Adherence to pharmacological treatment in patients with severe mental disorders

Medication is a vital component in the treatment of patients with severe mental disorders, but it can be a challenge for clinicians to motivate patients to stay on medication. Nonadherence estimates vary between studies and this variation seems to reflect inconsistency in study design and methods. This makes it difficult to compare results and limits the generalizability of findings. However, some of the variation could also reflect true differences in adherence due to characteristics of the samples or the health care systems. Thus, it is of importance to measure adherence in large well described samples from different health care systems. It seems reasonable that being able to motivate patients to better adhere to their medication would improve adherence and thereby reduce suffering and save money. Therefore, it is important to understand better why patients do not follow medical advice. Previous studies have attempted to indentify predictors of adherence to medication. There are some consistencies between the different studies with regards to the different predictors of nonadherence, but some inconsistencies as well, and it is still unclear which clinical predictors are most important in schizophrenia and bipolar disorder. The measurement of adherence is a long standing methodological problem. There are several available methods. Direct measures include observing patients swallowing tablets and the measurement of level of medicine or metabolites in the blood. Indirect measures cover self reports and electronic medication monitors. The main object of this thesis was to determine adherence rates in a Norwegian catchment area population of patients with severe mental disorders and to identify predictors for nonadherence in this population. To be able to do this, several methodological issues needed to be solved. This applied to the method of adherence measure, as well as the measure of some of the proposed predictors. The Birchwood Insight Scale (IS) used to measure insight and the Beliefs about Medicines Questionnaire (BMQ) used to measure beliefs about medication, needed to be validated for the patient sample in the current study. The first part of this thesis focuses on methodological issues regarding these questionnaires. This report is based upon naturalistic data from the cross-sectional part of the Thematically Organized Psychosis (TOP) Study, carried out in joint collaboration between the University and University Hospitals of Oslo. Inclusion criteria for the TOP Study are broad, consisting of 1) being registered in the psychiatric services of any of the 4 University Hospitals in Oslo; 2) aged 18 to 65 years; 3) meeting the DSM-IV criteria for any major psychotic or bipolar disorder; 4) understanding and speaking a Scandinavian language; 5) having no history of severe head trauma or neurological disease; and 6) having an Intelligence Coefficient (IQ) score over 70. From May 2003 through October 2006 a total of 385 patients were evaluated. Two hundred and eighty met with criteria for the studies of this thesis. Acceptable psychometric properties were found for the IS when applied to patients with schizophrenia and bipolar I disorder. However, for patients with bipolar II disorder the scale seemed to work poorly. The BMQ had satisfactory psychometric properties for use in patients with severe mental disorders. Multiple adherence measures were used to establish adherence level in the study sample. The result was that outpatients with severe mental disorders showed relatively good adherence to prescribed medication. In addition, the use of self-report in adherence studies was addressed, with the conclusion that simple self report questionnaires seem to be a valid method for measuring adherence. Regarding the proposed predictors for nonadherence; in schizophrenia, use of illegal substances, alcohol, beliefs about medication and poor insight were related to worse adherence. Schizophrenia patients with no adherence did better on tests of executive functioning, verbal learning and memory and had higher IQ than patients with better adherence. In bipolar disorder the use of illegal substances and alcohol and beliefs about medication were related to worse adherence. There was a significant association between poor adherence and some autonomic side effects; diarrhea, nausea and orthostatism in schizophrenia patients and with orthostatism and urine retention in bipolar disorder patients. Otherwise there was no significant relationship between side effects and adherence. Fully adherent schizophrenia patients had significantly higher BMI than partially adherent patients. In the bipolar patients there was no statistically significant difference of mean BMI between the different adherent groups. Taken together, the present thesis suggests that insight can be measured with the IS in patients with schizophrenia and bipolar disorder, and that beliefs about medicines can be measured using the BMQ in patients with severe mental disorders. Further, outpatients with severe mental disorders showed relatively good adherence to prescribed medication. In this sample substance and alcohol use and beliefs about medication were important risk factors for nonadherence in patients with schizophrenia and bipolar disorder. Poor insight was also a risk factor, especially in schizophrenia. The results suggest that cognitive dysfunction is not a risk factor for nonadherence in these diagnostic groups

Hvem bruger ISLEX og hvordan?

