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Objective@#To identify factors affecting adherence to medication, a subjective questionnaire survey was administered to schizophrenia patients regarding the prescribed antipsychotic formulations. @*Methods@#We evaluated the patients’ satisfaction and dissatisfaction with prescribed antipsychotic formulations, and patients answered the Drug Attitude Inventory-10 Questionnaire (DAI-10). Inclusion criteria for patients are as follows:age between 20 and 75 years and taking antipsychotic agents containing the same ingredients and formulations, for at least 1 month. @*Results@#In total, 301 patients answered the questionnaire survey. Tablets were found to be the most commonly used antipsychotic formulations among schizophrenia patients (n = 174, 57.8%), followed by long-acting injections (LAIs, n = 93, 30.9%). No significant differences in the formulation satisfaction level and DAI-10 scores were observed between all formulations. Formulations, except for LAI, were selected by physicians in more than half of the patients.Patients who answered “Decided by consultation with physicians” had significantly higher satisfaction levels and DAI-10 scores compared to those who answered “Decided by physicians” (4.11 ± 0.77 vs. 3.80 ± 1.00, p = 0.0073 and 6.20 ± 3.51 vs. 4.39 ± 4.56, p ＜ 0.001, respectively). Satisfaction levels moderately correlated with DAI-10 scores (r = 0.48, p ＜ 0.001). @*Conclusion@#No formulation had a high satisfaction level in all patients, and it is important to be reflect the patients’ individual preferences in pharmacotherapy. Shared decision-making in the selection of the formulations is seen to be useful for improving medication adherence.
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Objective@#To improve poor medication adherence in schizophrenic patients, long-acting injectable (LAI) antipsychotics are used. However, it has not yet become common in Japan. Recently, aripiprazole LAI was approved for alternative injection into the deltoid muscle in addition to the gluteal muscle. The acceptance for the proposal to switch from gluteal to deltoid injections of aripiprazole LAI was investigated. @*Methods@#The subjects were 32 outpatients with schizophrenia who had continuously received aripiprazole LAI administration into the gluteal muscle for ≥ 6 months. In the patients who had continued deltoid injection for 3 months after switching, the changes in the pain and shame in comparison with gluteal injections were evaluated. @*Results@#Switching to the deltoid injection was chosen by 17 out of 32 patients. Three months later, 9 patients were still receiving deltoid injections with highly rated satisfaction. The main reasons for switching to deltoid injections included the pain and shame associated with gluteal injections. The main reason for returning to the gluteal injection was the pain experienced from the injection in the deltoid. @*Conclusion@#The option to select the injected area was based on the amount of pain in the deltoid and gluteal sites, leading to the widespread use of aripiprazole LAI.
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In Japan, drug therapy for schizophrenia is characterized by high-dose antipsychotic polypharmacy, which is an uncommon approach internationally. In this study, we reduced the number of antipsychotic agents in 5 patients using the Safety Correction of High-dose Antipsychotic Polypharmacy (SCAP) method and conducted a survey regarding treatment satisfaction. The switch from polypharmacy to monotherapy was achieved in all patients. There was no deterioration in psychiatric symptoms, and adverse reactions were reduced. Three of the subjects were satisfied with the decrease in the number of antipsychotic agents and dose-reduction. These results suggest that the SCAP method is a safe and useful method that can be applied in a clinical setting.
