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1.
Neuropsychiatr Dis Treat ; 18: 1521-1534, 2022.
Article in English | MEDLINE | ID: mdl-35928793

ABSTRACT

Purpose: Schizophrenia is a severe, chronic condition accounting for disproportionate healthcare utilization. Antipsychotics can reduce relapse rates, but the characteristics of schizophrenia may hinder medication adherence. A phase 3b open-label clinical trial used aripiprazole tablets with sensor (AS; includes pills with ingestible event-marker, wearable sensor patches and smartphone application) in adults with schizophrenia. This post hoc analysis explored how healthcare providers' (HCPs) usage of a dashboard that provided medication ingestion information impacted treatment decisions and clinical assessments. Patients and Methods: Participants used AS for 3-6 months. HCPs were instructed to check the dashboard regularly, identify features used, and report impact on treatment decisions. After stratifying HCPs by frequency of dashboard checks and resulting treatment decisions, changes from baseline were calculated for Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression (CGI)-Severity of Illness and CGI-Improvement (CGI-I), and Personal and Social Performance (PSP), and compared using Mann-Whitney U-tests and rank-biserial correlation coefficient (r) effect sizes. Results: To ensure sufficient opportunity for AS engagement, 113 participants who completed ≥3 months on study were analyzed. HCPs most often accessed dashboard data regarding medication ingestion and missed doses. HCPs recommended adherence counseling and participant education most often. Participants whose HCPs used the dashboard more and recommended adherence counseling and participant education (n=61) improved significantly more than participants with less dashboard-active HCPs (n=49) in CGI-I mean score (2.9 versus 3.4 [p=0.004]), total PANSS (mean change: -9.2 versus -3.1 [p=0.0002]), PANSS positive subscale (-3.2 versus -1.5 [p=0.003]), PANSS general subscale (-4.3 versus -1.2 [p=0.02]), and Marder factor for negative symptoms (-1.9 versus 0.0 [p=0.03]). Most HCPs found the dashboard easy to use (74%) and helpful for improving conversations with participants about their treatment plan and progress (78%). Conclusion: This provider dashboard may facilitate discussions with patients about regular medication-taking, which can improve patient outcomes.

2.
J Clin Psychiatry ; 65(5): 652-5, 2004 May.
Article in English | MEDLINE | ID: mdl-15163250

ABSTRACT

BACKGROUND: Lithium is a highly effective agent for numerous psychiatric disorders but requires therapeutic monitoring because of its narrow therapeutic index. This article describes a novel instant blood test that will facilitate the routine monitoring process. METHOD: This instant blood test allows the clinician to take a finger-stick sample of whole blood and determine the plasma lithium level in a 2-minute period. This new test is compared with standard laboratory measurements for lithium in human subjects. The reliability of the new test is reported as agreement with standard laboratory values in 3 studies involving a total of 269 subjects. RESULTS: The test demonstrates extremely high reliability (r = 0.962, 0.928, 0.983 for studies 1-3, respectively) for the measurement of serum and plasma lithium levels as compared with standard laboratory measures. CONCLUSION: This new test is reliable and offers unique advantages over standard laboratory procedures for measuring lithium levels in patients.


Subject(s)
Blood Chemical Analysis/methods , Lithium/blood , Blood Chemical Analysis/instrumentation , Blood Specimen Collection , Cytapheresis , Drug Monitoring , Electric Power Supplies , Humans , Photometry , Porphyrins/administration & dosage , Reproducibility of Results
3.
Clin Drug Investig ; 23(10): 671-7, 2003.
Article in English | MEDLINE | ID: mdl-17535082

ABSTRACT

BACKGROUND AND OBJECTIVE: Oxcarbazepine, an antiepileptic and a derivative of carbamazepine, has been shown to have clinical utility as an antimanic agent. This study sought to assess the efficacy and tolerability of oxcarbazepine compared with divalproex sodium in the treatment of patients with mania. PATIENTS AND METHODS: 57 patients from a large clinical practice who had recently begun treatment with divalproex sodium were randomly assigned to one of two treatment groups. In this open-label, single (rater)-blind study, group 1 remained on treatment with divalproex sodium and group 2 was switched to oxcarbazepine. Both treatment groups were followed for 10 weeks after the switch. Pharmacotherapeutic efficacy was compared using the Clinician Administered Rating Scale for Mania (CARS-M). Weight and adverse events were monitored throughout the study. RESULTS: 83% of patients using oxcarbazepine showed a decrease in mania as assessed using the CARS-M, and 70% showed a net decrease in weight over the 10-week course of the study. For the divalproex sodium group, 53% showed a decrease in mania, as assessed by CARS-M, and 37% lost weight. CONCLUSION: Oxcarbazepine showed comparable efficacy to divalproex sodium, yet appeared to do so with an equal or more benign side-effect profile, particularly with regard to weight. These results suggest that oxcarbazepine, which has been used in Europe for the treatment of mood disorders for some time (albeit used off-label for this purpose) may show promise for use in the US as an agent for maintenance of non-acute mania.

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