ISLEX is a multilingual online dictionary with Icelandic as a source language and six Nordic target languages. It was opened on the web in 2011 and was from the start well received by its users. This paper discusses some aspects of the use and users of the dictionary. Some information is presented on measures that the logfiles of the database provide, e.g. the number of users at a given time and the proportional use of each target language. Moreover, the paper examines the main results of a user survey which was conducted in 2014. The survey gives valuable information on users’ opinions and their preferred methods of using the dictionary

Processering af en synonym-komponent i en flersproget ordbog

The ISLEX dictionary combines Icelandic as a source language (SL) and six Nordic languages as target languages (TLs) in a single database. This article describes the process of how Icelandic synonyms can be extracted and grouped together by using the TLs’ equivalents. Each word class is processed independently. Selected material, a list of lemmas with their ID number plus their TLs, is exported from the database, going through the languages one at a time. This produces long lists of results which consist of the Icelandic headwords and their equivalents. The lists are then processed in certain ways. In cases where a lemma has more than one sense there is a danger that the boundaries between the senses become blurred so that the words in those groups tend to get mixed up. An example is the Icelandic noun verslun which means both ’shop’ and 'trade’, and is therefore divided into two senses in the dictionary. All the material comes from within the dictionary and no external data is used. It means that all the synonyms obtained in this way are necessarily also lemmas. Despite this we consider the method justifiable because it is quick and simple, and in many instances it gives very good results, i.e. groups of synonyms with varying degrees of exactness

Íslensk nútímamálsorðabók. Kjarni tungumálsins

Publisher's version (útgefin grein)Íslensk nútímamálsorðabók er ný orðabók sem ætluð er til birtingar á vefnum. Orðabókin byggist að verulegu leyti á margmála veforðabókinni ISLEX (www.islex.is) og er m.a. flettiorðalistinn fenginn þaðan, svo og skipting í merkingarliði, framburður orða, myndefni, upplýsingar um fallstjórn sagna, málsnið o.fl. Við gerð orðabókarinnar var horft til þess að tungumálið er stöðugt í þróun / tekur breytingum, og hefur verið leitast við að láta uppflettiorðaforðann og notkunardæmin taka mið af því hvernig íslenska er raunverulega töluð og rituð af málnotendum nútímans, sem útheimtir reglulegar uppfærslur og viðbætur á orðaforðanum. Í greininni er í stórum fjallað um útgáfusögu íslenskra orðabóka frá upphafi og helsu áhrifavaldar verksins eru skoðaðir. Lýst er tilurð orðabókarinnar, innviðum hennar og helstu eiginleikum. Ennfremur er gerð grein fyrir ritstjórnarstefnunni og efnistökum eins og þau birtast í vali orðaforðans og orðskýringum, og er m.a. skýrt frá meðhöndlun á erlendum tökuorðum. Rætt er um hlutverk orðabóka í víðara samhengi og loks er fjallað um notkun á orðabókinni á tilteknu tímabili.Íslensk nútímamálsorðabók(A Dictionary of Contemporary Icelandic - islenskordabok.is) is a new dictionary designed for the web. It is largely modelled on the multilingual ISLEX project (www.islex.is), inheriting its lemmalist as well as its general structure, such as division into meanings, examples of use, information on the valency of verbs and prepositions, the use of labels, pronunciations, illustrations etc. The fact that a living language is always open to change has affected the work, so the dictionary’s lemma list and other contents reflect the spoken and written Icelandic of today, this also entails regular updates and additions to the material. The article first discusses the predecessors of Íslensk nútímamálsorðabók, it also briefly deals with the publishing history of Icelandic dictionaries. A description is given of the dictionary’s framework, linguistic approach, contents and its main features, as well as the editorial policy of the work as reflected in its vocabulary and definitions, and the way it deals with loan words and slang. Three important aspects of the dictionary come into focus which all can be said to be groundbreaking in Icelandic lexicography. These are: the processing of all articles according to the lemma’s semantic fields, a heavy use of corpora, and the dictionary’s original design for the web. Finally, some information is given on the use of the dictionary since its opening in late 2016.Peer Reviewe

ISLEX: Islandsk-skandinavisk webordbog.

