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The development and trial of a medication discontinuation program in the department of forensic psychiatry.

Murasugi K, Tsukahara T, Washizuka S - Ann Gen Psychiatry (2015)

Bottom Line: We also categorized 30 questions of the DAI-30 into three subscales: "awareness of the need for medication", "awareness of the effects of psychiatric drugs", and "impression of medication", and examined factors affecting improvement in medication adherence.The total DAI-30 score significantly increased after completion of the MDP (P = 0.002).Our study suggests that the MDP has a possibility of improving medication adherence, and this program might have multidirectional and stimulatory effects on each factor related to the improvement of medication adherence.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, National Hospital Organization, Komoro Kogen Hospital, 4598 Kou, Komoro, Nagano 384-8540 Japan ; Department of Psychiatry, Shinshu University School of Medicine, Nagano, Japan.

ABSTRACT

Background: When treating mentally ill criminal offenders, improving medication adherence is essential to achieving goals, such as long-term stabilization of symptoms and the prevention of recidivism. Most subjects who are treated under the Medical Treatment and Supervision Act have schizophrenia, which is considered a particularly difficult disorder for which to improve medication adherence. For such patients, we developed a Medication Discontinuation Program (MDP) that aims to improve medication adherence by discontinuing antipsychotic drugs and monitoring changes in psychiatric symptoms. We examined whether there was any utility for the MDP on a trial basis as well as whether it would be worthwhile to introduce the MDP to psychiatric programs.

Methods: We conducted the MDP with an intervention group (n = 7) and compared Drug Attitude Inventory-30 (DAI-30) scores before and after implementation of the MDP. We also categorized 30 questions of the DAI-30 into three subscales: "awareness of the need for medication", "awareness of the effects of psychiatric drugs", and "impression of medication", and examined factors affecting improvement in medication adherence.

Results: The total DAI-30 score significantly increased after completion of the MDP (P = 0.002). Significant elevations after completion of the MDP were also observed in the scores for three subscales of the DAI-30.

Conclusions: Our study suggests that the MDP has a possibility of improving medication adherence, and this program might have multidirectional and stimulatory effects on each factor related to the improvement of medication adherence.

No MeSH data available.


Related in: MedlinePlus

Process of hospital treatment provided under the Medical Treatment and Supervision Act (MTSA). The Medication Discontinuation Program (MDP) was conducted in the early stages of the recovery phase, in which medical conditions were stabilized.
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Fig3: Process of hospital treatment provided under the Medical Treatment and Supervision Act (MTSA). The Medication Discontinuation Program (MDP) was conducted in the early stages of the recovery phase, in which medical conditions were stabilized.

Mentions: Guidelines for psychiatric treatment provided under the MTSA published by the Japanese Ministry of Health, Labour and Welfare offer an approximately 18-month hospitalization, which is divided into three treatment phases: acute, recovery, and rehabilitation. Each phase has the following main achievement goals: improving symptoms, enhancing motivation in treatment, and establishing trust relationships with the persons who committed crimes in the acute phase; acquiring insight into diseases and the ability to control oneself and improving medication adherence in the recovery phase; and recovering the ability to live and preparing for reintegration in the rehabilitation phase (Figure 3). The improvement in medical adherence is an extremely important treatment issue for achieving treatment goals and social reintegration. Some reports show that denial of medication is an important predictor of violence derived from psychotic symptoms [2,3]. Moreover, Swartz et al. reported that drug abuse combined with poor adherence to medication among inpatients with severe mental illness may indicate a higher risk for violent behavior in the community after discharge [4].Figure 3


The development and trial of a medication discontinuation program in the department of forensic psychiatry.

Murasugi K, Tsukahara T, Washizuka S - Ann Gen Psychiatry (2015)

Process of hospital treatment provided under the Medical Treatment and Supervision Act (MTSA). The Medication Discontinuation Program (MDP) was conducted in the early stages of the recovery phase, in which medical conditions were stabilized.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4363327&req=5

Fig3: Process of hospital treatment provided under the Medical Treatment and Supervision Act (MTSA). The Medication Discontinuation Program (MDP) was conducted in the early stages of the recovery phase, in which medical conditions were stabilized.
Mentions: Guidelines for psychiatric treatment provided under the MTSA published by the Japanese Ministry of Health, Labour and Welfare offer an approximately 18-month hospitalization, which is divided into three treatment phases: acute, recovery, and rehabilitation. Each phase has the following main achievement goals: improving symptoms, enhancing motivation in treatment, and establishing trust relationships with the persons who committed crimes in the acute phase; acquiring insight into diseases and the ability to control oneself and improving medication adherence in the recovery phase; and recovering the ability to live and preparing for reintegration in the rehabilitation phase (Figure 3). The improvement in medical adherence is an extremely important treatment issue for achieving treatment goals and social reintegration. Some reports show that denial of medication is an important predictor of violence derived from psychotic symptoms [2,3]. Moreover, Swartz et al. reported that drug abuse combined with poor adherence to medication among inpatients with severe mental illness may indicate a higher risk for violent behavior in the community after discharge [4].Figure 3

Bottom Line: We also categorized 30 questions of the DAI-30 into three subscales: "awareness of the need for medication", "awareness of the effects of psychiatric drugs", and "impression of medication", and examined factors affecting improvement in medication adherence.The total DAI-30 score significantly increased after completion of the MDP (P = 0.002).Our study suggests that the MDP has a possibility of improving medication adherence, and this program might have multidirectional and stimulatory effects on each factor related to the improvement of medication adherence.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, National Hospital Organization, Komoro Kogen Hospital, 4598 Kou, Komoro, Nagano 384-8540 Japan ; Department of Psychiatry, Shinshu University School of Medicine, Nagano, Japan.

ABSTRACT

Background: When treating mentally ill criminal offenders, improving medication adherence is essential to achieving goals, such as long-term stabilization of symptoms and the prevention of recidivism. Most subjects who are treated under the Medical Treatment and Supervision Act have schizophrenia, which is considered a particularly difficult disorder for which to improve medication adherence. For such patients, we developed a Medication Discontinuation Program (MDP) that aims to improve medication adherence by discontinuing antipsychotic drugs and monitoring changes in psychiatric symptoms. We examined whether there was any utility for the MDP on a trial basis as well as whether it would be worthwhile to introduce the MDP to psychiatric programs.

Methods: We conducted the MDP with an intervention group (n = 7) and compared Drug Attitude Inventory-30 (DAI-30) scores before and after implementation of the MDP. We also categorized 30 questions of the DAI-30 into three subscales: "awareness of the need for medication", "awareness of the effects of psychiatric drugs", and "impression of medication", and examined factors affecting improvement in medication adherence.

Results: The total DAI-30 score significantly increased after completion of the MDP (P = 0.002). Significant elevations after completion of the MDP were also observed in the scores for three subscales of the DAI-30.

Conclusions: Our study suggests that the MDP has a possibility of improving medication adherence, and this program might have multidirectional and stimulatory effects on each factor related to the improvement of medication adherence.

No MeSH data available.


Related in: MedlinePlus