Adherence is defined as the extent to which a patient's behavior coincides with medical or prescribed health advice. Adherence is considered non-judgmental and is preferred over the term "compliance," which carries negative connotations and suggests blame for the patient. A major challenge in the field of psychiatry has been to understand why patients may or may not adhere to medication and other treatment recommendations. A comprehensive review of the literature on medication adherence among patients with psychiatric illnesses was conducted with the following objectives: (1) to better understand the impact of medication nonadherence, (2) to identify risk factors for medication nonadherence, and (3) to study interventions designed to improve patient adherence. The authors initially searched the Ovid Medline electronic database using the key words "medication adherence" and "compliance" to identify all articles written in the English language published through early 2008. This produced over 2000 references. The search was then narrowed to publications specific to psychotropic medication. The ultimate goal of the review was to increase awareness of this critical issue and to discuss strategies that the psychiatric clinician can implement to address patient adherence to prescribed medications. The authors chose to include articles that were deemed to be clinically useful to the practicing clinician.Studies that have specifically investigated adherence to psychiatric medications vary in the definitions of adherence and methodology that were used, making interpretation of results across studies difficult. Psychoeducational interventions have long been the mainstay of treatment for adherence problems. However, there is growing evidence that other approaches such as cognitive-behavioral strategies and motivational interviewing may be effective. Based on a comprehensive literature review, the authors recommend the following strategies for addressing adherence problems: focus on strengthening the therapeutic alliance; devote time in treatment specifically to address medication adherence; assess patients' motivation to take prescribed medications; and identify and address potential barriers to treatment adherence.
There are few studies of assaults against psychiatric residents. The only two domestic studies specifically investigating assaults against residents each surveyed a single residency program. In the present study, 333 psychiatric residents in 11 training programs in Pennsylvania were surveyed about assaults and threats on them during residency. One hundred fifty-five questionnaires (46%) were completed and returned. Of the respondents, 41 % experienced a physical assault and 48% were threatened at some time during their training. Ten percent of the respondents were assaulted more than once, and 30% of the respondents were threatened more than once. There was no significant correlation between rates of threats or assaults and age, sex, or training sites. The majority of threats and assaults occurred in either an inpatient setting (56%) or a psychiatric emergency service (31%). The authors found that residents were provided with minimal training in aggression management during their residency.
Thirty-one elderly depressive patients were evaluated with topographic, quantitative EEG using relative measures, absolute measures, and computations of interhemispheric asymmetry and interhemispheric coherence in four frequency bands: delta, theta, alpha and beta. Patients were found to have lower than normal delta, higher than normal theta, higher than normal alpha and lower than normal beta values. EEG values were greater over the left than the right hemisphere in theta, alpha and beta bands. Lower than normal anterior interhemispheric coherence was found in all four frequency bands.
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