Debbie Robson

Associations Between E-Cigarette Type, Frequency of Use, and Quitting Smoking: Findings From a Longitudinal Online Panel Survey in Great Britain

Introduction: E-cigarettes can be categorized into two basic types, (1) cigalikes, that are disposable or use pre-filled cartridges and (2) tanks, that can be refilled with liquids. The aims of this study were to examine: (1) predictors of using the two e-cigarette types, and (2) the association between type used, frequency of use (daily vs. non-daily vs. no use), and quitting. Methods: Online longitudinal survey of smokers in Great Britain was first conducted in November 2012. Of 4064 respondents meeting inclusion criteria at baseline, this study included (N = 1643) current smokers followed-up 1 year later. Type and frequency of e-cigarette use were measured at follow-up. Results: At follow-up, 64% reported no e-cigarette use, 27% used cigalikes, and 9% used tanks. Among e-cigarette users at follow-up, respondents most likely to use tanks versus cigalikes included: 40–54 versus 18–24 year olds and those with low versus moderate/high education. Compared to no e-cigarette use at follow-up, non-daily cigalike users were less likely to have quit smoking since baseline (P = .0002), daily cigalike or non-daily tank users were no more or less likely to have quit (P = .3644 and P = .4216, respectively), and daily tank users were more likely to have quit (P = .0012). Conclusions: Whether e-cigarette use is associated with quitting depends on type and frequency of use. Compared with respondents not using e-cigarettes, daily tank users were more likely, and non-daily cigalike users were less likely, to have quit. Tanks were more likely to be used by older respondents and respondents with lower education.

An exploratory, randomized controlled trial of adherence therapy for people with schizophrenia

Poor adherence limits the effectiveness of antipsychotic treatment in people with psychosis. The aim of the pragmatic, exploratory, single-masked trial conducted in the USA was to explore the efficacy, acceptability, and satisfaction with adherence therapy (AT) in a sample of people with schizophrenia. Twenty-six patients (12 experimental and 14 controls) were randomly allocated to receive eight weekly sessions of AT or continue with their treatment as usual (TAU). Patients were assessed at baseline and follow up (after therapy completion). The primary outcome was psychiatric symptoms, assessed using the Positive and Negative Syndrome Scale (PANSS). The secondary outcome, medication adherence, was measured by The Personal Evaluation of Transitions in Treatment. Patients receiving AT did not significantly improve in overall psychiatric symptomatology (change in PANSS total scores: AT: -10.2, TAU: -8.6; mean difference, -1.6; P = ns) or with medication adherence (AT: -2.8, TAU 1.5; P = ns) compared with the TAU group at follow up. Using the Adherence Therapy Patient Satisfaction Questionnaire, a high degree of satisfaction with AT was reported. Although AT did not result in a statistically-significant improvement in symptoms or medication adherence, evidence of active clinical engagement in treatment occurred.

Evaluation of smoking status identification using electronic health records and open-text information in a large mental health case register.

Background High smoking prevalence is a major public health concern for people with mental disorders. Improved monitoring could be facilitated through electronic health record (EHR) databases. We evaluated whether EHR information held in structured fields might be usefully supplemented by open-text information. The prevalence and correlates of EHR-derived current smoking in people with severe mental illness were also investigated. Methods All cases had been referred to a secondary mental health service between 2008-2011 and received a diagnosis of schizophreniform or bipolar disorder. The study focused on those aged over 15 years who had received active care from the mental health service for at least a year (N=1,555). The ‘CRIS-IE-Smoking’ application used General Architecture for Text Engineering (GATE) natural language processing software to extract smoking status information from open-text fields. A combination of CRIS-IE-Smoking with data from structured fields was evaluated for coverage and the prevalence and demographic correlates of current smoking were analysed. Results Proportions of patients with recorded smoking status increased from 11.6% to 64.0% through supplementing structured fields with CRIS-IE-Smoking data. The prevalence of current smoking was 59.6% in these 995 cases for whom this information was available. After adjustment, younger age (below 65 years), male sex, and non-cohabiting status were associated with current smoking status. Conclusions A natural language processing application substantially improved routine EHR data on smoking status above structured fields alone and could thus be helpful in improving monitoring of this lifestyle behaviour. However, limited information on smoking status remained a challenge.

