High Motivation For Treatment Research Articles

Treatment motivation in adolescent girls with obesity

Background. The prevalence of obesity among children is increasing, which is a serious healthcare problem. In healthcare, the problem of motivation affects an important area that reflects its effectiveness – patient motivation for treatment. A decrease in treatment motivation reduces therapeutic effect, increases the complication rate of the underlying disease, reduces the quality of life of patients and increases treatment costs.The aim of the work. To identify the differences in treatment motivation in adolescent girls with obesity.Materials and methods. The pilot study was carried out at the clinic of the Scientific Centre for Family Health and Human Reproduction Problems. The study included 40 girls aged 14–16 years suffering from grade 1 obesity. To study treatment motivation, we used the following methods: J. Nuttin’s, D. McClelland’s, S.R. Panteleev’s, J.K. Collins’, method of the self-conception research, the “Type of Attitude Towards the Disease” method; attitude towards the disease.Results. The study showed that the adolescents who were admitted into hospital for the first time had higher treatment motivation during the study than the adolescents who were readmitted into hospital. The adolescents who were readmitted into hospital felt guilty remorse, anxious suspiciousness, and fear of failure. The dominant type of treatment motivation in both groups consisted of the following attitudes: achieving symptomatic improvement; receiving a “secondary gain” from the disease; other motivation (passive position).Conclusion. The obtained data from the study of treatment motivation in adolescent girls with obesity can be used to optimize the process of therapy of such patients in a hospital setting.

Breaking the chains? The effects of training a shelter dog in prison on criminal behavior and recidivism

The effectiveness of Dutch Cell Dogs (DCD), a prison-based dog training program, in reducing criminal behavior and recidivism was assessed in a quasi-experimental study in twelve correctional facilities in the Netherlands (N = 241). DCD is a program in which incarcerated offenders train a shelter dog bi-weekly for eight weeks. Results demonstrated that DCD (n = 121) did not outperform treatment-as-usual (TAU; n = 120) in official recidivism outcomes and self-reported criminal behavior. However, subgroups based on age and detainees’ functioning responded differently in self-reported criminal behavior. Positive effects were found on self-reported criminal behavior for DCD participants who were older, had lower callous-unemotional traits, or had higher treatment motivation. In conclusion, findings provided initial evidence that subgroups may respond differently to a dog training program, however, more experimental research with larger sample sizes is needed.

The Perspective of Forensic Inpatients With Psychotic Disorders on Protective Factors Against Risk of Violent Behavior.

Background: Little is known about the opinions of forensic inpatients with psychotic disorders like schizophrenia on factors likely to prevent or decrease future violent behavior.Aims: To understand the perspectives of forensic inpatients with psychotic disorders on protective factors against risk of violent behavior and compare them to factors identified by professional staff.Method: Using the Structured Assessment of Protective Factors (SAPROF) checklist for self-appraisal of violence risk, we conducted semi-structured interviews with 32 inpatients of the Medical Treatment and Supervision Act Ward and compared the results with those of professionals.Results: Inpatients scored higher in the SAPROF total score, the motivational factors of “life goals” and “motivation for treatment,” and the protective level in general. Inpatients scored themselves lower in risk level than professionals. The degree of agreement between service users' and professionals' evaluations was low for all categories except external factors. Inpatients prioritized “life goals,” “self-control,” and “medication” as the top three key strengths currently preventing violent behavior, whereas the professionals selected “life goals” less often. The top three important future goals for preventing future violence selected by inpatients were “work,” “intimate relationships,” and “life goals,” with the former two being selected significantly less often by the professionals.Conclusions: This is the first study to shed light on Japanese forensic inpatients' perspectives about preventing future violent behavior. Despite professionals' underestimation, inpatients viewed themselves as having high motivation for treatment and positive life goals. Inpatients prioritized personal values such as life goals, work, and intimate relationships, whereas professionals prioritized understanding, treating, and observing the disease. Our findings are consistent with past reports on patients' and clinicians' perspectives. Awareness of such gaps in perceptions can help build fruitful therapeutic alliances. We discuss the implications in terms of treatment, how to address the gap therapeutically, and how to design treatment accordingly. Directions for future research are also discussed.

Biliary atresia in twins'population: a retrospective multicenter study in mainland China.

