text:
NTN-SNR BRINGS NEW BEARING TO OESAA
Bearing manufacturer NTN-SNR has become the latest company to join the Original Equipment Suppliers Aftermarket Association.
NTN-SNR becomes the 14th member of OESAA after signing up to the group and its slogan 'Our Quality, Your Reputation'.
Keith Skinner, NTN-SNR Sales Manager, Automotive Aftermarket Division, UK and Ireland, said: "We have seen that the UK automotive aftermarket has become very price driven which has resulted in more low quality parts being promoted with tenuous OE quality claims.
"NTN -SNR is a major supplier of bearings for original fitment to vehicle manufacturers worldwide, and we offer the same product to our aftermarket customers in the UK and Ireland – all produced using the same materials, processes and quality standards.
"By joining OESAA we are able to highlight the benefits of using an OE part compared to that of a lower quality item. We believe in healthy competition and everyone has the right to choose, but we think it has to an informed choice and that is the kind of message we wish to portray."
OESAA Chairman Nigel Morgan, Managing Director of Schaeffler Automotive Aftermarket said: "We are delighted that NTN-SNR has become the latest manufacturer to join OESAA. Its decision to become a member will only strengthen our campaign for workshops to recognise the risk of fitting inferior or sub-standard non-tested parts."
OESAA will exhibit examples of its OE parts alongside non-genuine alternative products at the Commercial Vehicle Show at Birmingham's NEC from April 29 to May 1 and at MechanEx at Event City, Manchester, on May 20/21.
Its members say that some aftermarket parts suppliers are claiming to match OE quality, even though it is clear by physically comparing the components that they don't.
The group stresses that there are other brands in the market offering quality products, but that its target is to raise the awareness of the need to fit the highest possible quality parts and also of the dangers of supplying and fitting sub-standard components.
Members only use the OESAA logo on products that are fitted as original equipment; they do not use it for non-OE product publicity.
Tags: Factor & Supplier News Garage News Uncategorised
Mall Wilson says:
Surely the OESAA credibility is in tatters – that`s if they had any to begin with. The news that two members have been penalised for systematic price fixing comes as no real shock. The further revelation that one member was putting out false scare stories of fake or poor quality product is further proof that they will resort to any tactic to justify their inflated prices that hit the poor motorist hard.
Any established organisation in the UK should think very carefully indeed about any association with them. SMMT, IAAF take note

redpajama_set_name: RedPajamaCommonCrawl


text:
News: Vampire Diaries Cast Interviewed by UK Morning Show
Paul Wesley, Nina Dobrev and Ian Somerhandler did a promotional interview on June 2 for the British TV show, 'This Morning in London'.
The cast of the Hit TV show, The Vampire Diaries, was in the studio of This Morning in London for a promotional interview. Paul Wesley, Nina Dobrev and Ian Somerhandler sat and answered questions for about 10 minutes on the British television show. Topics of conversation:
Nina admitted that she likes wearing corsets.
Ian and Paul being fitted for fangs
that they use squirrel and children's blood on the set
The large fan following for The Vampire Diaries and how the Twilight Saga has helped give the series life.
Nina admits how sexy vampires are to her.
They kiss the city of London's butt
That these three are "cuddly vampires"
What was missing from the interview was much info on the next season of Vampire Diaries. I am absolutely amazed that they are as relaxed and candid and are as well versed in the history of vampire stories, even discussing horror film pioneer, actor, Bela Lugosi. This is quite the stark contrast to the craziness that surrounds the the Cast of Twilight Eclipse. Watch the interview below in its entirety and enjoy:
Source: EntertainmentGather
Nina Dobrev Interview: Fashion, Beauty, Yoga and Season 2
Events: Meet 'n Greet at London HMV


