Therapeutic Adherence Research Articles

Cardiac rehabilitation makes a difference: lipid control targets and prognosis

Abstract Funding Acknowledgements None. Introduction Cardiac rehabilitation (CR) has become a fundamental element in the recovery of patients with acute coronary syndrome, since it achieves greater therapeutic adherence and better control of cardiovascular risk factors (CVRF). Purpose We aim to describe the characteristics of patients with ST-elevation acute coronary syndrome (STEACS) included in a cardiac rehabilitation program, as well as the achievement of prevention objectives and the occurrence of mayor adverse cardiovascular events (MACE). Methods We present a prospective registry of 664 patients admitted to a Coronary Unit with a diagnosis of STEACS during the years 2017-2020. They were classified according to their participation in a CR program. We compared history, lipid-lowering treatment (prior, at discharge and titration), lipid levels at discharge and at 1-year follow-up, and degree of compliance with lipid targets. MACE were observed at 2-year follow-up. Results From 664 patients, 351 were excluded due to lack of follow-up or early mortality. From a total of 313 patients (mean age 59.9±11.2 and 81% male), 55.3% were included in the CR program, with this group presenting a lower mean age (55.46±8.7 vs 65.39±11.5 p<0.001), as well as a higher frequency of a history of early ischemic heart disease and smoking, and a lower frequency of arterial hypertension and diabetes (Table). Lipid-lowering treatment at discharge was similar in both groups. In patients undergoing CR there was a lower level of total cholesterol and low-density lipoprotein cholesterol (LDLc) at one year (126.2±27 vs 137.2±34, p=0.002; 57.8±23 vs 67.5±26, p<0.001) compared to the group without CR. A greater reduction in LDLc (41.4% vs 0.86%, p<0.001) was achieved even from higher initial LDLc values. Titration of lipid-lowering treatment was also greater, with the old target of LDLc < 70 being achieved in a greater number of cases (81.5% vs 59.3%, p<0.001). At 1-year follow-up, the new cholesterol reduction target (LDL <55 or 50% reduction) was achieved in only 26.8% of patients, with a greater reduction being obtained in the CR group (34.1% vs 17.9%; p=0.02). At 2-year follow up, in CR group we found low rates of re-infarction (3.2% vs 4.1%), new revascularization (5.8% vs 7.3%), not statistically significant, but we could observe differences in mortality from all causes (0% vs 4.8%, p<0.01). Conclusions Participation in a CR program is associated with better lipid control in patients admitted for STEACS. These programs represent a basic tool for achieving increasingly demanding LDLc targets. Longer follow-up is needed to detect clinically important adverse events.

Gender differences in obstructive sleep apnea syndrome: a pilot study

PurposeOSAS is a syndrome that often presents clinically differently between men and women. The aim of this study was to assess the clinical presentation, nocturnal home sleep cardiorespiratory monitoring and therapeutic adherence to CPAP in both sexes to identify the most frequent patterns.MethodsData from the first visit, the nocturnal home sleep cardiorespiratory monitoring and follow-up visit of 74 OSA patients were collected. Exclusion criteria included other respiratory and/or neuromuscular diseases (including Obesity hypoventilation syndrome) and other non-respiratory sleep disorders.ResultsMen were older and had a higher supine AHI and ODI compared to women. In addition, BMI and age correlated positively with AHI in males. Women had a higher hypopneas frequency and better therapeutic adherence to CPAP.ConclusionsMen were associated with a higher AHI when sleeping in the supine position and this may be useful to look for new therapeutic options in combination with or as an alternative to CPAP. BMI correlated positively with AHI in men and this should be considered to stimulate weight loss as the main treatment to reduce the number of apneas/hypopneas, as men also had less therapeutic adherence to CPAP in our study. Females presented a significantly higher frequency of hypopneas than men, as well as a lower number of desaturation events per hour (ODI): these differences in the nocturnal home sleep cardiorespiratory monitoring could reflect different pathophysiological mechanisms of OSAS onset between the two sexes, which should be investigated in future scientific studies.

A Multi-Component Intervention to Improve Therapeutic Adherence in Uncontrolled Hypertensive Patients Within the Primary Care Level: A Before-and-After Study.

