| 1 | J Clin Psychopharmacol 2002 Feb 22: 11-9 |
|---|---|
| PMID | 11799337 |
| Title | Medication management ability assessment: results from a performance-based measure in older outpatients with schizophrenia. |
| Abstract | Patients with schizophrenia who adhere to physicians' recommended use of medications are less likely to relapse than those who do not. Self-report measures of adherence have been criticized on a number of grounds. Here we describe a performance-based measure of medication management, the Medication Management Ability Assessment (MMAA), which represents a modification of the Medication Management Test used in individuals with HIV infection. Subjects were 104 patients older than 45 years with diagnoses of schizophrenia or schizoaffective disorder, and 33 normal comparison subjects (NCs). Subjects participated in a role-play task (MMAA) that simulated a prescribed medication regimen similar in complexity to one that an older person is likely to be exposed to. The total number of pills over that prescribed, total number of pills under that prescribed, and total number of correct responses were calculated. Self-report and prescription record data on adherence as well as data on measures of psychopathology, global cognitive status, and other clinical measures were also gathered. MMAA role-plays required 15 minutes, and its 1-week test-retest reliability was excellent (intraclass correlation coefficient, 0.96). Patients committed significantly more errors in medication management compared with NCs. Significantly more patients were classified as being nonadherent (i.e., taking +/-5%, 10%, 15%, or 20% of prescribed pills) compared with NCs. Patients with more severe cognitive deficits performed worse on the MMAA. MMAA performance was significantly related to prescription refill records, performance-based measures of everyday functioning, and self-reported quality of life. The MMAA is a useful instrument for observing ability to manage medications in patients with schizophrenia. The measure was related to severity of cognitive impairment, suggesting that adherence may improve with psychotropic and psychosocial interventions that target these deficits. |
| SCZ Keywords | schizophrenia |
| 2 | Schizophr. Res. 2003 Sep 63: 49-58 |
| PMID | 12892857 |
| Title | Cognitive predictors of medication adherence among middle-aged and older outpatients with schizophrenia. |
| Abstract | Medication nonadherence presents a considerable problem in patients with schizophrenia. There are limited and conflicting data on the association of cognitive impairment with antipsychotic nonadherence. In this study, we evaluated the correlation of patients' scores on Mattis' Dementia Rating Scale (DRS; total and subscale scores) with scores on the Medication Management Ability Assessment (MMAA), a performance-based measure of medication management. Participants included 110 outpatients with schizophrenia or schizoaffective disorder. Each was evaluated using the MMAA role-play tasks and the DRS. Patients also completed the Drug Attitude Inventory (DAI), and the PANSS (Positive And Negative Syndrome Scale). Age, DAI score, and DRS scores were all correlated with MMAA performance. In a stepwise regression analysis, only DRS scores were predictive of MMAA performance. Among the DRS subscales, conceptualization and memory were the best statistical predictors of MMAA performance. Cognitive functions, especially conceptualization and memory, were the strongest patient-related predictors of his or her ability to manage medications, over and above the effects of age, gender, education level, symptom severity, and attitudes toward medications. These results suggest a need for intervention studies focused on improving, or at least compensating for, specific cognitive deficits such as those in memory and conceptualization among patients with schizophrenia in order to improve their ability to manage medications. |
| SCZ Keywords | schizophrenia |
| 3 | Psychiatr Rehabil J 2006 -1 29: 299-310 |
| PMID | 16689041 |
| Title | Medication nonadherence in older people with serious mental illness: prevalence and correlates. |