text:
10 Reasons Why Your About Page Isn't Working
When it comes to creating a well-crafted and cleverly designed website, there are a lot of factors to consider — and it's a lengthy process for sure.
You have to create impeccable landing pages, whip up imaginative copy and integrate stunning visuals throughout your website design. You have to make sure you're providing your users with all the information that they need, in as visually-pleasing in a way as possible. And web design has a major impact on consumer spending.
But one page that's often overlooked is the "About Us" page.
You can't forget to put the time and effort into these "About Us" pages. These landing pages are often the most visited pages on a website. In fact, 52 percent of users want to see these "About Us" pages once hitting on a company's website.
But often, companies brush off the importance of these pages and the information they provide users. This leads them to make major mistakes that affect the user experience and turn people away.
If you're making any of these 10 "About Us" page mistakes, it's time to give your landing page a refresh.
You don't have an "About Us" page
First things first. Do you have an "About Us" page? An "About" page is one of the most visited pages on a website, and people often look here to learn more about a company, its products, and its services. They go here to learn about an organization, its values, its history and how reliable it is.
Don't leave consumers in the dark. If you do, consumers will be less likely to go through with purchases or interact with the brand itself. Instead, invest in a stunning design that speaks to your demographic and represents the company well through stunning images, creative typography and messaging that's on-brand, like Refinery29 does.
Your "About Us" page is hard to find
Another mistake many brands make is making the "About" page difficult to find. Either it's buried in a drop-down list, hidden within a poorly described headline or lacking the real information users are looking for when seeking out the page itself.
You never want to make it more difficult for the consumer than it has to be — that's one of the first rules of marketing and design alike. And 44 percent of consumers will leave a website if they can't find this vital company and contact information.
Brands can't afford consumers leaving their site without completing the desired actions — so make sure the journey is an easy and simple one.
It's all video and no text
Video is a great medium for giving users information in a fun and creative way. But an "About" page is not the place to use a video to try and tell your audience everything about yourself.
They aren't going to waste time watching a video, especially because for a video to provide all the information necessary, it would be far too lengthy. They want quick facts. And while video is a useful medium to present information, there is just too much that needs to be said in this section for a video to cover.
Or it's all text and no visuals
Just like users don't want to see an "About" page that's all visuals and no text, they don't want to see a page that's just text and no visuals.
Show off your company style! Include a company photo, or photos. Have some fun with it. Show your company history and culture through fun visuals that will get users engaged and give them an understanding of your company as a while.
If you don't, they'll think you're boring. They'll think you lack imagination, compassion and humanity. And they certainly won't waste any more time trying to find out if you're the brand for them. Instead, go for a perfect balance of information and a star piece of content, like Salemtown Board Co.'s brand video above, which is featured on their "About Us" page.
Your "About Us" page is too self-absorbed
A lot goes in to a company's "About" page. But it's not a place to just talk about what makes you great. You have to touch on a variety of topics that give a well-rounded and accurate depiction of your brand.
You have to talk about your history. You have to talk about your accomplishments. But you should also do it through testimonials, reviews and other consumer feedback. You should talk about what makes you unique and what helps you stand out against the competition. But you should also be talking about your goals and objectives while you're at it.
The "About" page isn't the place for boasting. It's the place to provide valuable information to consumers.
It's too long
Of course, there is a lot of information you need to provide in an "About" section, but don't go overboard. An "About" page that has too many words is just as off putting as a page that doesn't have any.
Consumers care, but not enough to read through a novel's-worth of text about your company history and objectives.
Your "About Us" page doesn't include an opt-in lists or forms
Considering the "About" page is one of the most-visited pages on your site, you should be taking advantage of it. You should providing ways for consumers to opt in to newsletters, email lists and social media accounts. Seventy-one percent of social media users say that if they have a positive social media experience with a brand, they are likely to recommend that brand to a friend.
You want as much exposure as possible. You want as many people as possible interacting with your content at all times. By providing these one-click options, it's a no brainer! Something as simple as a subtle newsletter popup, like Airbnb utilizes, can help move the needle.
You're not linking to landing pages
Interlinking in articles is important, as you probably already know. But did you know that you can have extreme success by including links into your landing pages as well?
People will likely go to your "About" page before anything else. Don't make them have to search for your products, services or testimonials – just give them direct access! This makes their entire user experience easier and more pleasant, which will keep them clicking throughout your site and improve your overall conversions.
There's no personality
Every brand has a voice, but it's important to hone in on it in your "About" page. This is where you can let your true personality shine! Throw in some jokes, some silly puns and some clever asides.
People want to know that they are interacting with a human brand. Your voice can still be professional while having a bit of flare.
The creative agency Band executes this well. Their homepage doubles as their "About Us" page, with subtle animations, creative illustrations and a friendly, casual tone capturing potential clients.
The design of your "About Us" page is lacking
Of course, design is vital to the experience overall. Thirty-eight percent of people will stop interacting with a site if it is unappealing.
This means that your "About" page has too look the part just as well as it sounds and reads the part. Don't skimp on the effects — like interactive animations, clever copy, inspiring images and engaging video.
And make sure it's organized!
The 10 "About" Page Mistakes Most Brands Are Making
Are you making any of these mistakes? Because the time to act is now! Check out your company "About" page and give it a skim. If it:
Doesn't exist.
Is difficult to find.
Only includes video.
Only include text.
Is too "About You."
Is too wordy.
Doesn't include opt-in forms.
Doesn't include interlinks.
Lacks personality.
Has lacking design.
Then it's time for a refresh! Optimizing this page and its content is vital for an "About" page that wows and helps drive results. Make the edits today! It's never too late.
Stephanie is a New York City-based writer and editor. When she's not working as the Chief Editor of DesignRush, you can find her drinking copious amounts of coffee, baking in her peanut-sized apartment, or traveling with friends and her tiny dog, Melody.


