Multiple illness perceptions in older adults: Effects on physical functioning and medication adherence

Objective: Previous research on illness perceptions has focused on single illnesses, but most adults over 65 suffer from multiple illnesses (multimorbidity). This study tests three competing operationalisations of multiple illness perceptions in predicting physical functioning and adherence: (1) main effects and interactions model; (2) peak model with effects of the most prominent illness perception; and (3) combined model with averaged illness perceptions over multiple illnesses.

Design: Longitudinal study in N?=?215 individuals (65–86?years) with multimorbidity at two measurement points over six months. Participants filled in two Brief Illness Perception Questionnaires (B-IPQ) on their two most severe illnesses.

Main outcome measures: Physical functioning, medication adherence.

Results: Factor analyses suggest that the B-IPQ contains three dimensions; consequences, control and timeline. Multiple regression models fit the data best for (1) and (3). Timeline (β?=??.18) and control (β?=?.21) predict adherence in (1); consequences (β?=?.16) and control (β?=?.20) in (3). Physical functioning was significantly predicted by interacting control beliefs in (1; β?=?.13), by peak consequences in (2; β?=??.14) and by consequences (β?=??.15) in (3).

Conclusions: Individuals with multimorbidity hold both distinct and combined perceptions about their illnesses. To understand individual responses to multimorbidity, perceptions about all illnesses and multimorbidity as entity should be examined.     

Coping with adverse drug events in patients with heart failure: Exploring the role of medication beliefs and perceptions

This study describes coping strategies that patients with heart failure (HF) use to manage adverse drug events (ADEs). The included coping strategies were social support seeking, information seeking, non-adherence and taking alleviating medication. The role of beliefs about medication and ADE perceptions in explaining these coping strategies was assessed using the Self-Regulation Model. We performed a cross-sectional study including 250 HF patients who experienced an ADE. Patients completed validated questionnaires assessing their coping strategies, ADE perceptions and medication beliefs. Social support (60%) and information seeking (32%) were the most commonly used strategies to cope with ADEs. Non-adherence was reported by 7% of the patients. Multivariate linear regression analysis showed that demographics, clinical factors and medication beliefs explained only a small amount of the variance in coping strategies, whereas ADE perceptions explained a substantial amount of variance. Path analysis showed that patients’ perceptions about the timeline, consequences and controllability of ADEs by the health care provider were directly related to their coping behaviour. The effect of patients’ medication beliefs on their coping strategies was consistent with mediation through their ADE perceptions. Our results support the value of the Self-Regulation Model in understanding patients’ coping behaviour with regard to ADEs.     

Depression and medication adherence among breast cancer survivors: Bridging the gap with the theory of planned behaviour

Evidence suggests that more depressed breast cancer patients will less likely adhere to treatment plans. This study presents evidence that the theory of planned behaviour mediates the relation between depression and intentions to adhere to treatment plans and between depression and lack of adherence to medication regime. Two hundred and thirteen women undergoing breast cancer treatment participated in this study. Measures of depressive symptoms and planned behaviour variables were collected at the first time point; measures of medication adherence were collected at the second time point. Structural equation models were utilised to fit the data to the proposed models. Depressive symptoms were significantly correlated to both intentions and medication adherence. In support of hypotheses, the relation between depressive symptoms and treatment intention was mediated by attitudes towards health maintenance plans. The relation between depressive symptoms and medication adherence was fully mediated by the planned behaviour process. Conditions under which treatment intentions and perceptions of control in adhering to treatment were most related to medication adherence were elucidated. The results point to avenues for interventions to increase medication adherence among breast cancer patients. Manipulating attitudes and perceptions of control towards treatment plans will potentially serve to increase medication adherence.     

Assessment of children's receptive vocabulary using event-related brain potentials: Development of a clinically valid test

The combined verbal and motor impairments characteristic of children with disorders such as Cerebral Palsy (CP) frequently compromise the accuracy of standard psychometric assessments. What is needed is a test to measure language that does not require verbal or motor responses. This study was designed to determine whether single-word receptive vocabulary could be assessed in young children without CP, using an ERP-compatible test based on Form M of the Peabody Picture Vocabulary Test-Revised (PPVT-R). Fifteen 10-year-old children with normal levels of psychometric intelligence participated. Ninety pictures were selected from the PPVT-R (Form M), representing three levels of single-word receptive vocabulary (Preschool, Child-Adolescent, Adult). Each picture was presented twice (pseudo-random), once paired with a spoken word that was semantically congruent with the picture and once paired with a semantically incongruent word. The children's N400 was significantly larger to incongruent than to congruent pairs, but only when the vocabulary was within their repertoire. The results are discussed in terms of electrophysiologic correlates of acquired language and the clinical use of this ERP test as an adjunct to assessing patients with moderate to severe communication and/or motor impairments (e.g., cerebral palsy, autism, head injury).     

