Key Barriers to Medication Adherence in Survivors of Strokes and Transient Ischemic Attacks

Background: Even though medications can greatly reduce the risk of recurrent stroke, medication adherence is suboptimal in stroke survivors. Objective: To identify key barriers to medication adherence in a predominantly low-income, minority group of stroke and transient ischemic attack (TIA) survivors. Design: Cross-sectional study. Participants: Six hundred stroke or TIA survivors, age ≥ 40 years old, recruited from underserved communities in New York City. Main Measures: Medication adherence was measured using the 8-item Morisky Medication Adherence Questionnaire. Potential barriers to adherence were assessed using validated instruments. Logistic regression was used to test which barriers were independently associated with adherence. Models were additionally controlled for age, race/ethnicity, income, and comorbidity. Key Results: Forty percent of participants had poor self-reported medication adherence. In unadjusted analyses, compared to adherent participants, non-adherent participants had increased concerns about medications (26 % versus 7 %, p < 0.001), low trust in their personal doctor (42 % versus 29 %, p = 0.001), problems communicating with their doctor due to language (19 % versus 12 %, p = 0.02), perceived discrimination from the health system (42 % versus 22 %, p <0.001), difficulty accessing health care (16 % versus 8 %, p = 0.002), and inadequate continuity of care (27 % versus 20 %, p = 0.05). In the fully adjusted model, only increased concerns about medications [OR 5.02 (95 % CI 2.76, 9.11); p< 0.001] and perceived discrimination [OR 1.85 (95 % CI 1.18, 2.90); p = 0.008] remained significant barriers. Conclusions: Increased concerns about medications (related to worry, disruption, long-term effects, and medication dependence) and perceived discrimination were the most important barriers to medication adherence in this group. Interventions that reduce medication concerns have the greatest potential to improve medication adherence in low-income stroke/TIA survivors

The creation of a reality: The portrayal of mental illness and violent crime on television

This study presents a comprehensive review of the literature to support the argument that: (1) television falsely portrays the mentally ill as violent, dangerous, and unpredictable; (2) the public holds negative attitudes toward mental illness because the mentally ill are perceived as violent, dangerous, and unpredictable; and (3) there is a causal link between false portrayals of mental illness on television and negative public attitudes toward mental illness. The study investigated the portrayal of mental illness on television using a content analysis of 168 hours of prime time television programming broadcast in September 1994. The findings indicate that the rate of characters committing a murder, rape, robbery, or non-simple assault on television was 3.28, but for the mentally ill on television the rate was 30.2%. The United States crime rate for these offenses is less than 1.5% over an entire year. The mentally ill are portrayed on television to commit violent crime approximately ten times more often than other television characters and twenty times more often than the general United States population. All six research hypotheses were supported. The mentally ill are portrayed on television as violent, with a quality of life and an impact on society which is more negative than other characters, and the distribution of violent crime offenses on television is significantly different than the distribution of offenses in the U.S. The study found the most frequently portrayed disorders of the mentally ill on television, according to the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, were: undifferentiated psychosis (11.8%); paraphilia (9.5%); drug abuse (7.9%); alcohol abuse (7.1%); and mental retardation (7.1%). The study created a taxonomy of mentally ill character types on television and found the most frequently portrayed types were: chemically affected (26%); sex offender (16.5%); neurologically impaired (10.2%); snapped from pressure (9.5%); comic mentally ill (9.5%); psychopath (7.8%); and obsessed with another person (6%)

Trichotillomania: A Challenge to Research and Practice.

This review explores several aspects of trichotillomania relevant to clinical theory and practice. It is concluded that research outlining the phenomenology and patterns of comorbidity of trichotillomania have been advanced significantly in recent years. However, no current diagnostic category appropriately classifies trichotillomania. Research with nonclinical populations suggests that trichotillomania is more common than previously believed and that additional epidemiological research is warranted. Continued elaboration of existing etiological models incorporating varying theoretical perspectives is also encouraged. Assessment of trichotillomania could also be improved by the continued development of reliable and valid standardized measures. This article reviews both pharmacological and psychological treatments for trichotillomania, with an emphasis on habit-reversal training. Though some interventions appear effective in the short-term, reported relapse rates are high and future research on treatment for trichotillomania should focus on improving long-term outcomes. It is clear that despite a recent flux of research centering on trichotillomania, significant challenges for understanding and treating this psychological disorder still exist for researchers and clinicians. Based on this review of the literature, and on our clinical experience with trichotillomania, we propose directions for future research with this underserved psychiatric group