Non-adherence to medication severely affects chronic disease control. To assess whether a multi-component intervention implemented at the public primary care level in Argentina improves adherence to antihypertensive medication and helps to reduce blood pressure (BP) levels in uncontrolled hypertensive patients. A before-and-after study was conducted in five public primary care clinics located in the city of Almirante Brown, Argentina. One hundred and twenty-five uncontrolled hypertensive patients received a multi-component intervention based on the Chronic Care model and the 5As strategy (Ask, Advise, Agree, Assist, and Arrange). Medication possession ratio (MPR) and BP values were assessed before and after a 6-month period. The follow-up rate was 96.8%. Main baseline characteristics were as follows, male: 44.8%, mean age: 57.1 years (±8.1), exclusive public healthcare coverage: 83.5%, primary school level or less: 68.8%, and mean systolic/diastolic BP: 157.4 (±13.6)/97.7 (±8.2) mmHg. After implementing the intervention, a significant increase in the proportion of adequate adherence (MPR ≥ 80%) was observed, from 16.8% at baseline to 47.2% (p < 0.001). A significant reduction of 16.4 mmHg (CI 95%: 19.6, 13.1) was observed for systolic blood pressure (SBP) and 12.0 mmHg (CI 95%: 14.2, 9.9) for diastolic blood pressure (DBP) (p < 0.001). At 6 months, 51.2% of the population achieved blood pressure control (SBP < 140 mmHg and DBP < 90 mmHg). The study intervention was associated with an increased adherence rate, achieving a significant reduction in BP values and reaching BP control in more than half of the population.

Association between plasma imatinib levels and response to treatment of chronic myeloid leukemia in patients from Manaus, Brazil.

Imatinib mesylate (IM) is the drug of choice for the treatment of chronic myeloid leukemia (CML). However, despite most of the results obtained with this therapy being positive, some patients still present a suboptimal therapeutic response or still develop some type of resistance. Therefore, the aim of this study was to evaluate IM plasma levels in CML patients treated at a referral unit in Manaus and correlate them with variables that might interfere with these levels. Data from 52 patients were obtained through a standardized questionnaire containing clinical, sociodemographic, lifestyle, and use of other medication information, as well as an estimate of therapeutic adherence. Additionally, blood collection was performed to measure the plasma concentration of the drug using the HPLC-UV technique. Molecular studies were done to identify the presence of polymorphism in the ABCG2 C421A membrane transporter. Most patients were male with a mean age of 52 ± 12.3 years (95% CI 49.0-55.9). There was a high variation in drug concentrations in the range from 0 to 4694 ng/mL, with a mean of 1558.59 ± 989.79 ng/mL (95% CI 1283.0-1834.1). Approximately two-thirds of patients were classified in the drug-level range considered therapeutic, and there was a correlation between plasma concentration and higher molecular response. Additionally, most individuals had the normal genotype for the ABCG2 C421A polymorphism but further studies should be performed to reveal the role of this variable in the outcome of the disease in this population.

TREAT TRIAL: MULTI-CENTER CROSS-SECTIONAL TREATMENT EVALUATION OF APPARENT RESISTANT HYPERTENSION IN BELGIUM

Objective: The goal of the TREAT study is to evaluate the prevalence of apparent treatment-resistant hypertension (aRHT) in a Belgian setting and to evaluate which determining factor of pseudo-resistant hypertension contributes the most to this prevalence: white coat hypertension (WCH), underdosing of adequate drugs or poor adherence to prescribed medicines. Design and method: TREAT is a single-visit, multicentric, non-interventional, cross-sectional survey. Inclusion criteria were the following: patients over 18 years old receiving 3 or more antihypertensive molecules and referred to specialized hospital centres for aRHT. The data were collected according to the patient’s medical records. Self-reported adherence to antihypertensive treatment was collected and a Hill-bone medication adherence scale was also proposed. Results: A total of 232 patients were included. Mean anti-hypertensive treatment duration was 10.6(±9.1) years. Patients were treated with a mean of 3.8(±1.1) antihypertensive molecules and 2.8(±1.1) antihypertensive pills. Only 48.5% of the aRHT patients were treated with the triple therapy recommended by the 2023 ESH hypertension guidelines (i.e. renin-angiotensin-aldosterone system inhibitor (RAASi), calcium channel blocker (CCB) and diuretic), and only 29.1% of patients were treated with the maximal recommended dose. Inadequate dosing was mostly present with diuretics, only 60% of patients was treated with at least half the maximum dose of a diuretic. WCH was present in 11% of patients in whose ambulatory BP measurements were available in records (n=136). Therapeutic adherence was self-reported as poor or moderate in 17.6% of patients (n=41). The Hill-bone medication adherence scale (n=140, 60.4%) showed a mean score of 12(±4.2) (good adherence). In this cohort, 31.8% of patients seemed to have true resistant hypertension. Conclusions: Among patients referred to specialized centres for aRHT, about 2/3 of patients have in reality pseudo-resistant hypertension. Whereas WCH and poor adherence seems to be limited in our dataset, many patients were polymedicated with non-recommended combinations of antihypertensive molecules in 1 out of 2 patients, with inadequate dosing in 2 out of 3 patients. Pseudo-resistant hypertension seems in our cohort to be mainly related to under-use of triple combination therapy and most likely also due to underdosing.

