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We reviewed 112 pediatric renal transplant recipients to document the rate of medication non-adherence (NA) and to examine the relationships between NA, comorbid psychiatric illness, and the outcome variables of acute and chronic rejection and graft loss. A total of 32.5% of subjects had clinically significant NA with treatment based on review of serum immunosuppressant levels. NA was found to be significantly related to acute and chronic rejection, and graft loss (p < 0.001). NA was also related to the presence of comorbid psychiatric illness (p < 0.001). Logistic regression indicated that NA was a significant predictor for acute and chronic rejection, while psychiatric illness predicted graft loss. Adolescents had significantly higher rates of NA as well as shorter intervals between transplant date and onset of NA when compared with child patients (p < 0.001). Physician ratings of the primary reasons for NA suggested that lack of parental supervision and parent-child conflict were the major factors related to NA.

SynopsisOne hundred and fifty unselected elderly community subjects were assessed by Mini Mental State Examination (MMSE), Abbreviated Mental Test (AMT) and Mental Status Questionnaire (MSQ). The effects on cognitive test scores of potential confounding (non-cognitive) variables were evaluated. Sensitivities and specificities were: MMSE 80% and 98%; AMT 77% and 90%; and MSQ 70% and 89%. The MMSE identified significantly fewer false positives than the AMT and MSQ. The major effect of intelligence on cognitive test scores has previously been underestimated. Age, social class, sensitivity of hearing and history of stroke were also significantly correlated with cognitive test scores. Years of full time education and depression only affected the longer MMSE and CAMCOG. The MMSE (cut-off 20/21) can be recommended for routine screening. However, as scores are affected by variables other than cognitive function, particularly intelligence, further assessment of identified cases may fail to reveal significant functional impairment.

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The failure of the adolescent medical patient to adhere to prescribed medical treatment is one of the major reasons for psychiatric consultation in pediatric medical settings. This article reviews the developmental issues that interfere with treatment adherence in adolescents with chronic physical illness as well as the importance of co-morbid psychiatric disorders. Incomplete adherence is conceptualized as a clinical phenomenon that can be understood by considering both developmental and psychopathological factors that influence health care behavior. Interventions designed to enhance treatment adherence need to consider both developmental issues and psychiatric co-morbidity in order to improve outcome.

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