Religion and anxiety treatments in primary care patients

Earlier data suggested that religious physicians are less likely to refer to a psychiatrist or psychologist. This follow-up study measures how religious beliefs affect anxiety treatments in primary care. We surveyed US primary care physicians and psychiatrists using a vignette of a patient with anxiety symptoms. Physicians were asked how likely they were to recommend antianxiety medication, see the patient for counseling, refer to a psychiatrist, refer to a psychologist or licensed counselor, encourage meaningful relationships and activities, and encourage involvement in religious community. We experimentally varied symptom severity, whether the patient was Christian or Jewish, and whether she attended religious services. Physician attendance at religious services was assessed in the survey. The response rate was 896 out of 1427 primary care physicians and 312 out of 487 psychiatrists. Religious physicians were more likely to promote religious resources. There was no statistically significant difference between physicians' recommendations for religious and nonreligious patients. There was no statistically significant difference in religious and nonreligious physicians' referrals to a psychologist, licensed counselor, or psychiatrist. Ultimately, we did not find a difference in religious and nonreligious physicians' support for mental health referrals, however, religious physicians were more likely to encourage using religious resources.     

Differential Associations Between Perceived and Objective Measurement of Distress Tolerance in Relation to Antiretroviral Treatment Adherence and Response Among HIV-Positive Individuals

The present study sought to extend prior work, showing an association between self-reported distress tolerance and self-reported antiretroviral treatment (ART) adherence, by conducting a multimethod test of the association between distress tolerance and objective measures of ART adherence among a sample of 140 individuals (23.6% female) with human immunodeficiency virus (HIV). Findings indicated that, after accounting for negative affectivity and ART side-effect severity, distress tolerance was significantly associated with pill count adherence as well as viral load. Specifically, a differential association was observed whereby self-reported distress tolerance was associated with pill count adherence, whereas behavioral distress tolerance was associated with viral load. Importantly, no associations were observed between either measure of distress tolerance and CD4 count. Findings are discussed in terms of the importance of both behavioral and perceived distress tolerance assessment among patients with HIV as well as potential clinical implications related to the integration of distress tolerance-focused treatments into existing interventions for individuals with HIV.     

A multidisciplinary treatment for encopresis in children with developmental disabilities

Achieving continence of one's bowel movements is a key step in development and failure to do so leads to many negative consequences. Treatments for encopresis appearing in the literature have employed behavioral strategies; medications such as suppositories, laxatives, or enemas; and in some studies a combination of these approaches. To date, attempts to extend successful treatments for encopresis in typically developing children to those with developmental disabilities have been limited. The current study included three participants diagnosed with developmental disabilities who had a history of encopresis. None of the participants had a continent bowel movement under baseline conditions. Continent bowel movements increased during treatment that included the addition of suppositories to elicit continent bowel movements. Two participants began having independent continent bowel movements (i.e., without requiring suppositories) and medication was successfully faded out for the remaining participant. Treatment took between 13 and 21 days.     

Psychotropic Medication Practices for Youth in Systems of Care

Concerns have been raised about the quality and appropriateness of psychiatric medication treatment for youth treated in the child welfare or juvenile justice systems. Unfortunately there is a lack of empirical research to indicate whether there are indeed widespread problems related to psychopharmacologic treatment for youth served by public sector systems. This exploratory study utilized data from a national survey of social workers to examine differences in reports on medication type, processes, and perceived outcomes for adolescent clients in the juvenile justice and/or child welfare system (n = 90) versus non-systems clients (n = 305). Relevant clinical and demographic factors were controlled in hierarchical binary logistic and linear regression analyses. The results indicated that social workers referring to systems cases were more likely to report the use of highly potent medication (antipsychotics, mood-stabilizers, and poly-pharmacy), less likely to report that clients were receptive to or involved in the decision to utilize medication, and less likely to report beneficial medication outcomes. However, these reported differences, suggesting that medication treatment for systems youth tends to be less participatory and beneficial, were largely accounted for by differences in clients’ level of functional impairment and rate of disruptive behavior disorders. Implications for further research are discussed.     

Sex Differences in Effectiveness of Extended-Release Stimulant Medication among Adolescents with Attention-Deficit/Hyperactivity Disorder

This study examined whether adolescent females with attention-deficit/hyperactivity disorder (ADHD) are differentially responsive than their male counterparts to extended-release stimulant medications. This investigation may bear special importance for an adolescent (as opposed to child) population, because hormonal and metabolism differences between sexes are most likely to emerge at this time. Male (n = 19) and female (n = 16) adolescents, ages 16–19 with ADHD, participated in a randomized, double-blind crossover study evaluating the effectiveness of osmotic-release methylphenidate, extended release amphetamine salts, placebo, and routine limited medication regimen. Medication efficacy was evaluated using ADHD symptom ratings from adolescent self-report and parent report, along with objective measures of inattention and hyperactivity/impulsivity during driving performance and neuropsychological tasks. Males and females were largely equivalent in impairment, and medication was similarly effective in reducing symptoms. No interactions were found between sex and medication on any measure of effectiveness or side effects. This finding suggests that the efficacy and tolerability of extended-release stimulant medications is equivalent for male and female adolescents with ADHD.