Psychosocial and Psychodynamic Issues Affecting Noncompliance with Psychostimulant Treatment

Stine, John J.

doi:10.1089/cap.1994.4.75

Cited by 30 publications

(25 citation statements)

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“…Unfortunately, the large number offamilies who did not enrol in the parent groups (36%) and the high number of families who did not adhere to these groups (40%) make it difficult to assess the reasons for the lack of or negative change in acceptability. This problem is not unique to the current study, as compliance rates for nonpharmacological interventions have been found to be similar across several studies (for example, 7,5,20).…”

Section: Discussionmentioning

confidence: 86%

Parental Knowledge of Attention-Deficit Hyperactivity Disorder and Opinions of Treatment Options: Impact on Enrolment and Adherence to a 12-Month Treatment Trial

1999

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Objective: This study examines the relationship between parents' knowledge ofattention-deficit hyperactivity disorder (ADHD) combination with one another. For example, Wolraich and colleagues found that 80% of children with ADHD were treated with stimulant medication (3). As well, systematic nonpharmacological interventions (for example, parenttraining courses, family therapy, behavioural-management training) were found to be recommended with less frequency than was medication.Long-term outcome for children with ADHD appears to be correlated with the length ofadherence to treatment (4); however, many families do not enrol in recommended treatments or do not adhere to the treatment for the entire duration. In a study that examined adherence in families with a child with ADHD receiving methylphenidate (MPH) alone, MPH with a behavioural program, or placebo with a behavioural program, 20% of children had discontinued medication by 4 months, 45% had discontinued by 10 months, and 51% ofthe families did not follow the behavioural intervention program to completion (5).Lack of adherence to treatments for ADHD is not explained by factors such as socioeconomic status, parenting stress, or

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Section: Discussionmentioning

confidence: 86%

Parental Knowledge of Attention-Deficit Hyperactivity Disorder and Opinions of Treatment Options: Impact on Enrolment and Adherence to a 12-Month Treatment Trial

1999

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“…Considering that nearly half of the youths referred from hospitals to CMHCs for aftercare never register (see Irwin et al 1993), and assuming that youths referred but not enrolled in outpatient aftercare had been similarly prescribed medication on discharge from the hospital, then the 29% rate of antidepressant medication continuance (Table 2) would reasonably be halved to 15%. Should one take into account the likelihood that at least one-third of youths prescribed psychotropic medications are surreptitiously nonadherent (Sleator 1985, Stine 1994, the actual rate of antidepressant medication maintenance during CMHC aftercare would then drop to 10% at 3 months.…”

Section: Discussionmentioning

confidence: 99%

Changing Patterns of Psychotropic Medications Prescribed by Child Psychiatrists in the 1990s

Safer¹

1997

Journal of Child and Adolescent Psychopharmacology

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The active (1994) and closed (1988 to 1992) outpatient records of youths seen in four separate community mental health centers (CMHC) in Baltimore County, Maryland were reviewed in mid-1994 to document recent changes in the medication-prescribing practices of local child psychiatrists. Inpatient summaries of previously hospitalized CMHC youths were also reviewed to supplement the outpatient medication assessment with hospital data. This regional survey of medication treatments in child psychiatry revealed that, during the half decade before 1994, there was an increase in overall psychotropic medication treatment, multiple concurrent medication treatments (polypharmacy), and antidepressant treatment with serotonin reuptake inhibitors (SRIs). Inpatient youths were consistently prescribed more psychotropic medications and diagnosed more frequently with major depressive disorder than outpatients. Medications typically used to first treat mood disorders became the predominant medication prescribed for both outpatients and inpatients by child psychiatrists in 1994, leading to a proportional decline in prescribed stimulant treatment. The shift from tricyclic antidepressants to SRI antidepressants in the 1990s by child psychiatrists matches the same recent practice shift by adult psychiatrists. Likewise, the increased prescription of drugs to treat mood disorders and the increased rate of polypharmacy notable of late among child psychiatrists now also mirrors adult psychiatry practice. Wide geographic variations in neuroleptic and antidepressant medication patterns were noted, even among facilities in the same metropolitan region. After psychiatric hospitalization, most youths who continued treatment at a CMHC outpatient clinic discontinued their inpatient medications within 3 months; the sole exception were children who had been placed on psychostimulants.

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“…take medication) in order to gain control of mental and behavioral states [27]. Individuals sometimes express reluctance or anxiety about becoming 'dependent' on a medication, even if it provides symptomatic relief [21,32,33]. Teens can also resent the intrusiveness accompanying medical scrutiny and the familial over-protection that sometimes ensues [24,34,35].…”

Section: Youths' Subjective Reactions To Psychotropic Medicationmentioning

confidence: 99%

Adolescents’ Commitment to Continuing Psychotropic Medication: A Preliminary Investigation of Considerations, Contradictions, and Correlates

Moses

2010

Child Psychiatry Hum Dev

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This mixed-method study examines (1) the extent to which fifty adolescents receiving wraparound treatment and prescribed psychotropic medication for various psychiatric disorders report that they would continue taking medication if the decision was entirely their own (termed "medication commitment"); (2) their general subjective experiences with medication; and (3) which medication experiences and clinical, social, and demographic factors are associated with greater medication commitment. We found that most adolescents (62%) would discontinue treatment; these "less committed" youth were more likely to report various negative medication perceptions and experiences in open-ended questions, relative to "committed" youth. Multivariate analysis indicated that significant correlates of commitment to medication were: taking antipsychotic medication, greater perceived family support, and lack of perceived coercion to take the medication; clinical or demographic factors were not significantly related to medication commitment. The results reinforce the importance of addressing youths' concerns about medication and maximizing their participation in treatment decision-making.

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Psychosocial and Psychodynamic Issues Affecting Noncompliance with Psychostimulant Treatment

Cited by 30 publications

References 1 publication

Parental Knowledge of Attention-Deficit Hyperactivity Disorder and Opinions of Treatment Options: Impact on Enrolment and Adherence to a 12-Month Treatment Trial

Parental Knowledge of Attention-Deficit Hyperactivity Disorder and Opinions of Treatment Options: Impact on Enrolment and Adherence to a 12-Month Treatment Trial

Changing Patterns of Psychotropic Medications Prescribed by Child Psychiatrists in the 1990s

Adolescents’ Commitment to Continuing Psychotropic Medication: A Preliminary Investigation of Considerations, Contradictions, and Correlates

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