The Session is the Council of Elders for the congregation. These Elders are set forth in Scripture as those who have the responsibility for governing the congregation and guiding its witness to the sovereign activity of God. The Session has the responsibility and power to provide that the Word of God may be truly preached and heard, to provide that the sacraments may be rightly administered and received, and to nurture the covenant community of disciples of Christ.
The Mission and Outreach Committee leads the congregation toward Christ's mission by creating opportunities for discerning his call to ministries of outreach. This committee nurtures a discerning call in prayer; it equips members to consider where Christ is moving in our neighborhood, and it prepares opportunities to build relationships with our local community and broader church.
The Worship and Music Committee ensures the worship service brings honor and glory to God through the preaching of the Word, the celebration of the sacraments, corporate prayers and the offering of praise to God in song. Our hope is to create a welcoming and authentically uplifting church experience.
The Christian Education Committee forms disciples through creating opportunities to learn about God's story for our lives. The CE committee provides opportunities for children, youth, and adults through Sunday school, Bible studies, youth group, and the Westminster Preschool. Our ministry encourages church members to deepen their faith in choosing curriculum to support classes, supporting youth ministry and confirmation programs, and overseeing the preschool.
The Generosity Committee seeks to grow the church's understanding that giving is the primary expression of Christian discipleship. This committee organizes a year-round emphasis on Christian giving and discipleship through fellowship, prayer, and tithing to support the mission of the congregation.
The Finance Committee oversees the financial welfare of the church through preparing a budget that supports Westminster's mission to our members, the local community, and the church of Jesus Christ.
The Nominations Committee works to ensure a discerning process for church members to be called by God and the congregation to serve the offices of Ruling Elder and Deacon as active members of the Session and Board of Deacons. Additionally, this committee recommends Trustees to serve on the Board of Trustees.
The Personnel Committee provides a focused and considered means for the Session to provide a healthy work environment, encourage professional growth and development for all staff, and seek congregational input to help church staff be more responsive to changing needs of the church membership, the community, and the larger church.
The Safe Church Task Force strives to extend a generous welcome to all who enter our doors. We hope to treat everyone with the love and dignity that God bestows upon each and every one of us. We want people of all ages and capabilities to be able to deepen their relationship with God and each other in a safe space.
The ministry of the Board of Deacons is set forth in Scripture is one of compassion, witness, and service. The Deacons provide congregational care for those in the church and community who are in need of extra care through life's circumstances. Additionally, the Deacons host congregational events for the nurturing of relationships in fellowship.
The Board of Trustees ministers to the congregation through providing for the church's property as a tool for the accomplishment of the mission of Jesus Christ.
The Manse Committee ensures that the manse continues to be a well-maintained and attractive home for the Westminster congregation and the Pastor's family.
The Westminster Church Youth Program continually strives to gain knowledge of our Lord and Savior as we grow in faith. This ministry supports church and community programs, has fun, encourages others, gives time and talents, and lives-out a Godly example.


Main opposition Maldivian Democratic Party (MDP) on Tuesday filed a motion asking the parliament to look into the recent government housing policy alleging that it was denying housing for ordinary people.
South-Henveiru MP Mohamed Abdul Kareem said the motion was filed to find the stand of the parliament in the matter.
The motion would also seek to force the government revise its current housing policy which would allow affordable housing to ordinary people, the opposition lawmaker added.


In 2014, APNEP collaborated with North Carolina Sea Grant to tackle the spread of the invasive aquatic plant Hydrilla in the Albemarle-Pamlico region. As part of that effort, APNEP developed an informational video about Hydrilla that is intended to increase awareness about this invasive plant. This video as well as other APNEP-created videos are available on the APNEP Youtube channel.
In 2015, APNEP staff partnered with NC Sea Grant once more to conduct a survey of Hydrilla on the Chowan River. This was the first baseline survey to determine the location and extent of Hydrilla in the region.