Behavioural antecedents to pro re nata psychotropic medication administration on acute psychiatric wards

This study examined the antecedents to administration of pro re nata (PRN) psychotropic medication on acute psychiatric wards, with a particular focus on its use in response to patient aggression and other conflict behaviours. A sample of 522 adult in-patients was recruited from 84 acute psychiatric wards in England. Data were collected from nursing and medical records for the first 2  weeks of admission. Two-thirds of patients received PRN medication during this period, but only 30% of administrations were preceded by patient conflict (usually aggression). Instead, it was typically administered to prevent escalation of patient behaviour and to help patients sleep. Overall, no conflict behaviours or further staff intervention occurred after 61% of PRN administrations. However, a successful outcome was less likely when medication was administered in response to patient aggression. The study concludes that improved monitoring, review procedures, training for nursing staff, and guidelines for the administration of PRN medications are needed.

Parent-Child Interaction of Mothers with Depression and Their Children with ADHD.

Attention deficit/hyperactivity disorder (ADHD) is a developmental disorder that may have a chronic and pervasive impact on the childs function and cause long-term stress to parents. A higher rate of depression is associated with mothers of children with ADHD. This observational study aimed to investigate the effect of maternal depression and the childs ADHD on the quality of the parent-child interaction in children with ADHD and their mothers with depression. The study participants comprised 39 mother-son dyads including children with ADHD and mothers with depression, children with ADHD and mothers without depression, and children without ADHD and mothers without depression. The Specific Affect Coding System, 20-code version was used to code interactional affect, including positive engagement, negative engagement, negative disengagement, and neural affect. There were no statistically significant group-by-context interaction effects or group effects on all affective variables between the group of children with ADHD and mothers without depression and the group of children without ADHD and mothers without depression. Stimulant medication may account for these nonsignificant findings. No significant difference of positive affect between neutral and conflict-solving contexts was observed in depressed mothers whose children were diagnosed as ADHD. Children with ADHD whose mothers were depressed were less positive in their parent-child interaction compared with children in the other groups. Maternal depression may play an important role in the affective presentation of dyads of children with ADHD and mothers with depression. Implications for clinical practice and future research are provided.

Attitudes regarding mental health nurse prescribing among psychiatrists and nurses: A cross-sectional questionnaire study

BACKGROUND In the United Kingdom, mental health nurses (MHNs) can independently prescribe medication once they have completed a training course. This study investigated attitudes to mental health nurse prescribing held by psychiatrists and nurses. METHOD 119 MHNs and 82 psychiatrists working in South-East England were randomly sampled. Participants completed a newly created questionnaire. This included individual item statements with 6-point likert scales to test levels of agreement which were summated into 7 subscales. RESULTS Psychiatrists had significantly less favourable, albeit generally positive attitudes than MHNs regarding general beliefs (63% vs. 70%, p<0.001), impact (62% vs. 70%, p<0.001), uses (60% vs. 71%, p<0.001), clinical responsibility (69% vs. 62%, p<0.001) and legal responsibility (71% vs. 64%, p<0.001). More MHNs than psychiatrists believed that nurse prescribing would be useful in emergency situations for rapid tranquilisation (82% vs. 37%, p<0.001), and that the consultant psychiatrist should have ultimate clinical responsibility for prescribing by an MHN (42% vs. 28%, p<0.001). Approximately half of all participants agreed nurse prescribing would create conflict in clinical teams. CONCLUSIONS The majority of both groups were in favour of mental health nurse prescribing, although significantly more psychiatrists expressed concerns. This may be explained by a perceived change in power balance.

The predictive validity of subjective adherence measures in patients with schizophrenia

Despite frequent use of subjective adherence measures in patients with schizophrenia as well as other chronic conditions, there are several reports that question the validity of these instruments. Three well known, representative subjective measures are the Medication Adherence Questionnaire (MAQ), the Drug Attitude Inventory (DAI), and the Compliance Rating Scale (CRS). In this study we explored the predictive validity of these instruments in a European sample of 119 stabilized outpatients with schizophrenia. Clinical outcome variables were relapse and admission to a psychiatric hospital during a follow‐up period of 12 months. Results indicate that the predictive validity of all three measures was poor. The MAQ was the least problematic predictor for relapse (Nagelkerke R2 = 0.09), and time to relapse (R2 = 0.07) and had the best sensitivity for relapse (63.6%) as well as admission (87.5%). The MAQ and CRS were both moderate predictive for admission (Nagelkerke R2 = 0.21, and R2 = 0.29). We conclude that the validity of the instruments studied here is questionable and have limited clinical relevance. Given the feasibility and ease of most subjective instruments, researchers may be tempted to use them but should be aware of the serious drawbacks of these instruments. Copyright