| Abstract | Medication nonadherence in people with schizophrenia and other serious mental illnesses (SMI) is multidetermined and has been consistently associated with relapse and rehospitalization, but little is known about the prevalence and correlates of nonadherence in older people with SMI. This study evaluated the interrelationships between different measures of medication adherence (including pill counts, self-report, informant report, and attitudes toward medications), and their associations with demographic characteristics, and clinical, functional, skill, and cognitive measures in a group of 72 older people with SMI living in the community. Pill counts of adherence to psychotropic medications were highly correlated with pill counts for nonpsychiatric medications. However, pill counts were weakly correlated with self-report and informant ratings, which tended to overestimate adherence. Lower medication adherence was associated with: mood disorder (compared to schizophrenia), lack of supervision, fewer prescription medications, less insight, more severe negative symptoms, and worse community functioning. Among individuals with little or no supervision of their medications, higher adherence was related to better performance on the Medication Management Administration Assessment (MMAA) role-play, which was highly correlated with several domains of cognitive functioning, suggesting that the MMAA may be a more ecologically valid measure of cognitive functioning related to medication adherence. This study highlights the importance of using multiple measures for the assessment of medication adherence in older people with SMI, including pill counts, and suggests that interventions are needed to improve adherence in this population. |
| SCZ Keywords | schizophrenia |
| 4 | Int J Geriatr Psychiatry 2007 Dec 22: 1223-8 |
| PMID | 17506025 |
| Title | Suicidality in middle aged and older patients with schizophrenia and depressive symptoms: relationship to functioning and Quality of Life. |
| Abstract | Suicidality is a health concern in patients with schizophrenia. We examined the hypotheses: (1) Middle aged and older patients with schizophrenia, depressive symptoms and suicidality would exhibit worse quality of life and worse everyday functioning, social skills and medication management relative to those without suicidality; (2) higher levels of suicidality would be significantly associated with worse functioning, worse quality of life and older age. We examined 146 outpatients with schizophrenia and depression. Patients were at least 40 years old and were diagnosed with schizophrenia or schizoaffective disorder and had two or more depressive symptoms based on DSM-IV criteria for major depression. We assessed suicidality with the Intersept Suicide Scale (ISS) and functioning with the UCSD Performance-based Skills Assessment (UPSA), Social Skills Performance Assessment (SSPA), and Medication Management Ability Assessment (MMAA). Quality of life was assessed with the Heinrichs Quality of Life Scale (QLS). The mean age of patients was 52.4+ 6.9 years. Subjects with suicidality (ISS scores > 0) had lower QLS scores compared to those without suicidality. However, there were no differences in UPSA, SSPA nor MMAA scores between the two groups. In addition, based on Spearman's rho correlational analysis, there were significant associations of QLS scores with ISS scores (r = - 0.236) and with MMAA "total errors" scores (r = 0.174). Logistic regression demonstrated that only QLS scores predicted suicidality. Thirty-six percent of our sample had at least mild degrees of suicidality. Lower quality of life appears to be an important predictor of suicidality. |
| SCZ Keywords | schizophrenia |
| 5 | Am J Geriatr Psychiatry 2008 Aug 16: 660-3 |
| PMID | 18669944 |
| Title | Functioning in middle aged and older patients with schizophrenia and depressive symptoms: relationship to psychopathology. |
| Abstract | Depressive symptoms are common in middle aged and older patients with schizophrenia. The authors hypothesized that worse functioning in these patients would be associated with worse psychopathology. Outpatients with schizophrenia were > or =40 years old with subsyndromal depression and Hamilton Depression Rating Scale Scores of > or =8. Exclusions were dementia, two months of either mania or major depression or 1 month active substance abuse/dependence. The authors administered performance based functional assessments, the Positive and Negative Syndrome Scale of schizophrenia [PANSS], and Calgary Depression Rating Scale. PANSS (-) scores were negatively correlated with the UCSD Performance Skills Based Assessment, Social Skills Performance Assessment and Medication Management Ability Assessment total error (MMAA) scores. Digit symbol scores served as a moderator of the relationship between MMAA and PANSS (-) scores. Negative symptoms were associated with functioning. The relationship between negative symptoms and medication errors seem to weaken in subjects with quicker processing speed. |
| SCZ Keywords | schizophrenia |
| 6 | J Clin Psychopharmacol 2008 Apr 28: 225-9 |
| PMID | 18344736 |
| Title | Assessment of medication management ability in middle-aged and older adults with bipolar disorder. |