The Zonin family has been making wine since 1821 and currently operates Italy's largest privately owned vineyard and winemaking complex. The house produces 25 million bottles and exports its wines to 69 countries. To increase their presence in the chinese market, we were requested to develop concept brands for their wines that transmit the idea of "Italian" to the chinese audiences.
ITALIANI brand relates each wine with an italian region and the wine gets the name from the way its inhabitants are called. ITALIANI wine rage targets mid-age consumers. The wines are produced on the region they are named after (Sicily, Venice and Tuscany).
The labels are inspired in the image that Zonin used for their "Americano" Vermouth in the 50s.


text:
Marco Vernaschi named finalist in international photo competition
July 02, 2009 | Project news
Pulitzer-supported photojournalist Marco Vernaschi was among 10 finalists selected at the Ojo de Pez Award for Human Values, a major international photography competition, for his in-depth examination of the illegal activity within Guinea Bissau, "West Africa's New Achilles' Heel." He and his fellow finalists were chosen from 620 entries.
In October, their work will be showcased in a special issue of OjoDePez magazine. Vernaschi's vivid images of prostitution and drug trafficking in the West African country will also be exhibited throughout Europe in the Fall.
Guinea-Bissau: West Africa's New Achilles' Heel
Nathalie Applewhite
Pulitzer Center staff
Nathalie joined the Pulitzer Center in 2006, shortly after its founding, and has played a key role in the development of the Center's model and approach towards journalism initiatives and educational...
Conflict, Human Rights, Terrorism
Pulitzer Center Update:


Inspiring showcases designs living room 25 for online design with. Showcase designs for living room fresh at popular wonderful. Living room : unforgettable showcases designs living room images. Living room : wooden showcase designs for living room interior.


If you are 1 of the many people in Milton Keynes who are experiencing marital issues, separation or divorce the are probably numerous questions that keep elevating their heads. Right here are a few answers to the most typical types.
Do your values now differ from these of your partner? People often change their outlook on lifestyle, as they get older. If this prospects to two people thinking extremely in a different way about essential problems, it can direct to a break-up.
Do the same previous arguments keep rearing their head? When arguments are settled, they should stay so. If one of you keeps bringing up the past, it shows an unwillingness to move on.
If you want to conserve and nurture your marriage you should discover to be a good partner. You must listen to your partner and understand them. Attempt to understand what they really feel and why they really feel that way.
Where there are disagreements or you are unaware of your rights, seek the advice of your divorce solicitor and inquire for their guidance. They will assist make certain you get what you're legally entitled to.
If you're established that your children's grandparents will nonetheless have visiting rights and other duties and rights, then you'll want your Divorce solicitors Manchester to be aware of this, and to assist you.
A tough summary of your family members's financial position, including details of any home, its tough worth and any financial debt excellent on it, details of any pensions, financial savings, shares, endowment policies or other investments, and any other family members property or debts.
Finally, as well as contemplating how the divorce proceedings will affect your children throughout the proceedings, you'll also need to believe about their lengthy-term interests. Which mother or father will they be living with? What accessibility should the other mother or father have? Can you reach an agreement in between you? If the solution to the final query is 'yes', this might be simple to function out. Otherwise, a family law solicitor will be required.