We evaluated the demographic of biliary atresia (BA) children from twins family and aimed to investigated what it can add to the twins' literature and our understanding of the disease. This study contains 11 medical centers in mainland China and the medical record of twins with BA was retrospectively analyzed from January 2012 to December 2018. Follow-up was carried out by out-patient review and questionnaire. The study included 19 twin pairs in whom there was discordance for BA. Sixteen (84.2%) affected twin underwent Kasai Procedure (KP); median age at KP was 78 (49-168) days. There were ten affected twins that became jaundice-free at 3 months post-KP, and eight occurred with different degrees of cholangitis post-KP. Six affected twins received Liver Transplantation (LT) successfully. The 2year native liver survival rate and the 2year overall survival rate of affected twins were 61.1 and 94.4%, respectively. There were three affected monozygotic (MZ) twins and one healthy co-twin with BA-associated congenital malformations, all of which were cardiac malformations. The number of virus infection of affected MZ twins was significantly more (p = 0.04) than affected dizygotic (DZ) twin. Discordance for BA in 19 pairs of twins supported that BA may be related to genetic phenotype or penetrance. The difference in genetic background between MZ and DZ affects the susceptibility of the host to virus infection. High acceptance of KP (84.2%) in our study implied a high motivation for treatment for twins with BA. Delays of KP (78days) in affected twin may be related to the postnatal gradual onset and the late diagnosis.

Persistence of Denosumab Therapy among Patients with Osteoporosis

Study DesignRetrospective study in a single center.PurposeTo examine denosumab persistence in patients of different ages with severe osteoporosis in Japan.Overview of LiteratureDenosumab is an antibody drug used for the treatment of osteoporosis. It is mainly used in patients with severe osteoporosis who might have high motivation for treatment, and the need for only semi-annual subcutaneous injection might improve the continuation rate. However, no English-language articles have reported on denosumab persistence in the Japanese population, including young people, despite the importance of this issue in a super-aging society. MethodsThe subjects started treatment with subcutaneous denosumab in our department from July 2013 until December 2017. Persistence rates were calculated using Kaplan-Meier curves. Patients were defined as “persistent” or “non-persistent” according to the use of therapy after 60 months.Results The study included 101 patients (84 females) with a median follow-up period of 23.6±14.2 months. The persistence rate declined to 85.3%, 78.3%, 74.1%, 71.3%, and 69.3% at 12, 24, 36, 48, and 60 months, respectively. Age at the initiation of denosumab therapy differed significantly between non-persistent (n=31) and persistent (n=70) patients (81.3 vs. 72.8 years, p<0.01). Persistence was significantly lower in patients aged ≥80 years than in those aged <60 and 60–79 years (both p<0.01). The reasons for non-persistence of denosumab therapy were transfer to another hospital (n=13), interruption of outpatient visits (n=11), dental treatment (n=4), adverse events (n=2), and patient request (n=1).ConclusionsPersistence was significantly lower in patients aged ≥80 years than in patients of other ages, and strategies promoting persistence are needed for these elderly patients.

\u201cWho needs secure services for personality disorder?\u201d Results of an expert Delphi study with professional staff

BackgroundPersonality Disorder (PD) is an enduring, multi-faceted mental disorder, associated with adverse health effects, difficulties with interpersonal relationships and in some cases increased risk to others. A limited number of dedicated forensic mental health services are available for serious offenders with severe personality disorder. The recent Offender Personality Disorder (OPD) strategy aims to ensure that most such offenders are treated in prison rather than secure psychiatric services, except in highly complex cases where this is not possible. While the strategy sets out very broad criteria relating to this, greater clarity is needed to support decisions about appropriate transfer and hence enhance public protection. This study explored which characteristics professional experts associate with appropriate transfer from prison to forensic mental health services for high-risk offenders with PD.MethodA modified Delphi survey distributed through an online survey system was conducted in two-rounds with a group of professional experts recruited from forensic mental healthcare; criminal justice and specialist commissioning.ResultsFifty-one (56%) respondents completed stage one of the Delphi and 34 (61%) of these completed stage two. Consensus was reached for a total of 22 items indicating complexity, including co-morbid mental illness, high level of risk, lack of progress in prison and high motivation for treatment. A preliminary checklist for these factors was developed. Panel members consistently emphasised the importance of the individual’s presenting need, the overall clinical picture and formulation in their free text responses.ConclusionsProfessionals face a complex picture when making decisions regarding suitability for hospital admission for high-risk male offenders with PD, with varied opinions amongst professional experts as to priorities for intervention and a focus on individual needs through formulation. It was, nevertheless, possible to condense these views into a set of consistent variables that can be used to highlight the need for transfer into hospital-based treatment services.