Redefining the relationship in digital care: A qualitative study of the Digital Therapeutic Alliance

Digital therapeutic programs are emerging almost daily, offering the potential to reduce healthcare access inequalities by providing more flexible and accessible care options. However, as with traditional healthcare, the issue of patient engagement is fundamental, and the latest research have reported that fewer than 30% of users complete these programs in their entirety. Hence, many authors emphasize the importance of studying the role of therapeutic alliances specifically adapted to digital care. The therapeutic alliance encompasses the collaborative aspects of the relationship between the therapist and the patient. In this context there is a need to reconceptualize the alliance within the context of digital healthcare as it can enhance engagement, adherence, and the effectiveness of such treatments. The objective of this qualitative study was to identify the components of the digital therapeutic alliance. A thematic analysis has identified three major themes that appear to constitute the digital therapeutic alliance among 44 users of an online program: trust in the program, perception of interactions, and feeling of consideration. These results prompted a discussion of the challenges of digital healthcare, including the terminology to use. The term “digital therapeutic adherence” is proposed, thereby opening up a field for research and clarification of this important concept distinct from traditional alliance.

Beauty Therapy to Support Psychosocial Recovery from Oncological Care: A Qualitative Research on the Lived Experience of Women with Breast Cancer Treated with Chemotherapy.

During the oncological care path, breast cancer patients treated with chemotherapy suffer from a number of psycho-physical changes, and appearance-related side effects are among the primary determinants of psychosocial impairment. Appropriate interventions are needed due to the fact that treatment-induced transformations have been associated with a decline in overall quality of life, interpersonal and sexual difficulties, and adverse effects on therapeutic adherence. In the framework of integrative oncology, beauty therapy is an affordable and straightforward intervention that could be used in the clinical management of breast cancer side effects. This study aims to comprehend the emotional and lived experiences of women undergoing chemotherapy after a brief beauty therapy intervention with licensed beauticians. The Interpretative Phenomenological Analysis was used as a methodological guideline. Sixteen women were purposefully recruited in a day hospital of a cancer unit, where the beauty therapy was implemented. At the end of the intervention, data were gathered using a semi-structured interview with open-ended questions. A thematic analysis was performed on verbatim transcriptions. Findings support the proposal of beauty therapy for patients undergoing chemotherapy. Assuming a relational viewpoint, beauty therapy could improve patients' feelings about themselves and the way they feel about others, even if they do not declare a specific interest in their outward appearance.

Analysis of the Effect of Family-Centered Empowerment Model (FCEM) Health Education Through WeChat on Medication Compliance and Blood Pressure of Elderly Hypertensive Patients in Rural Areas

Objective: To validate the effectiveness of a Family-Centered Empowerment Model (FCEM) health education through WeChat on medication compliance and blood pressure among elderly hypertensive patients in rural areas. Methods: One hundred and two rural elderly hypertensive patients aged 65–80 years were selected and randomly divided into an experimental and control group of 51 each. The control group implemented conventional health education, and the experimental group implemented FCEM health education through WeChat platform for 4 consecutive weeks. The Therapeutic Adherence Scale for Hypertensive Patients (TASHP) scores and blood pressure measurements were compared between and within the two groups. Results: After the intervention, there were significant differences in medication compliance and blood pressure between the two groups (P &lt; 0.001). In the control group, before and after the intervention, there was a significant difference in medication compliance (P &lt; 0.001), but no significant difference in blood pressure (P &gt; 0.05). In the experimental group, there were significant differences in medication compliance and blood pressure before and after the intervention (P &lt; 0.001). Conclusion: The FCEM health education through an online social platform significantly improved medication compliance and led to effective blood pressure control in rural elderly hypertensive patients. Therefore, as an effective, safe, and economical model, it is also necessary to explore its effectiveness in improving health problems in other chronic diseases and other age groups.