ISLEX is a multilingual dictionary with modern Icelandic as source language and Danish,Norwegian and Swedish as target languages. The project is a collaboration of fourinstitutes in the Nordic countries with a central base in Reykjavík, Iceland.With 50.000 entry words, ISLEX is a medium sized dictionary. Set in a custom-maderelational database, it is designed as an on-line dictionary where the various possibilitiesof the web are utilised. So ISLEX has pictures and animated images, and pronunciationgiven as sounds. There is a special emphasis on Icelandic phrases and fi xed epressions, allof which are translated into the three target languages.The work on the dictionary takes place simultaneously in four countries. Theprocessing of the base language and coordination is based in Iceland, the Danish translationteam is located in Denmark, the Norwegian team in Norway, and the Swedish team inSweden. ISLEX is a six year project, begun in 2005. The aim is to complete the dictionaryin mid-year 2011

Clozapine treatment and discontinuation in Iceland: A national longitudinal study using electronic patient records.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.Clozapine is the only drug approved for treatment-resistant schizophrenia. There is evidence that clozapine is underutilized.To evaluate the initiation and discontinuation of clozapine at Landspitali University Hospital in Iceland and the prevalence of antipsychotic polypharmacy in clozapine-treated patients.The study is a part of an ongoing longitudinal study of schizophrenia in Iceland. We identified 201 patients on clozapine or who have been on clozapine by using a keyword search in the electronic health records and by reviewing their medical records.Mean age at first treatment with clozapine was 37.8 years. Mean follow-up period on clozapine was 11 years. After 20 years of treatment 71.2% of patients were still on clozapine. After one year of treatment 84.4% of patients were still receiving clozapine treatment. We estimate that 11.4% of patients with schizophrenia in Iceland are taking clozapine and that 16% have been treated with clozapine at some point. Polypharmacy is common, since nearly 2/3, 65.6%, of patients taking clozapine use at least one other antipsychotic and 16.9% are also receiving depot injections.We need to increase the awareness of psychiatrists in Iceland with regard to treatment with clozapine, since only about half of the estimated population of patients with treatment-resistant schizophrenia in Iceland have ever been treated with clozapine. Nearly two thirds of patients who are prescribed clozapine in Iceland remain on it long-term.info:eu-repo/grantAgreement/EC/FP7/279227 National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College Londo

Neutropenia and agranulocytosis during treatment of schizophrenia with clozapine versus other antipsychotics: an observational study in Iceland

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files.Data on the haematological outcomes of patients who continue clozapine treatment following neutropenia are very rare as even mild neutropenia results in mandatory discontinuation of clozapine in most countries. However, in Iceland where clozapine monitoring is less stringent allows an observational study to be done on the risk of agranulocytosis and neutropenia during treatment with clozapine compared with other antipsychotics among patients with schizophrenia.The present study is a part of a wider ongoing longitudinal study of schizophrenia in Iceland. We identified 201 patients with schizophrenia treated with clozapine and 410 patients with schizophrenia who had never been on clozapine by searching the electronic health records of Landspitali, the National University Hospital. Neutrophil counts were searched in electronic databases to identify patients who developed neutropenia/agranulocytosis and the frequency of neutrophil measurements was examined as well.The median number of days between neutrophil measurements during the first 18 weeks of clozapine treatment was 25 days but after the first 18 weeks on the drug the median became 124 days. Thirty four cases of neutropenia were identified during clozapine treatment with an average follow up time of 9.2 years. The majority, 24 individuals developed mild neutropenia (1500-1900 neutrophils/mm(3)). None of these progressed to agranulocytosis. The remaining 10 patients developed neutropenia in the range 500-1400 /mm(3) of whom one developed agranulocytosis, three stopped clozapine use and 6 patients continued on clozapine for at least a year without developing agranulocytosis. Unexpectedly, schizophrenia patients on other antipsychotics had an equal risk of developing neutropenia as those on clozapine.Neutropenia is common both in patients with schizophrenia on clozapine treatment and in those never on clozapine. Therefore a large part of neutropenia during clozapine treatment is probably not caused by clozapine. These findings have implications in assessing the balance between the risk of progression from neutropenia to agranulocytosis against the morbidity resulting from the premature discontinuation of clozapine under the current monitoring regulations in the US and in most of Europe.info:eu-repo/grantAgreement/EC/FP7/279227 National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London, Maudsley NHS Foundation Trust and King’s College London