The Role of Motivation in Predicting Addiction Treatment Entry Among Offenders With Substance Use Disorders Under Probation Supervision.

Many offenders with a substance use disorder (SUD) do not enter addiction treatment. The aim of this study was to examine predictors of addiction treatment entry and to get more insight in the predictive value of treatment motivation. A total of 83 male offenders with a SUD under probation supervision in the Netherlands were assessed at the start of probation supervision and at 12-month follow-up. A total of 38 offenders (45.5%) entered addiction treatment in the follow-up period. Offenders with any mandated treatment (p = .028) and higher treatment motivation (p = .005) were more likely to enter treatment. Multiple logistic regression analysis showed that treatment motivation predicts addiction treatment entry in the first year of probation (OR = 2.215, p < .01). This emphasizes the relevance of treatment motivation for addiction treatment entry among offenders with a SUD. Pretreatment motivational interventions are therefore recommended for offenders with low motivation for treatment in probation settings.

Predictors of long-term outcome of CBT for youth with anxiety disorders treated in community clinics

Cognitive behavioral therapy (CBT) has proven long-term effects in youth with anxiety disorders. However, only a few studies have examined predictors of long-term outcomes of CBT treatment. The present study investigated possible predictors of long-term treatment outcomes in youth with mixed anxiety disorders treated in community mental health clinics. A total of 139 youth (mean age at assessment 15.5 years, range 11–21 years) with a principal diagnosis of separation anxiety disorder, social anxiety disorder, and/or generalized anxiety disorder were evaluated a mean of 3.9 years post-treatment (range 2.2–5.9 years). Outcomes were loss of all inclusion anxiety diagnoses, loss of the principal inclusion anxiety diagnosis, and changes in youth- and parent-rated youth anxiety symptoms. Predictors encompassed youth, parent and demographic factors, and post-treatment recovery. The most consistent finding was that low family social class predicted poorer outcomes. Higher treatment motivation was associated with better outcome whereas a diagnosis of social anxiety was associated with poorer outcome. Identified predictors extend on previous findings from efficacy trials, and the results indicate a need for more specific treatment protocols.

Homeless women’s service use, barriers, and motivation for participating in substance use treatment

ABSTRACTBackground: Homeless women are at high risk for substance use disorder (SUD), and are a growing proportion of the homeless population. However, homeless women experience barriers to engaging in substance use services. Objectives: Among homeless women with SUD, to explore service use, motivation to change, service barriers, and willingness to have substance use and mental health problems addressed in primary health care. Methods: Women with SUD were sampled from 11 Health Care for the Homeless (HCH) primary care clinics in 9 states, yielding 241 with either an alcohol or drug use disorder who then completed questions about SUD services. Results: Over 60% of women with dual alcohol and drug use disorders used some type of SUD service in the past year, while 52% with a drug only disorder, and 44% with an alcohol only disorder used services. The most mentioned barrier to service use was depression, but cost, wait time, where to find treatment, and facilities located too far away, were also frequently noted. A large proportion across all groups indicated high motivation for treatment and willingness to discuss their SUD in a primary care setting. Conclusion: There are continued barriers to SUD service use for homeless women despite high motivation for treatment, and willingness to be asked about SUD and mental health problems in primary care. HCH primary care sites should more systematically ask about SUD and mental health issues and address women’s expressed need for support groups and alternative therapies to more holistically address their SUD needs.

Depot-medication compliance for patients with psychotic disorders: the importance of illness insight and treatment motivation.

BackgroundNoncompliance is a major problem for patients with a psychotic disorder. Two important risk factors for noncompliance that have a severe negative impact on treatment outcomes are impaired illness insight and lack of motivation. Our cross-sectional study explored how they are related to each other and their compliance with depot medication.MethodsInterviews were conducted in 169 outpatients with a psychotic disorder taking depot medication. Four patient groups were defined based on low or high illness insight and on low or high motivation. The associations between depot-medication compliance, motivation, and insight were illustrated using generalized linear models.ResultsGeneralized linear model showed a significant interaction effect between motivation and insight. Patients with poor insight and high motivation for treatment were more compliant (94%) (95% confidence interval [CI]: 1.821, 3.489) with their depot medication than patients with poor insight and low motivation (61%) (95% CI: 0.288, 0.615). Patients with both insight and high motivation for treatment were less compliant (73%) (95% CI: 0.719, 1.315) than those with poor insight and high motivation.ConclusionMotivation for treatment was more strongly associated with depot-medication compliance than with illness insight. Being motivated to take medication, whether to get better or for other reasons, may be a more important factor than having illness insight in terms of improving depot-medication compliance. Possible implications for clinical practice are discussed.