Treatment of type 2 diabetes mellitus in the elderly - Special considerations.

Type 2 diabetes is a frequent chronic disease. Given its strong positive association with older age, it is a significant public health issue in elderly populations. Furthermore, the aging of the population, driven by increasing life expectancy in high and middle-income countries leads to an increasing prevalence of diabetes.Although the same diagnostic criteria apply to the elderly and to younger people, there are unique aspects to the care for elderly type 2 diabetes patients. Both treatment goals and preferred medications, as well as non-pharmacological approaches should be adjusted in the elderly. For example, increasing the amount of physical activity may encounter difficulties, while introducing an appropriate diet may be more challenging. The patients' therapeutic adherence requires special attention due to cognitive and physical limitations. The most important treatment goal is to avoid hypoglycemia. Frailty, social and economic issues, comorbidities and the consequent polypharmacy frequently causing drug-drug interactions, as well as the increased danger of drug toxicity due to renal failure are only some of the problems that make the health care for old diabetes patients extremely difficult. Adequate care requires cooperation from a multidisciplinary team of health care professionals.Acute diabetes complications have a higher mortality in the elderly, thus close attention must be paid to avoid them. Family members should be involved in the care of elderly diabetes patients, and it is recommended to educate them on clinical signs of complications. Regular care for the patients including feedback on quality of life and early signs of health issues are essential.

Impact of pharmaceutical care for asthma patients on health-related outcomes: An umbrella review.

Recent systematic reviews suggest that pharmacists' interventions in asthma patients have a positive impact on health-related outcomes. Nevertheless, the association is not well established, and the role of clinical pharmacists is poorly represented. The aim of this overview of systematic reviews is to identify published systematic reviews assessing the impact of pharmacists' interventions on health-related outcomes measured in asthma patients. PubMed, Embase, Scopus, and Cochrane Library were searched from inception to December 2022. Systematic reviews of all study designs and settings were included. Methodological quality was assessed using AMSTAR 2. Two investigators performed study selection, quality assessment and data collection independently. Nine systematic reviews met the inclusion criteria. Methodological quality was rated as high in one, low in two, and critically low in six. Reviews included 51 primary studies reporting mainly quality of life, asthma control, lung capacity, and therapeutic adherence. Only four studies were carried out in a hospital setting and only two reviews stated the inclusion of severe asthma patients. The quality of the systematic reviews was generally low, and this was the major limitation of this overview of systematic reviews. However, solid evidence supports that pharmaceutical care improves health-related outcomes in asthma patients.

Access to health services and its influence on adherence to treatment of arterial hypertension during the COVID-19 pandemic in a Hospital in Callao, Peru: A cross-sectional study

Background Access to health services compromises therapeutic adherence in patients with arterial hypertension (HTN), which is a risk factor for cardiovascular disease and premature death. The aim of the research is to determine the influence of access to health services on adherence to antihypertensive treatment during the COVID-19 pandemic. Methods We included a cross-sectional analytical study. A survey was applied to 241 hypertensive patients at the Daniel Alcides Carrión Hospital, Callao-Peru. Data were analyzed using SPSS software. Absolute and relative frequencies were reported and the chi-square test was applied with a statistical significance level of p&lt;0.05. In addition, multiple logistic regression analysis was performed using the Stepwise method. Results Our results show that non-adherence to treatment is associated with health expenses (ORa: 1.9 CI 95% 1.7-2.2), considers the environment clean (ORa: 1.4 IC 95% 1.2-1.8), not receiving care due to lack of a doctor (ORa: 2.8 CI 95% 1.5-3.2), difficult with procedures (ORa: 2.8 IC 95% 1.2-2.8), having difficulty with schedules (ORa: 3.7 CI 95% 2. 3-5.5), fear of receiving care at the hospital (ORa: 4.5 CI 95 % 2.7-6.8), trust in health staff (ORa: 7.5 CI 95% 2.3-10.5) and considering that the physician does not have enough knowledge (ORa: 3.1 CI 95% 2.4-7.8). Conclusion Therapeutic adherence was associated with expenses in the consultation considers the environment clean, not receiving care due to lack of a doctor, difficult with procedures, having difficulty with schedules, fear of receiving care at the hospital, trust in health staff and considering that the physician does not have enough knowledge.

