ABSTRACT
While it has long been recognized that self-reported drug use may be at variance with objectively obtained evidence such as urine toxicology assays, few studies have explored the behavioral correlates of such discrepancies. Here we compared self-reported and objective measures of stimulant drug use for 162 HIV infected individuals and identified a sub-group with discrepancies between data obtained via the two methods. Results showed poorer neurocognitive performance (attention, learning/memory) and lower medication adherence rates for the discrepant group as compared to those who either acknowledged their drug use or accurately denied recent stimulant use. Using the Millon Clinical Multiaxial Inventory-III, it was also found that those in the discrepant group were more hesitant to reveal psychopathology. Comparisons of self-reported and objectively measured medication adherence data are also discussed.
Subject(s)
Central Nervous System Stimulants , HIV Infections/drug therapy , Patient Compliance/statistics & numerical data , Substance-Related Disorders/psychology , Adult , Analysis of Variance , Data Collection/methods , Female , HIV Infections/psychology , Health Knowledge, Attitudes, Practice , Humans , Male , Medical Records , Self Disclosure , Substance-Related Disorders/diagnosis , Surveys and Questionnaires/standardsABSTRACT
BACKGROUND: Although the use of highly active antiretroviral therapy in the treatment of HIV infection has led to considerable improvement in morbidity and mortality, unless patients are adherent to their drug regimen (i.e., at least 90 to 95% of doses taken), viral replication may ensue and drug-resistant strains of the virus may emerge. METHODS: The authors studied the extent to which neuropsychological compromise and medication regimen complexity are predictive of poor adherence in a convenience sample of 137 HIV-infected adults. Medication adherence was tracked through the use of electronic monitoring technology (MEMS caps). RESULTS: Two-way analysis of variance revealed that neurocognitive compromise as well as complex medication regimens were associated with significantly lower adherence rates. Cognitively compromised participants on more complex regimens had the greatest difficulty with adherence. Deficits in executive function, memory, and attention were associated with poor adherence. Logistic regression analysis demonstrated that neuropsychological compromise was associated with a 2.3 times greater risk of adherence failure. Older age (>50 years) was also found to be associated with significantly better adherence. CONCLUSIONS: HIV-infected adults with significant neurocognitive compromise are at risk for poor medication adherence, particularly if they have been prescribed a complex dosing regimen. As such, simpler dosing schedules for more cognitively impaired patients might improve adherence.
Subject(s)
Anti-HIV Agents/administration & dosage , Antiretroviral Therapy, Highly Active , Cognition Disorders/psychology , HIV Seropositivity/drug therapy , HIV Seropositivity/psychology , Patient Compliance/psychology , Adult , Aged , Anti-HIV Agents/therapeutic use , Blotting, Western , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Education , Enzyme-Linked Immunosorbent Assay , Female , Humans , Intelligence Tests , Male , Middle Aged , Neuropsychological Tests , Regression Analysis , Sex FactorsABSTRACT
This study was conducted to evaluate the smooth pursuit system functioning of patients with obsessive-compulsive disorder (OCD). For Study 1, 12 subjects with OCD and 12 nonpsychiatric subjects were administered 9-deg-per-sec ramp stimuli to elicit smooth pursuit eye movements. Consistent with a previous report, patients with OCD did not significantly differ from nonpsychiatric subjects on pursuit gain, or frequency of corrective and intrusive saccades. Patients with OCD, however, had smaller catch-up saccades during smooth pursuit than nonpsychiatric subjects. For Study 2, 12 subjects with OCD and 12 nonpsychiatric subjects were administered 2 different triangle wave stimuli with target velocities of 12 (0.2 Hz) deg per sec and 24 (0.4 Hz) deg per sec. Subjects with OCD and nonpsychiatric subjects did not significantly differ on any variable in the slow target velocity condition. When following 24-deg-per-sec targets, however, patients with OCD had significantly lower pursuit gain than the nonpsychiatric subjects. Results from Study 1 and 2 are consistent with the hypothesis that patients with OCD have a modest smooth pursuit deficit that is elicited only while following faster velocity targets.
