SCIT may be a promising intervention for community agencies serving individuals with psychotic disorders who seek to improve their social functioning.

The current study examined beliefs about medication and their association with adherence to antiepileptic drugs (AEDs) among predominantly ethnic minority, low-income patients with epilepsy (PWE). Seventy-two PWE completed standardized questionnaires. The Beliefs about Medicines Questionnaire was used to assess perceptions about AEDs and medications in general. Adherence was measured with the Morisky 4-item scale and via participant self-rating. On the Morisky scale, 63% of patients endorsed at least one item for nonadherence. There was a significant relationship between seizure frequency and adherence (Morisky: r= 0.33, p= 0.006; Self-rating: r =−0.35; p= 0.003). Patients with lower self-rated adherence expressed greater concerns about AEDs (r= −0.25, p= .036) and beliefs that medications, in general, may be intrinsically harmful (r= −0.26; p= 0.032) and minimally beneficial (r= 0.36; p< 0.002), as compared to more adherent patients. These findings inform future educational interventions in this population of PWE.

Objectives: Poststroke delirium may be underdiagnosed due to the challenges of disentangling delirium symptoms from underlying neurologic deficits. We aimed to determine the prevalence of individual delirium features and the frequency with which they could not be assessed in patients with intracerebral hemorrhage. Design: Prospective observational cohort study. Setting: Neurocritical Care and Stroke Units at a university hospital. Patients: Consecutive patients with intracerebral hemorrhage from February 2018 to May 2018. Interventions: None. Measurements and Main Results: An attending neurointensivist performed 257 total daily assessments for delirium on 60 patients (mean age 68.0 [sd 18.4], 62% male, median intracerebral hemorrhage score 1.5 [interquartile range 1–2], delirium prevalence 57% [n = 34]). Each assessment included the Confusion Assessment Method for the ICU, Intensive Care Delirium Screening Checklist, a focused bedside cognitive examination, chart review, and nurse interview. We characterized individual symptom prevalence and established delirium diagnoses using Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria, then compared performance of the Confusion Assessment Method for the ICU and Intensive Care Delirium Screening Checklist against reference-standard expert diagnosis. Symptom fluctuation (61% of all assessments), psychomotor changes (46%), sleep-wake disturbances (46%), and impaired arousal (37%) had the highest prevalence and were never rated “unable to assess,” while inattention (36%), disorientation (27%), and disorganized thinking (18%) were also common but were often rated "unable to assess" (32%, 43%, and 44% of assessments, respectively), most frequently due to aphasia (32% of patients). Including nonverbal assessments of attention decreased the frequency of "unable to assess" ratings to 11%. Since the Intensive Care Delirium Screening Checklist may be positive without the presence of symptoms that require verbal assessment, it was more accurate (sensitivity = 77%, specificity = 97%, area under the receiver operating characteristic curve, 0.87) than the Confusion Assessment Method for the ICU (sensitivity = 41%, specificity = 88%, area under the receiver operating characteristic curve, 0.64). Conclusions: Delirium is common after intracerebral hemorrhage, but severe neurologic deficits may confound its assessment and lead to underdiagnosis. The Intensive Care Delirium Screening Checklist’s inclusion of nonverbal features may make it more accurate than the Confusion Assessment Method for the ICU in patients with neurologic deficits, but novel tools designed for such patients may be warranted.

Background Anticholinergic/sedative drug use, measured by the Drug Burden Index (DBI), has been linked to cognitive impairment in older adults. Subjective Cognitive Decline (SCD) may be among the first symptoms patients with Alzheimer’s Disease (AD) experience. We examined whether DBI values are associated with SCD in older adults at risk of AD. We hypothesized that increased DBI would be associated with greater SCD at older ages Methods Two-hundred-six community-dwelling, English speaking adults (age=65±9 years) at risk of AD (42% apolipoprotein ε4 carriers; 78% with AD family history) were administered a single question to ascertain SCD: “Do you feel like your memory is becoming worse?” Response options were “No;” “Yes, but this does not worry me;” and “Yes, this worries me.” DBI values were derived from self-reported medication regimens using older adult dosing recommendations. Adjusting for relevant covariates (comorbidities and polypharmacy), we examined independent effects of age and DBI on SCD, as well as the moderating effect of age on the DBI-SCD association at mean±1 standard deviations of age Results Both SCD and anticholinergic/sedative drug burden were prevalent. Greater drug burden was predictive of SCD severity, but age alone was not. A significant DBI*Age interaction emerged with greater drug burden corresponding to more severe SCD among individuals age 65 and older Conclusion Anticholinergic/sedative drug exposure was associated with greater SCD in adults 65 and older at risk for AD. Longitudinal research is needed to understand if this relationship is a pre-clinical marker of neurodegenerative disease and predictive of future cognitive decline