The Simplified Medication Adherence Questionnaire: validation of a Brazilian-Portuguese version in hypertensive adults.

Self-reported adherence scales are widely used in research and practice because they are low in cost and easy to apply. A free version in Brazilian-Portuguese of the Simplified Medication Adherence Questionnaire (SMAQ) can be a useful alternative for determining the adherent behavior of hypertensive patients. To translate and evaluate the psychometric properties of the Brazilian-Portuguese version of the SMAQ therapeutic adherence scale for patients with arterial hypertension. A multicenter, cross-sectional study was conducted in five outpatient units in Maceió-AL and Aracaju-SE between January and July 2019. A total of 117 patients aged over 18years using antihypertensive drugs were recruited. The cross-cultural adaptation followed international methodological recommendations. Internal consistency (Cronbach's alpha) was tested as a reliability parameter. Criterion and construct validity were verified by concurrent validation, exploratory factor analysis (EFA), and validation by known groups. The participants had a mean age of 56.6years (SD = 10.7years); most were female (72.6%). The mean number of antihypertensives prescribed per patient was 1.87 (SD = 0.87). There were 79.5% (n = 86) of patients considered non-adherent. Internal consistency was satisfactory (Cronbach's alpha = 0.63). A satisfactory correlation coefficient was verified with the Morisky-Green-Levine test as an external criterion (r = 0.56, p < 0.001). The scale's sensitivity measured through known group validity was 75.3%, specificity 29.5%, positive predictive value 63.9%, and negative predictive value 41.9%. We identified two factors of the instrument's construct from EFA: specific medication-taking behaviors and barriers to adherence. The initial KMO measure of sampling adequacy was 0.691, and Bartlett's test of sphericity was significant (χ2 = 118.342, p < 0.001). The Brazilian-Portuguese version of the SMAQ scale proved valid and reliable for determining adherence to the pharmacotherapy in hypertensive patients. It showed more ability to detect non-adherent patients but with low specificity, possibly influenced by high social desirability.

How to Manage Beta-Blockade in Older Heart Failure Patients: A Scoping Review.

Beta blockers (BBs) play a crucial role in enhancing the quality of life and extending the survival of patients with heart failure and reduced ejection fraction (HFrEF). Initiating the therapy at low doses and gradually titrating the dose upwards is recommended to ensure therapeutic efficacy while mitigating potential adverse effects. Vigilant monitoring for signs of drug intolerance is necessary, with dose adjustments as required. The management of older HF patients requires a case-centered approach, taking into account individual comorbidities, functional status, and frailty. Older adults, however, are often underrepresented in randomized clinical trials, leading to some uncertainty in management strategies as patients with HF in clinical practice are older than those enrolled in trials. The present article performs a scoping review of the past 25 years of published literature on BBs in older HF patients, focusing on age, outcomes, and tolerability. Twelve studies (eight randomized-controlled and four observational) encompassing 26,426 patients were reviewed. The results indicate that BBs represent a viable treatment for older HFrEF patients, offering benefits in symptom management, cardiac function, and overall outcomes. Their role in HF with preserved EF, however, remains uncertain. Further research is warranted to refine treatment strategies and address specific aspects in older adults, including proper dosing, therapeutic adherence, and tolerability.

Factores asociados a la adherencia al tratamiento en niños de 1 a 3 años: un estudio en el centro de salud “Señor de los Milagros” Huaycán – Ate

Objective: To determine the factors associated with treatment adherence in children aged 1 to 3 years at the "Señor de los Milagros" Health Center in Huaycán – Ate. Methods: This observational, retrospective, cross-sectional study investigated adherence to anti-anemic treatment in 169 children aged 1 to 3 years diagnosed with anemia, selected from an initial group of 300. Using a data collection form, variables covering maternal, sociocultural, treatment, and health system aspects were evaluated through bivariate analysis and Pearson's Chi-square test. Results: The results highlighted low treatment adherence, with only 4.7% of children showing high adherence and 15.4% demonstrating non-adherence. Higher adherence was observed in mothers with secondary education, homemakers, and those living with their partners. Factors such as receiving understandable information, respectful treatment, and proximity to the health center positively influenced adherence. Conclusion: There is a significant association between adherence to anti-anemic treatment and maternal, sociocultural, and treatment-related factors (p&lt;0.05), suggesting that improving communication, socioeconomic support, and accessibility could enhance therapeutic adherence.

