard. Adherence as assessed by PMRs and SRs was compared to the eDEM data (reference standard). Results: PRMs overestimated adherence by 5%. Patients’ self reports on forgetting AD intakes or extra intakes were not consistent with the eDEM data. Conclusions: PRMs are quite accurate for measuring overall medication adherence whereas SRs are not. However, for detailed intake patterns, eDEMs are superior. PMRs provide perhaps a more complete, practical, and less intrusive method for assessing adherence in clinical practice.
The efficacy of duloxetine (60 mg qd) in the treatment of painful physical symptoms in patients with major depressive disorder Wohlreich MM, Mallinckrodt CH, Lu Y, Detke MJ Introduction: Physical symptoms are common in depressed patients. We report the efficacy of duloxetine, a dual reuptake inhibitor of both serotonin and norepinephrine, in alleviating painful physical symptoms in depressed patients. Methods: Efficacy data were pooled from 2 identical, 9-week randomized, double-blind trials of duloxetine 60 mg qd (N = 244) and placebo (N = 251). Efficacy measures included Visual Analog Scales (VAS) for pain. Patients were not screened for pain. The average baseline score for overall pain was 26 on the 0 (no pain) to 100 (as severe as I can imagine) scale. Results: Pooled over all visits, mean changes for duloxetine-treated patients corresponded to improvements of 22 – 41% compared with 5 – 18% mean improvements for placebo. Differences were significant for all outcomes except headache ( P = .051). In visitwise results, significant improvements for duloxetine over placebo were observed as early as Week 1 (back pain, shoulder pain) or Week 2 (overall pain, headache, pain while awake, daily activities). Path analyses demonstrated that over half the improvement in back, shoulder, and overall pain associated with duloxetine was independent of improvements in HAMD17. Conclusion: In these studies, duloxetine (60 mg qd) demonstrated robust efficacy in treating painful physical symptoms in depressed patients.
Does the alleviation of painful physical symptoms associated with depression lead to higher remission rates? Wohlreich MM, Fava M, Mallinckrodt CH, Watkin JG, Detke MJ Introduction: While psychological symptoms of depression have been shown to respond to current antidepressants, physical symptoms may be less responsive. Treating both may lead to a higher percentage of patients achieving remission. Methods: Efficacy data were pooled from 2 identical, 9-week randomized, double-blind trials of duloxetine 60 mg qd (N = 244) and placebo (N = 251).