Adherence therapy following acute exacerbation of schizophrenia: A randomised controlled trial in Thailand

Background: Up to 50% of patients with schizophrenia are non-adherent with antipsychotic medication. Aims: To establish the efficacy of adherence therapy (AT) compared to treatment as usual (TAU) in improving clinical outcomes in patients with schizophrenia following an acute exacerbation of illness. Method: A parallel-group, single-blind, randomised controlled trial. Fieldwork was conducted in Thailand. Patients received eight weekly sessions of AT in addition to TAU. The primary outcome was improvement in psychopathology (measured using the Positive and Negative Syndrome Scale (PANSS)) at 26-week follow-up. Secondary outcomes included patient attitudes towards medication, global functioning and side-effects. Results: In total, 70 inpatients with schizophrenia were recruited to the trial. At 26-week follow-up, PANSS total scores improved in the AT compared to the TAU group by a mean of −3.94 points (effect size = 0.24). The number needed to treat (NNT) was 5. There was no significant effect on patients’ attitudes towards treatment, functioning or medication side-effects. No treatment-related adverse effects were reported. Conclusion: AT improves psychopathology in Asian patients with schizophrenia following an acute exacerbation of illness.

Effect of medication-related factors on adherence in people with schizophrenia: A European multi-centre study

AIM To investigate the relation between medication-related factors and adherence in people with schizophrenia in outpatient treatment. METHODS The sample comprised 409 outpatients (ICD-10 diagnosis of schizophrenia) with clinician-rated instability in four European cities (Amsterdam, The Netherlands; Verona, Italy; Leipzig, Germany; London, Great Britain). Adherence was assessed using the Medication Adherence Questionnaire (patient perspective), and the Clinician Rating Scale (clinician perspective). Examined medication-related factors were type (atypical vs. typical), application (oral vs. depot), daily dose frequency of antipsychotic medication (Medication History Scale), number of side effects (Liverpool University Neuroleptic Side Effect Rating Scale), and patient attitudes toward medication (Drug Attitude Inventory). Multiple regression analysis was used to identify predictors of adherence by medication-related factors. RESULTS Adherence, as rated by patient and clinician, was predicted by patient attitude towards medication, but was unrelated to type of drug, formulation or side effects of antipsychotic medication. A high daily dose frequency was associated with better adherence, but only when rated by the patient. CONCLUSIONS In order to improve adherence there is a need to seriously consider and attempt to improve patient attitude toward medication. However, type of antipsychotic and other medication-related factors may not be as closely related to adherence as it has often been suggested.

Effect of implementation of a smoke-free policy on physical violence in a psychiatric inpatient setting: an interrupted time series analysis

BACKGROUND Smoke-free policies are important to protect health and reduce health inequalities. A major barrier to policy implementation in psychiatric hospitals is staff concern that physical violence will increase. We aimed to assess the effect of implementing a comprehensive smoke-free policy on rates of physical assaults in a large UK mental health organisation. METHODS We did an interrupted time series analysis of incident reports of physical assault 30 months before and 12 months after the implementation of the policy in the inpatient wards of South London and Maudsley National Health Service Foundation Trust, London, UK. We used a quasi-Poisson generalised additive mixed model to model the monthly incidence of physical assaults as a function of several explanatory variables. FINDINGS 4550 physical assaults took place between April 1, 2012, and Sept 30, 2015; 225 (4·9%) of which were smoking-related. After adjustment for temporal and seasonal trends and key confounders (sex, age, schizophrenia or related disorders, or having been sectioned under the Mental Health Act), there was a 39% reduction in the number of physical assaults per month after the policy introduction compared with beforehand (incidence rate ratio 0·61, 95% CI 0·53-0·70; p<0·0001). INTERPRETATION Introduction of a comprehensive smoke-free policy appeared to reduce the incidence of physical assaults. Adequately resourced smoke-free policies could be part of broader violence reduction strategies in psychiatric settings. FUNDING National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London (Kings College Hospital NHS Foundation Trust).