Factors associated with therapeutic non-adherence inrenal transplant patients: a bicentric study in Algeria

Medication non-adherence is a global concern, particularly in the context of renal transplantation, where it leads to graft failures, increased hospitalizations, diminished quality of life for patients, and higher healthcare costs. The aim of this study was to assess the level of therapeutic adherence among Algerian kidney transplant recipients and identify potential influencing factors. A descriptive, cross-sectional bicenter study was conducted among kidney transplant patients receiving outpatient care at two specialized medical centers in Algeria: the Urology Department of the Hospital Establishment for Urology, Nephrology, and Renal Transplantation in Constantine, and the Nephrology and Renal Transplantation Department of the University Hospital Center (CHU) in Blida, spanning from January to December 2022. Therapeutic adherence was assessed using the 8-item Morisky questionnaire, while the level of knowledge was analyzed through a 12-item questionnaire. Logistic regression was used to identify factors associated with non-adherence to therapy. This study included 130patients with an average age of 47years and a sex ratio of 1.7. The results revealed therapeutic non-adherence in 40.8% of the patients. Multivariate analysis identified several potentially associated factors, including residence, unemployment status, lack of affiliation with a health insurance fund, the use of a therapeutic regimen involving triple therapy, the occurrence of adverse effects, limited education level, and insufficient disease knowledge. Furthermore, non-adherence was associated with an increased risk of graft rejection. The findings of this study highlight concerning therapeutic adherence among kidney transplant recipients, emphasizing the crucial importance of therapeutic education to improve treatment adherence and underscoring the need to integrate these factors into clinical patient management.

Understanding Lithium intoxication in Bipolar Disorder: a comparative analysis and clinical implications

IntroductionLithium treatment is a proven method for bipolar disorder management, but its narrow therapeutic range and the risk of severe side effects, including lithium intoxication, pose significant clinical hurdles. Lithium intoxication, a potentially life-threatening complication, can occur during treatment, raising ongoing questions about its clinical factors, risk elements, and best practices for management.ObjectivesOur objective is a comparative analysis between patients who have experienced lithium intoxication and those who have not, aiming to identify influencing factors and enhance clinical care.MethodsWe collected demographic data, age at lithium treatment initiation, treatment duration, therapeutic adherence, Mental Health consultations, and lithium level monitoring from 14 individuals requiring clinical attention due to lithium intoxication and 14 patients with similar gender, age, and diagnosis with lithium treatment but without intoxication during four years of follow-up.ResultsRegarding the results, the age of onset of lithium treatment in patients with lithium intoxication was 30.2 years (SD=8), and the duration of lithium treatment averaged 11.1 years (SD=8.8), which did not significantly differ from the control group with ages of onset at 38.1 years (SD=15.1) and treatment duration of 9.27 years (SD=8.8), respectively. Lithium intoxication patients developed severe complications, including hospitalizations in medical-surgical units, the necessity for dialysis, and death, one fatal case. Although therapeutic adherence to lithium, measured through pharmaceutical dispensation, exceeded 90% and was comparable in both groups, patients affected by lithium intoxication exhibited a significantly higher treatment discontinuation rate (OR 32.5; 95% CI, 3.1 to 337.8) during the follow-up period. Patients who experienced lithium intoxication had an average of psychiatric consultations every 11.2 months (SD=13.4), with 35.7% not attending at least once a year, while the control group had an appointment every 5.31 months (SD=2.7) (p &gt; 0.05). Lastly, despite both groups having a similar frequency of plasma lithium level monitoring, occurring approximately every 5.5 months (SD=2.6) and 7.8 months (SD=4.8), respectively, in 28.5% of those who suffered from lithium intoxication did not undergo any monitoring for periods exceeding 18 months (p &lt; 0.05).ConclusionsOur research highlights the significance of delivering thorough clinical care and continuous monitoring to patients receiving lithium treatment for bipolar disorder. Ensuring effectiveness therapeutic adherence and maintaining strict monitoring of lithium levels are critical factors that significantly enhance treatment safety. Appropriate management has the potential to improve the quality and safety of care for people with bipolar disorder who are dependent on lithium therapy.Disclosure of InterestNone Declared

Descriptive study of 100 patients with a diagnosis of psychosis treated with Paliperidone Palmitate 6-Month Long-Acting Injectable.