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【Objective】 Nowadays, the pharmacist’s work changed from product-centered to patient-centered care. In this research, we make it clear through patient’s talk what a patient expects of a family pharmacist and a pharmacy. We think it is utilized to construct a communication standard required for family pharmacists. 【Method】 Focus group interviews were conducted with 3 groups of 11 patients who utilize pharmacies, recruited through snowball sampling. Interview data were categorized using qualitative analysis method. 【Results】 As a result of analysis, 7 categories and 43 subcategories were generated. Based on these, a diagram was created representing the relationships between categories. 【Discussion】 The generated categories indicated “factors influencing patient’s relationship with pharmacists” and subcategories indicated “requests to or expectations from pharmacists by patients.” Many of them overlapped with the image of “family pharmacist/pharmacy” depicted in the “Pharmacy Vision for Patients” indicated by the Ministry of Health, Labour and Welfare in 2017. Meanwhile, patients wanted attitude, ethics, and sense of mission as basic qualifications originally required in a medical professional. Moreover, the research showed broader viewpoints and expectations for advanced communication skills such as support of patient’s self-determination of medication, relationship between the patient and the physician, and consideration of social and economic background of the patient.
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【Objective】 Nowadays, the pharmacist’s work changed from product-centered to patient-centered care. In this research, we make it clear through patient’s talk what a patient expects of a family pharmacist and a pharmacy. We think it is utilized to construct a communication standard required for family pharmacists. 【Method】 Focus group interviews were conducted with 3 groups of 11 patients who utilize pharmacies, recruited through snowball sampling. Interview data were categorized using qualitative analysis method. 【Results】 As a result of analysis, 7 categories and 43 subcategories were generated. Based on these, a diagram was created representing the relationships between categories. 【Discussion】 The generated categories indicated “factors influencing patient’s relationship with pharmacists” and subcategories indicated “requests to or expectations from pharmacists by patients.” Many of them overlapped with the image of “family pharmacist/pharmacy” depicted in the “Pharmacy Vision for Patients” indicated by the Ministry of Health, Labour and Welfare in 2017. Meanwhile, patients wanted attitude, ethics, and sense of mission as basic qualifications originally required in a medical professional. Moreover, the research showed broader viewpoints and expectations for advanced communication skills such as support of patient’s self-determination of medication, relationship between the patient and the physician, and consideration of social and economic background of the patient.
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OBJECTIVE: Suvorexant is a novel hypnotic drug that does not interact with the conventional γ-aminobutyric acid (GABA)-A receptor. We investigated the method by which suvorexant was introduced in insomnia patients who were taking benzodiazepine receptor agonists (BzRA). METHODS: This was a retrospective study. We extracted clinical data for patients who were prescribed suvorexant and were already using BzRA. The patients were assigned to two groups, the switching and add-on groups. We assessed the suvorexant discontinuation rate at one month after the prescription of the drug. RESULTS: One hundred and nineteen patients were assigned to the switching group, and 109 were assigned to the add-on group. The add-on group exhibited a significantly higher all-cause discontinuation rate than the switching group (odds ratio, 2.7; 95% confidence interval, 1.5 to 5.0; adjusted p < 0.001). Intolerability was a significantly stronger risk factor for suvorexant discontinuation in the add-on group (22.0% vs. 7.6%, p < 0.002), and the most common adverse effect was oversedation. CONCLUSION: Our results show that the add-on of suvorexant increases the frequency of oversedation compared with switching in insomnia patients that are taking BzRA. However, this was only a preliminary retrospective study, and further studies will be required to confirm our findings.
Subject(s)
Humans , Benzodiazepines , Methods , Orexin Receptor Antagonists , Prescriptions , Receptors, GABA-A , Retrospective Studies , Risk Factors , Sleep Initiation and Maintenance DisordersABSTRACT
Background: To obtain suggestions regarding the methods of cooperative learning in basic nursing education, the nursing students' perceptions of cooperative learning and the relationship between such perceptions and their influencing factors were elucidated.Methods: Anonymous, self-administered questionnaires were conducted among 131 nursing students at University A in the Chubu region of Japan.Results: Binomial logistic regression confirmed that cooperative learning experiences in high school, learning satisfaction at University A, social support, styles of handling interpersonal conflicts, and undervaluing others in regard to assumed competence were significant influencing factors on the cooperative work recognition scale.Discussion: Factors, including professional identity, communication ability and students' past negative experiences, may have an effect on the recognition of cooperative work. This suggests the need for the continued investigation of the aspects of cooperative learning that take these factors into account.