| Abstract | Medication nonadherence is a key clinical concern in bipolar disorder (BD) across the life span. Cognitive deficits in older adults with BD may hinder medication management ability, which, in turn, may lead to nonadherence. Using an innovative performance-based measure of medication management ability, the Medication Management Ability Assessment (MMAA), we compared performance of 29 middle-aged older community-dwelling outpatients with BD who were clinically stable (mean age, 61 years; SD, 11 years; range, 45-86 years) with those of 59 normal control subjects (NCs) and 219 outpatients with schizophrenia. The MMAA is a role-play task that simulates a medication regimen likely to be encountered by older adults. Within the BD group, we examined the relationships of MMAA scores to demographic, psychiatric symptoms severity, and the Mattis Dementia Rating Scale (DRS) scores. The BD group made 2.8 times the errors on the MMAA than NCs (BD group, 6.2; SD, 5.5 vs NCs, 2.2; SD, 2.5) and did not significantly differ from the schizophrenia group in errors on the MMAA. Errors in the BD group were more likely to be taking in too few medications as taking in too many. Within the BD group, a significant correlation was seen between MMAA scores and the DRS Total score, but not with age, education, Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale, number of psychiatric medications, or medical conditions. Among DRS subscales, the Memory Subscale correlated most strongly with MMAA errors. This small cross-sectional study suggests that deficits in medication management ability may be present in later-life BD. Neurocognitive deficits may be important in understanding problems with unintentional nonadherence. |
| SCZ Keywords | schizophrenia |
| 7 | Psychiatry Res 2008 Jan 157: 47-52 |
| PMID | 17897721 |
| Title | Predictors of medication competence in schizophrenia patients. |
| Abstract | Competence in self-administration of a drug regimen is related to both treatment adherence and functional outcome. Previous research with middle-aged and older schizophrenia patients suggests a central role for cognitive performance in predicting this competence. We examined the relative and joint contributions of demographic, clinical and cognitive predictors of medication management ability in an age-representative group of patients. The study participants comprised 147 patients with schizophrenia or schizoaffective disorder ranging from 21 to 65 years of age. Measures included demographic variables, current symptoms, subjective treatment response and a battery of cognitive tests. Competence in medication management was indexed with the Medication Management Ability Assessment (MMAA). Multiple regression analyses revealed that cognitive variables accounted for a significant proportion of the variance in MMAA scores over and above the contribution of all other variables. Measures of word recognition and pronunciation, auditory working memory and verbal learning yielded unique contributions to prediction. Positive and negative symptoms and subject treatment evaluations did not independently predict medication competency. This study documents a considerable range in MMAA scores across a demographically broad schizophrenia sample and supports the unique contribution of specific cognitive factors in predicting medication competence. |
| SCZ Keywords | schizophrenia |
| 8 | Psychiatry Res 2010 Apr 176: 120-5 |
| PMID | 20202689 |
| Title | Functional significance of preserved affect recognition in schizophrenia. |
| Abstract | Affect recognition (AR) is a core component of social information processing; thus, it may be critical to understanding social behavior and functioning in broader aspects of daily living. Deficits in AR are well documented in schizophrenia, but there is also evidence that many individuals with schizophrenia perform AR tasks at near-normal levels. In the current study, we sought to evaluate the functional significance of AR deficits in schizophrenia by comparing subgroups with normal-range and impaired AR performance on proxy and interviewer-rated measures of real-world functioning. schizophrenia outpatients were classified as normal-range (N=17) and impaired (N=31) based on a logistic cut point in the sample distribution of Bell-Lysaker Emotion Recognition Task (BLERT) scores, referenced to a normative sample of healthy control subjects (N=56). The derived schizophrenia subgroups were then compared on proxy [University of California San Diego Performance-Based Skill Assessment (UPSA), Social Skills Performance Assessment (SSPA), Medication Management Ability Assessment (MMAA)] and interviewer-rated [Quality of Life Scale (QLS), Independent Living Skills Survey (ILSS)] measures of functioning, as well as a battery of neurocognitive tests. Initial analyses indicated superior MMAA and QLS performance in the near-normal AR subgroup. Covariate analyses indicated that group differences in neurocognition fully mediated the observed associations between AR and MMAA, and attenuated the observed relationships between AR classification and QLS. These results support three main conclusions. First, AR, like many other domains of psychopathology studied in schizophrenia, is preserved in select subgroups. Second, there is a positive relationship between AR performance and functional outcome measures. Third, neurocognition appears to mediate the relationship between AR and measures of functioning. |