IntroductionPsychotic disorders are serious mental illnesses that require long-term antipsychotic treatment that provides sufficient efficacy, safety and therapeutic adherence. The latter is an essential factor that must be emphasized in clinical practice in order to avoid relapses. On this occasion, we have the need to know the long-term impact on our clinical practice and on the evolution of patients after the change in formulation of paliperidone palmitate 1 (PP1M) and 3 Month long-acting injectable antipsychotic (PP3M) to paliperidone palmitate 6 Month (PP6M).ObjectivesThe present study describes a sample of patients with severe mental disorders (n= 100) treated with six-monthly paliperidone palmitate (PP6M) studying the diagnoses, socio-demographic characteristics, number of relapses, tolerability and treatment adherence of patients.MethodsProspective descriptive study with a sample selected by non-probabilistic consecutive sampling, retrospective type, in a time interval of 15 month (n= 100 outpatients). The patients selected were all those who received 6 monthly paliperidone palmitate treatment from May 2022 to September 2023. A descriptive analysis was performed. Mean and standard deviation were calculated for quantitative variables and N and percentage for categorical variables.ResultsProspective study with consecutive sampling of 100 outpatients (62% men, 38% women; mean age 48 years) diagnosed with psychosis (76 % Schizophrenia, 21 % Unspecified psychosis, 3 % Delusional disorder) those who are administered PP6M long-acting injectable antipsychotic previously treated with PP1M (35%) and PP3M (65%).After 15 months of the study, 4 patients (4%) have suffered a relapse, one of them (1%) requiring hospitalization. 5 patients (4%) declined to continue PP6M and have returned to their previous injectable. 1 patient (1%) has died of unknown causes outside the treatment. 90 patients continue treatment with PP6M (90% retention rate). 54 patients maintain antipsychotic monotherapy (54%). No additional adverse effects were reported after switching to PP6M. The subjective perception of satisfaction after the switch to PP6M by patients and caregivers was very high.ConclusionsThe present real clinical practice study shows that PP6M could be an effective and well tolerated treatment in patients with severe mental disorder, for patients diagnosed with psychosis, with a high rate of relapse prevention and high rates of compliance. Changing treatment from PP1M or PP3M to PP6M could help patients with severe mental disorder to normalize their lives and functionality.Disclosure of InterestNone Declared

Clinical experience with once-monthly risperidone ISM in a mental health center. A retrospective study.

IntroductionLong-acting injectable antipsychotics have undergone a great development in recent years, becoming useful tools to facilitate therapeutic adherence. Once-monthly risperidone ISM is a new way of treatment which has been commercialized in Spain since September 2022.ObjectivesIn this study we will analyze our clinical experience with this treatment, especially in terms of tolerance and efficacy, during its first year of widespread use.MethodsLongitudinal retrospective study of monhtly risperidone users in a mental health center in the Autonomous Community of Madrid (Spain), between September 2022 and September 2023.A sample of 13 patients was selected, collecting both sociodemographic (age, gender) and clinical variables (diagnosis, dose, time elapsed, number of hospital readmissions, adverse effects and monotherapy or combined use). A descriptive analysis of the collected data was then carried out.ResultsMonthly risperidone was used in 13 patients: 15% (n=2) were women, and 85% (n=11) were male. The mean age of the patients was 43.6 years. The most frequent diganosis of these patients was “psychotic disorders” (84,6%, n= 11), with other diagnoses such as schizoaffective disorder (7,7%, n=1) and obsessive compulsive disorder (7,7%, n=1).The doses used of risperidone were 100mg every month in 61,5% of patients (n=8) and 75mg in 38,5% of patients (n=5). The mean time since the first administration was 4.35 months. Concerning monotherapy, 84,6% (n=11) of patients on monthly risperidone were on antipsychotic monotherapy, while 15,4% (n=2) required more than one antipsychotic. Among the switches made to monthly risperidone, 69,2% (n=9) were previously treated with oral risperidone, 15,4% (n=2) were treated with once-biweekly risperidone long-acting injectable, 7,9% (n=1) with oral paliperidone and 7,9% with aripiprazole monthly injectable.During the study period, hospital readmissions for psychiatric descompensations occurred in one patient (7,9%, n=1), while the rest of the patients (92,1%, n=12) did not present decompensations that required psychiatric admission.Moderate or severe effects occurred in one patient (7,9%, n=1), in the form of acute dystonia, which led to the interruption of injectable treatment. The rest of the patients (92,1%, n=12)) did not present severe adverse effects. Minor adverse effects appeared in 3 patients (25%); these adverse effects were already present in the previous treatment with oral risperidone and did not condition the suspension of the treatment.ConclusionsIn the sample analyzed, once-monthly Risperidone ISM had reasonable tolerance levels. Also, it´s shown to be effective in preventing psychotic decompensations and hospital admissions.Therefore, this new injectable of monthly risperidone represents a therapeutic alternative to consider in order to guarantee therapeutic adherence and improve the quality of life of patients with psychotic symptoms.Disclosure of InterestNone Declared