Factors associated with receipt of residential rehabilitation by opiate users indicate that these clients are more amenable to drug treatment

Aims: Residential rehabilitation (RR) is relatively expensive and is received by a minority of drug users seeking treatment. It is perceived to be particularly effective, but those entering RR may be more amenable to treatment than those treated in other modalities. The objective of this study was to explore ways in which opiate users treated in a residential setting differ, at treatment entry, from those treated in a community setting. Methods: Opiate users (N = 406) who received either RR or community substitute prescribing (CSP) were sampled from the UK Drug Treatment Outcomes Research Study (DTORS). A logistic regression analysis, controlling for Drug Action Team, was used to predict the occurrence of RR versus CSP for the treatment of opiate dependence. Measures included self-reported levels of drug use, offending, social measures and health. Findings: RR clients were different to CSP clients in a number of respects that may positively influence treatment outcome; most importantly, their reasons for seeking treatment were different and they were better motivated. Conclusions: Higher treatment motivation may be one factor that explains why RR is a more effective treatment for clients with complex drug-related problems.

Motivation for Treatment Among Women Offenders in Prison-Based Treatment and Longitudinal Outcomes Among Those Who Participate in Community Aftercare

Participation in aftercare may reduce risk of recidivism among women offenders with substance use problems following their release to the community. This study examines motivation to participate in aftercare among women offenders and whether their participation in both in-custody and aftercare treatment reduces their risk of recidivism. Surveys were conducted with women (N = 1,158) in prison-based substance abuse treatment programs. Return-to-prison was examined among participants in community-based aftercare (N = 1,182) over 12 months following treatment discharge. Higher treatment motivation was associated with child welfare involvement, prior treatment, and use of “harder” drugs; ethnic minority women had lower treatment motivation compared with White women. Participants who completed the aftercare program, or who had longer treatment duration, and those who had participated in an in-prison program prior to parole had reduced risk of recidivism. Study findings suggest the value of community aftercare for women offenders, particularly when combined with prior in-prison treatment.

Illness uncertainty and treatment motivation in type 2 diabetes patients

To characterize the uncertainty in illness and the motivation for treatment and to evaluate the existing relation between these variables in individuals with type 2 diabetes. Descriptive, correlational study, using a sample of 62 individuals in diabetes consultation sessions. The Uncertainty Stress Scale and the Treatment Self-Regulation Questionnaire were used. The individuals with type 2 diabetes present low levels of uncertainty in illness and a high motivation for treatment, with a stronger intrinsic than extrinsic motivation. A negative correlation was verified between the uncertainty in the face of the prognosis and treatment and the intrinsic motivation. These individuals are already adapted, acting according to the meanings they attribute to illness. Uncertainty can function as a threat, intervening negatively in the attribution of meaning to the events related to illness and in the process of adaptation and motivation to adhere to treatment. Intrinsic motivation seems to be essential to adhere to treatment.

Sex differences in addict careers. 4. Treatment.

Comparisons of behaviors during treatment were made between a sample of women and a sample of men methadone maintenance clients. Women in this study exhibited high motivation for treatment. Overall, however, small differences were found between the sexes with respect to treatment process and outcome measures. The observed differences that were significant included use of substances other than heroin, interpersonal relationships, drug dealing, employment, and criminal behaviors. The differences seemed to be in accordance with traditional sex role expectations. The distinctive behavior pattern of Chicanas demonstrated in this study demands special attention. It is suggested that treatment programs should incorporate more services to meet women-specific needs.

Early dropouts in brief dynamic psychotherapy.

Brief dynamic psychotherapy at the Psychiatric Clinic of Athens University follows the approach of Malan and Sifneos and the selection criteria proposed by Davanloo. The early dropout phenomenon was studied in 24 therapies, in relation to variables included in the selection criteria. The statistical analysis was based on discriminant analysis. A high final score, early transference confrontation, circumscribed problem of the patient, high motivation for treatment and existence of crisis were strongly associated with continuation of brief psychotherapy.