Improving self-report measures of non-adherence to HIV medications

The aim of this article is to clarify what factors should be measured to assess non-adherence to an antiretroviral medication regimen among individuals with the Human Immunodeficiency Virus (HIV). In order to consider a patient as non-adherent, a clear operational definition of medication non-adherence should be formulated. This definition should specify the medication to be taken, the medical advice to be followed as well as the behaviors a patient should adopt in a given period of time. Techniques aimed at reducing the influence of several potential biases in self-report questionnaires, such as forgetfulness and social desirability, are also reviewed.     

Type D personality predicts poor medication adherence in myocardial infarction patients

Type D personality, the combination of negative affectivity (NA) and social inhibition (SI), is an emerging risk factor in cardiovascular disease. This study aimed to examine one possible behavioural mechanism to explain the link between Type D and ill-health. It was hypothesised that Type D personality would predict medication adherence in myocardial infarction (MI) patients. In a prospective study, 192 MI patients (54 females and 138 males) completed measures of Type D personality and provided demographic and medical information 1 week post-MI, and then 131 patients went on to complete a self-report measure of medication adherence 3 months post-MI. It was found that Type D personality predicts adherence to medication, after controlling for demographic and clinical risk factors. Critically, the constituent components of Type D, NA and SI, interact to predict medication adherence, after controlling for the effects of each component separately. Poor adherence to medication may represent one mechanism to explain why Type D cardiac patients experience poor clinical outcome, in comparison to non-Type D patients. Interventions, which target the self-management of medication, may be useful in these high-risk patients.     

伤害回避的脑机制及其生物基础

伤害回避是指个体对厌恶刺激信号做出强烈的反应,并学会被动地回避惩罚的一种倾向,这一倾向使得个体反复思考未来的结局,并谨慎小心地对待不确定情景中的事件,进而更有可能诱发情感障碍。伤害回避涉及的神经网络包括三个子网络,即额顶叶-前扣带皮层的连接、皮层-杏仁核的连接和白质通道的结构性连接,这三个子网络分别与羞怯感-易疲劳性、预期担心以及不确定环境中的害怕情绪有关。而其生物基础则包括单一基因多态性和基因多态间的交互作用。今后的研究应该集中在深化伤害回避神经网络与生物基础间的联合机制、研究三种及以上基因多态间的交互作用、考察其他因素对基因效应的调节作用、注重伤害回避四种亚型相关神经网络之间的连接、探讨5-HT4等其他几种5-羟色胺受体多态性与伤害回避的关系以及分析伤害回避内部机制在抗抑郁治疗中的作用等方面。     

Medication for Complex Posttraumatic Disorders

Treatment guidelines and reviews of outcome studies agree that drugs are valuable for moderation of irrational moods and impulsivity that interfere with thoughtfulness and cooperativeness. As such, they empower patients to make good use of psychotherapy for mastery of the risk of betrayal in intimate relationships, which is the typical recurrent traumatic event in complex posttraumatic disorders. Psychotherapy, for its part, has demonstrated correction and lasting remission of disorder in the aftermath of certain kinds of single trauma and promises further development to achieve similar efficacy for complex posttraumatic disorders. This article summarizes the strengths and limitations of each class of psychiatric drugs. It explains how the natural course of complex posttraumatic disorders greatly contaminates observations of medication efficacy and fosters unrealistic expectations for drug development.     

Queering Black Homophobia: Black Theology as a Sexual Discourse of Transformation

Abstract

This article explores black homophobia as a co-constitutive phenomenon which harbors the fear of the loss of a black archetypal identity that can be understood as (hetero)normative. Using a method of queering black homophobia from a hetero non-normative viewpoint, an exploration of the authenticity of a liberation viewpoint that is multivocal, multidimensional, and offering an interpretation that is inclusive of identities that trouble the waters of black hetero-patriarchal hegemony will be in question as it relates to the role of the Hamitic hypothesis and those interpretations that conflate evil, sexual perversion, and human degeneration within blackness.     

Religiosity and treatment response to antidepressant medication: a prospective multi-site clinical trial

The present study examined the relationship between religiosity/spirituality and treatment response to antidepressant medication (citalopram). One-hundred and forty-eight Caucasian and African-American adults with uncomplicated major depression were treated with citalopram (20–60?mg/day) over an eight-week period in a prospective multi-site clinical trial. Treatment response was assessed weekly with the Hamilton Rating Scale for Depression. Religiosity (i.e., religious behaviours) and spirituality (i.e., spiritual well-being) were assessed at week 3. No significant associations between spirituality and treatment response were found; however, there was a strong curvilinear relationship between religiosity and treatment response. Compared to lower or higher levels of religiosity, a moderate level of religiosity was significantly associated with a higher likelihood of remission and greater reduction in severity of depression. This association was independent of social support, ethnicity, gender, education, and baseline depression severity. A moderate amount of religiosity appears to be independently associated with an enhanced treatment response to citalopram.     

The association of tanning behavior with psycho-tropic medication use among young adult women

Despite its known association with skin cancer, tanning remains popular among young adult women. Indoor tanning behavior has been found to be associated with affective and addictive disorders. To better understand potential psychological and biological mechanisms of tanning behavior, we investigated associations between tanning and medication (psychotropic and other) use among young women. Two hundred and fifty-three women age 18–29 years old were recruited from two northeastern university campus communities. Women self-reported tanning frequency and chronic medication use. In both univariate and multivariate analyses, indoor tanning ≥12 times last year was significantly associated with use of psychotropic medication and anti-depressants in particular. Sunbathing was not associated with medication use. Potential reasons for associations between tanning and psychotropic medication use are discussed. Indoor tanners should be warned that some psychotropic medications are photosensitizing, thus increasing risk for burns and other skin damage from indoor tanning.     

Antidepressant Medication: Is It a Viable and Valuable Adjunct to Cognitive-Behavioral Therapy for School Refusal?

Cognitive-behavioral therapy (CBT) is an evidence-based treatment for school refusal. However, some youth do not respond to CBT. The serious risks associated with school nonattendance call for novel approaches to help those who do not respond to CBT. Because school refusal is commonly associated with anxiety disorders, and the combination of CBT and antidepressant medication enhances outcomes in the treatment of anxiety disorders, combined treatment may be effective for school refusal. This narrative review evaluates the current evidence base for adding antidepressant treatment to CBT for school refusal. Six randomized controlled trials (RCTs), two open trials, six case studies/series, and one observational study were identified and reviewed. There is support for combined CBT and imipramine, but this medication is not typically used due to the risk of concerning side effects. Two recent RCTs failed to provide evidence for the superiority of combined CBT and fluoxetine. Further research in this area is required because the extant studies have a number of methodological limitations. Recommendations are provided for clinicians who consider prescribing antidepressant medication or referring for adjunctive antidepressant treatment for school refusal.     

抗抑郁药应用选择的思考

目前市场上可供选择的抗抑郁药越来越多.从系统方法论、医学模式转变和矛盾重点论的角度来阐述临床上应该如何选择用药,才能使治疗效果和医疗费用更符合个体的情况,达到比较和谐的状态.