“Ekbom syndrome: delirium engraved on the skin”

IntroductionEkbom syndrome also known as Morgellons syndrome or delirium of parasitosis is a psychiatric condition where the patient has the absolute conviction of being infested in spite of medical evidence. Patients may even mutilate themselves or apply toxic substances in order to get rid of these hypothetical organisms. Sometimes they bring samples of these hypothetical parasites to the office to prove their existence, which is known as the “matchbox sign”, a pathognomonic finding.ObjectivesThe aim of this clinical case is to make visible the impact that this psychiatric condition can have on the patient’s quality of lifeMethodsWe present the case of a 40-year-old woman from Peru who was admitted to the otorhinolaryngology unit for injuries compatible with necrosis of the right pinna. When the patient was examined, scars were found on the lower limbs and back. The patient justifies the scratching lesions with the presence of pathogenic organisms, with no trace of them by the physician.ResultsThe patient was evaluated by psychiatry service during her admission in otorhinolaryngology, being diagnosed with Ekbom’s delirium and starting treatment with 3 mL of Aripiprazole. Subsequently she was referred to the mental health unit where she left the follow-up until today.Conclusions Different effective treatments have been described, among them pimozide, atypical antipsychotics and some SSRIs. However, the complexity of treatment arises when dealing with the irreducible idea that the patient has of being infested, refusing in most cases to receive psychiatric treatment. This can degenerate into major organic and psychological problems that turn the patient’s life into a real hell, which often end up losing much of their daily functionality. The fact of empathizing with the patient and trying to elaborate a plan adjusted to the reality and needs of the moment, can help us to establish a good therapeutic bond that facilitates an early start of treatment and greater therapeutic adherence, enabling a significant improvement in their quality of life.Disclosure of InterestNone Declared

Treatment adherence and insight in schizophrenia spectrum disorders

IntroductionLack of adherence to antipsychotic medication in patients with schizophrenia spectrum disorders is a major risk factor for relapse and rehospitalizations which contributes to major social and economic consequences. A high proportion of patients with schizophrenia are partially or completely unaware of their mental disorder.ObjectivesThe aim of this study was to investigate the association between insight and medication adherence.MethodsA total number of 30 outpatients with schizophrenia spectrum disorders ,according to (DSM-V) diagnostic criteria who were attending the department of psychiatry A Razi hospital between august and September 30, 2023 were included in this study. Patients’ insight was measured by the birchwood insight scale. The degree of medication adherence was measured by using Medication Adherence Rating Scale (MARS).ResultsPatients enrolled in the study had a mean (SD) age of 43.2 .There was no significant correlation between patients’ insight and patients’ ages, duration of illness and hospitalization times. In addition, there was no significant association between medication adherence and age, duration of illness, number of hospitalization or social level. Impaired insight was associated with poor antipsychotic medication adherence in patients with schizophrenia spectrum disorders .Higher insight was correlated to higher therapeutic adherence. Our results showed that the level of insight and compliance to treatment are positively correlated.Conclusions The results of this study support the hypothesis that insight and treatment adherence are closely related. Interventions to enhance insight may be helpful in improving medication adherence.Disclosure of InterestNone Declared