| SCZ Keywords | schizophrenia |
| 9 | Int J Geriatr Psychiatry 2010 Feb 25: 183-90 |
| PMID | 19711335 |
| Title | Treatment of subsyndromal depressive symptoms in middle-aged and older adults with schizophrenia: effect on functioning. |
| Abstract | Subsyndromal symptoms of depression (SSD) in patients with schizophrenia are common and clinically important. SSRI's appear to be helpful in alleviating depressive symptoms in patients with schizophrenia who have SSD in patients age 40 and greater. It is not known whether SSRI's help improve functioning in this population. We hypothesized that treating this population with the SSRI citalopram would lead to improvements in social, mental and physical functioning as well as improvements in medication management and quality of life. Participants were 198 adults > or = 40 years old with schizophrenia or schizoaffective disorder who met study criteria for subsyndromal depression based on having two or more of the nine DSM-IV symptoms of a major depressive episode, for at least 2 weeks, and a Hamilton depression rating scale (HAM-D 17) score > or = 8. Patients were randomly assigned to flexible-dose treatment with citalopram or placebo augmentation of their current antipsychotic medication(s) which was stable for 1 month. Subjects were assessed with the following functional scales at baseline and at the end of the 12-week trial: (1) social skills performance assessment (SSPA), (2) medication management ability assessment (MMAA), (3) mental and physical components of the medical outcomes study SF-12 Scale, and (4) the Heinrichs quality of life scale (QOLS). Analysis of covariance (ANCOVA) was used to compare differences between endpoint scores of the citalopram and placebo treated groups, controlling for site and baseline scores. ANCOVAs were also used to compare differences in the above endpoint scores in responders versus non-responders (responders = those with > 50% reduction in depressive symptoms). Overall, the citalopram group had significantly higher SSPA, mental functioning SF-12, and quality of life scale (QOLS) scores compared to the placebo group. There was no effect on MMAA or physical functioning SF-12 scores. Responders had significantly better endpoint mental SF-12 and QOLS scores compared to non-responders. Response to citalopram in terms of depressive symptoms mediated the effect of citalopram on mental functioning, but not on the quality of life. Citalopram augmentation of antipsychotic treatment in middle aged and older patients with schizophrenia and subsyndromal depression appears to improve social and mental health functioning as well as quality of life. Thus it is important for clinicians to monitor these aspects of functioning when treating this population of patients with schizophrenia with SSRI agents. |
| SCZ Keywords | schizophrenia |
| 10 | Psychiatry Res 2014 Aug 218: 31-4 |
| PMID | 24751379 |
| Title | The effect of language on functional capacity assessment in middle-aged and older US Latinos with schizophrenia. |
| Abstract | The U.S. Latino population is steadily increasing, prompting a need for cross-cultural outcome measures in schizophrenia research. This study examined the contribution of language to functional assessment in middle-aged Latino patients with schizophrenia by comparing 29 monolingual Spanish-speakers, 29 Latino English-speakers, and 29 non-Latino English-speakers who were matched on relevant demographic variables and who completed cognitive and functional assessments in their native language. There were no statistically significant differences between groups on the four everyday functioning variables (UCSD Performance-Based Skills Assessment [UPSA], Social Skills Performance Assessment [SSPA], Medication Management Ability Assessment [MMAA], and the Global Assessment of Functioning [GAF]). The results support the cross-linguistic and cross-cultural acceptability of these functional assessment instruments. It appears that demographic variables other than language (e.g., age, education) better explain differences in functional assessment among ethnically diverse subpopulations. Considering the influence of these other factors in addition to language on functional assessments will help ensure that measures can be appropriately interpreted among the diverse residents of the United States. |
| SCZ Keywords | schizophrenia |