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OBJECTIVE: The adverse effects of antipsychotic agents can have a marked influence on medication adherence. In this study, we investigated the adverse events of antipsychotics that are less likely to be reported by patients and the reasons why such symptoms remain latent. METHODS: Data were collected by interviewing patients using a subjective questionnaire, and the associations between unreported symptoms and background factors were investigated. RESULTS: A total of 306 patients with schizophrenia or schizoaffective disorder were examined. Their major symptoms were daytime sleepiness (50.0%), weight gain (42.2%), and sexual dysfunction (38.9%). Sexual dysfunction was nominal significantly more common among the patients that had been treated with antipsychotic agent polypharmacy (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.07 to 4.30), and was nominal significantly more common among outpatients (OR, 1.78; 95% CI, 1.02 to 3.13). Only approximately 30% of the patients had reported their symptoms to their physicians. CONCLUSION: Patients receiving antipsychotic treatment tolerate some symptoms and do not feel able to report them to their physicians. The most common reason for this is an insufficient patient-physician relationship. Sexual dysfunction is especially hard to identify because it is a delicate problem, and our findings demonstrate that subjective questionnaires are helpful for detecting such symptoms.
Subject(s)
Humans , Antipsychotic Agents , Asian People , Drug-Related Side Effects and Adverse Reactions , Medication Adherence , Outpatients , Polypharmacy , Psychotic Disorders , Schizophrenia , Surveys and Questionnaires , Weight GainABSTRACT
OBJECTIVE: It is well documented that clozapine treatment causes agranulocytosis, but it can also induce drowsiness, constipation, and hypersalivation; however, these symptoms are usually less severe. It has been reported that clozapine-treated patients with schizophrenia and psychiatric healthcare professionals consider different side effects to be important. The aim of this study was to assess current practice related to the side effects of clozapine in clozapine-treated patients with schizophrenia and psychiatric healthcare professionals in Japan. METHODS: Data were collected from January 2014 to August 2015 in Okehazama Hospital, Kakamigahara Hospital, and Numazu Chuo Hospital. Clozapine-treated patients with schizophrenia and psychiatric healthcare professionals (psychiatrists and pharmacists) were enrolled in this study. RESULTS: Of the 106 patients and 120 psychiatric healthcare professionals screened, 100 patients and 104 healthcare professionals were included in this study. We asked the patients what side effects caused them trouble and we asked psychiatric healthcare professionals what side effects caused them concern. The patients and psychiatrists held similarly positive views regarding the efficacy of clozapine. The healthcare professionals were concerned about agranulocytosis (92.4%), blood routines (61.3%). On the other hand, the patients experienced hypersalivation (76.0%), sleepiness (51.0%). A positive correlation (R=0.696) was found between patient satisfaction and DAI-10 score. CONCLUSION: Patients experienced more problems than healthcare professionals expected. However, usage experience of clozapine healthcare professionals tended to have similar results to patients. It is necessary that all healthcare professionals fully understand the efficacy and potential side effects of clozapine. This is very important for promoting clozapine treatment in Japan.
Subject(s)
Humans , Agranulocytosis , Clozapine , Constipation , Delivery of Health Care , Hand , Japan , Patient Satisfaction , Psychiatry , Schizophrenia , Sialorrhea , Sleep StagesABSTRACT
<p> The WHO reported the importance of IPE (Interprofessional Education) in order to implement team-based medicine smoothly. Some Japanese medical educational institutes presented their IPE programs, which involved real patients, but most IPE programs used scenario-based or standardized patients. Moreover, few reports showed IPE programs for diabetic patient education. We created a new program, called the "Diabetes education class IPE" . Participants were 2 medical, 4 nursing, 4 pharmacy, and 3 dietician students. The students experienced the planning and management of and reflection on diabetes education classes. As a result of reflection, the "Diabetes education class IPE" was viewed as a useful IPE program.</p>
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OBJECTIVE: This study examined the utility of adenine for preventing clozapine-induced neutropenia. METHODS: This retrospective study examined the effect of adenine on clozapine-induced neutropenia in patients with treatment-resistant schizophrenia and was conducted at Okehazama Hospital in Japan from July 2010 to June 2013. Adenine was available for use from June 2011 onwards. Twenty-one patients started receiving clozapine treatment from July 2010 to April 2011 (the pre-adenine adoption group), and 47 patients started receiving it from May 2011 to June 2013 (the post-adenine adoption group). The effects of adenine were assessed based on changes in the patients' leukocyte counts and the frequency of treatment discontinuation due to clozapine-induced neutropenia. RESULTS: Sixty-eight patients were treated with clozapine from July 2010 to June 2013. Of the 21 patients in the pre-adenine adoption group, 4 discontinued treatment due to clozapine-induced neutropenia, whereas only 2 of the 47 patients in the post-adenine adoption group discontinued treatment. The frequency of treatment discontinuation due to clozapine-induced neutropenia was significantly lower in post-adenine adoption group than in the pre-adenine adoption group (p=0.047). CONCLUSION: Adenine decreased the frequency of treatment discontinuation due to clozapine-induced neutropenia. Our data suggest that combined treatment with clozapine and adenine is a safe and effective strategy against treatment-resistant schizophrenia.
Subject(s)
Humans , Adenine , Clozapine , Japan , Leukocyte Count , Neutropenia , Retrospective Studies , SchizophreniaABSTRACT
Clozapine has been demonstrated to be useful for treating refractory schizophrenia. However, hypersalivation occurs in 31.0-97.4% of the patients treated with clozapine. Accordingly, some patients who are disturbed by their hypersalivation refuse to continue with clozapine treatment. This study investigated the efficacy of the anticholinergic agent scopolamine butylbromide against clozapine-induced hypersalivation. Five schizophrenia patients were coadministered scopolamine butylbromide (30-60 mg/day) for 4 weeks. At the baseline and after 4 weeks' treatment, we subjectively evaluated hypersalivation using a visual analog scale and objectively assessed it using the Drooling Severity Scale and Drooling Frequency Scale. As a result, improvements in the patients' Drooling Severity Scale and Drooling Frequency Scale scores, but no improvements in their visual analog scale scores, were observed after scopolamine butylbromide treatment. These results indicate that at least some schizophrenic patients with clozapine-induced hypersalivation would benefit from scopolamine butylbromide treatment. We conclude that clozapine-induced hypersalivation is one factor of stress to patients. Subjective hypersalivation was not improved, but objective hypersalivation was, by scopolamine butylbromide treatment. However, scopolamine butylbromide and clozapine possess anticholinergic effects so clinicians should closely monitor patients who take scopolamine butylbromide.
Subject(s)
Humans , Clozapine , Schizophrenia , Scopolamine , Sialorrhea , Visual Analog ScaleABSTRACT
Pharmacists must have a holistic understanding of patients and should make efforts to communicate with patients to support their medical therapy. In this study, we analyzed the effects of communication education by role-playing on first-year students who did not possess pharmaceutical knowledge or an image of pharmacists. All 248 first-year pharmacy students were educated about communication through the following four steps: 1) understanding the basics of communication, 2) the importance of role-playing by pharmacists and patients, 3) observation of role-playing by senior students and patients, and 4) observation of role-playing by classmates and simulated patients. After each step, students were given time to reflect and to write their impressions. These written comments were classified into the following four categories: 1) communication with patients, 2) respect for patients, 3) the role of pharmacists, and 4) the student's own attitudes and skills. As a result of our education program, more than 90% of the first-year students were able to understand the role of a pharmacist and why a pharmacist requires communication skills. The communication education made the students more aware of the patient in health-care.These results suggest that education increasing first-year students' understanding of and respect for patients is an essential component of professional education.