text:
Orders Downloads Address Payment methods Account details
Psychiatrist.com About JCP About PCC About
Error: Search field were incomplete.
Search (required):
JCP Current Issue
JCP Weekly
JCP Archives
PCC Current Issue
PCC Weekly
PCC Archives
Academic Highlights
ASCP Corner
Banner Alzheimer's Institute
Childhood and Adolescent Mental Health
Clinical and Practical Psychopharmacology
Inadequate Response to Antidepressants in MDD
Focus on Geriatric Psychiatry
Focus on Psychosis
Focus on Suicide
InfoPacks
Insights Videos
Living With Tardive Dyskinesia
Rounds in the General Hospital
Depression (MDD)
Neurodevelopmental
Neurologic and Neurocognitive
Obsessive-Compulsive and Related Disorders
Schizophrenia and Schizoaffective Disorders
Sleep-Wake
Depression with Suicidal Ideation
MS Team Meeting
Schizophrenia Treatment with LAI
COVID Depression
The Black Physician Experience
JCP: Submit Your Manuscript
JCP: Info for Authors
JCP: Info for Reviewers
PCC: Submit Your Manuscript
PCC: Info for Authors
PCC: Info for Reviewers
This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher's Terms & Conditions.
CME Academic Highlights
Optimizing Treatment Choices to Improve Adherence and Outcomes in Schizophrenia
John M. Kane, MD, and Christoph U. Correll, MD
See letter by Hirakawa and Ishii and reply by Kane and Correll
CME Background
Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results.
To obtain credit, read the article, correctly answer the questions in the Posttest, and complete the Evaluation.
This Academic Highlights activity is derived from the planning teleconference series "Optimizing Treatment Choices to Improve Adherence and Outcomes in Schizophrenia," which was held in March and April 2019. This report was prepared and independently developed by the CME Institute of Physicians Postgraduate Press, Inc., and was supported by an educational grant from Indivior Inc.
The teleconference was chaired by John M. Kane, MD, Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York. The faculty was Christoph U. Correll, MD from the Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York.
After studying this article, you should be able to:
Monitor adherence to treatment in patients with schizophrenia
Identify patients who would benefit from LAI treatment
Address somatic and psychiatric comorbidities in the care of patients with schizophrenia
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Release, Expiration, and Review Dates
This educational activity was published in September 2019 and is eligible for AMA PRA Category 1 Credit™ through October 31, 2021. The latest review of this material was August 2019.
All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Marlene P. Freeman, MD, Editor in Chief, has received research funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes, and Sunovion; has been a member of the Independent Data Safety and Monitoring Committee for Janssen; and, as a Massachusetts General Hospital (MGH) employee, works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Sunovion, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure appears at the end of the article.
J Clin Psychiatry 2019;80(5):IN18031AH1C
To cite: Kane JM, Correll CU. Optimizing treatment choices to improve adherence and outcomes in schizophrenia. J Clin Psychiatry. 2019;80(5):IN18031AH1C
To share: https://doi.org/10.4088/JCP.IN18031AH1C
© Copyright 2019 Physicians Postgraduate Press, Inc.
Schizophrenia is a serious, lifelong mental illness. Recovery is possible with consistent, supportive treatment, but relapse is common. A frequent contributor to relapse is treatment nonadherence. Long-acting injectable (LAI) antipsychotics can improve treatment adherence and continuity, potentially improving outcomes for patients, but these agents are underused. Experts John M. Kane, MD, and Christoph U. Correll, MD, described the frequency and consequences of nonadherence and strategies to improve adherence and overall patient outcomes.
MONITORING ADHERENCE IN PATIENTS WITH SCHIZOPHRENIA AND IDENTIFYING CANDIDATES FOR LAI ANTIPSYCHOTICS
Medication adherence is a major problem in all areas of medicine, not just psychiatry, whether patients have heart disease, diabetes, asthma, epilepsy, or any other condition that requires daily medication.1,2 According to a report by the World Health Organization, poor medication adherence for chronic diseases is a worldwide problem of enormous importance—the rate of adherence averages 50% in developed countries and is lower in developing countries.3 As many as two-thirds of patients with schizophrenia are estimated to be at least partially nonadherent to oral antipsychotic treatment.4 Clinicians need to address the problem of nonadherence with patient-tailored interventions and education. In his presentation, Dr Kane offered insight into communication with patients about adherence and about interventions to diminish nonadherence.
Factors in Nonadherence
Prescribers would like for patients to believe that their medicine is beneficial, makes them feel better, and is worth the cost. However, many factors contribute to nonadherence. It may be related to patient issues, specific treatments (eg, side effects, lack of efficacy), or the patient's overall condition.3 Individuals with schizophrenia face special challenges in taking medication as prescribed. The illness is often complicated by poor insight and cognitive dysfunction; poor symptom control can contribute to nonadherence; patients are less likely to take medicine if they cannot see the value in taking it; adverse effects may be intolerable; patients may have poor social support; and substance abuse is common and can contribute to nonadherence.5-7 Social, economic, and health system factors may interfere as well.
Keeping up with daily medications can be difficult, as one person shared about her brother with schizophrenia:
Family Perspectives
"It seems that deciding to take medication is one thing for diagnosed people, but deciding to ensure that it is taken exactly as prescribed at the exact right time is another issue entirely. My brother is proof that it is extremely difficult to keep track of many different medications simultaneously. . . . A single mismanaged dose can potentially lead to weeks of hardship. . . . Going without has caused a lot of unnecessary hardship for my brother and it's possible that some of his visits to the emergency room for psychological distress could have been avoided entirely."8
Assessing Nonadherence
Unfortunately, many physicians overestimate treatment adherence.9,10 Dr Kane said that clinicians' perceptions of their own patients can be biased and may reflect the view that nonadherence is a problem that other clinicians have. Physicians may think that their patients are better with compliance or are more likely to listen to them than the patients reported in the literature,11 even though this may not necessarily be the case.
Expert consensus recommendations are to assess adherence via not only self-report but also objective tools.12 For example, the Medication Adherence Rating Scale can be used with patients who have schizophrenia.13,14 Pill counts and informant ratings can also be useful.15
To improve the accuracy of patients' self-report, asking about their experiences taking medication may be more useful than asking a direct question about nonadherence (Figure 1).6,16 Dr Kane recommended that clinicians avoid conveying an attitude that patients who miss or stop taking medications are "bad patients"; instead, they should communicate that nonadherence is human nature and happens frequently and that doctors want to help patients benefit from their medications as much as possible.
Relationship Between Nonadherence and Relapse
Poor adherence to oral antipsychotics is the most common cause of relapse.4 A summary of 5 studies compared continuous antipsychotic treatment with intermittent treatment (ie, patients were treated only when clinicians thought they were experiencing early signs of relapse).17 All 5 studies showed a significantly lower rate of relapse in patients with continuous treatment than in those with intermittent treatment.
Patients with schizophrenia are at risk for relapse and hospitalization after intervals of missed medication as short as 10 days or less (Figure 2).18,19
A systematic review20 of 6 studies assessing the risk of relapse after treatment discontinuation found that 77% of patients relapsed within 1 year. The rate of relapse among these patients jumped to 90% after 2 years. In comparison, the rate of relapse among patients with good adherence has been reported as 18%.21
A study22 by Robinson and colleagues followed 104 first-episode patients and found that after 5 years, 82% of the cohort had experienced at least one relapse. Stopping medication was found to be the most powerful predictor of relapse; patients who stopped were 5 times more likely to relapse than patients who continued with their medication.
Consequences of Relapse
Dr Kane noted that, with each relapse, the onset of therapeutic effect of medication may be slower, treatment may be less effective, and patients can experience greater hardships and illness burden. Relapses have been associated with progressive decline in brain volume.23 Ramifications of relapse among patients with schizophrenia include the following24:
Increased risk of self-harm
Increased risk of harm to others
Increased distress for patients and families
Increased strain on friendships and relationships
Disruptions in education
Disruptions in vocational functioning
Decreased patient autonomy
Increased social stigma
Increased economic burden associated with treatment
Increased risk of not returning to baseline functioning
Increased resistance to treatment
A study25 that followed 130 patients showed that reaching the same degree of improvement after a relapse took longer with the second episode than the first. The illness, in other words, became less responsive to treatment.
A Dutch study26 of 603 patients with schizophrenia investigated the relationship between an interruption in medication of at least 30 days and suicide. After adjusting for age and gender, the relative risk of suicide attempt was found to increase approximately 4-fold among patients with a 30-day or more interruption compared with patients who did not have an interruption.
Cooperation between patients and clinicians is necessary to minimize relapses and their consequences such as lost jobs, as illustrated by a patient who experienced multiple relapses:
Patient Perspectives
"I was diagnosed as schizophrenic when I was 13 years old. I spent the better part of my adolescence and young adulthood in hospitals. . . . I fought my disease and the stigma of mental illness in my struggle for employment. I learned from my mistakes which cost me several jobs, and along with my psychiatrist, we experimented with different medications. Fortunately, we found a combination of medications which kept me out of hospitals and I kept employment."27
Using Long-Acting Injectable Antipsychotics
Long-acting injectable (LAI) antipsychotics can play a role in helping patients with schizophrenia remain adherent.4,28,29 Research indicates that patients treated with LAI antipsychotics have decreased hospitalization and use of emergency services compared with those treated with oral antipsychotics.30-32 A real-world comparative effectiveness trial33 that included almost 30,000 patients found that LAIs and clozapine were the most effective treatments for preventing schizophrenia relapse; rehospitalization rates among patients receiving LAIs were 20%-30% lower than for patients receiving equivalent oral formulations. However, this treatment modality is not prescribed as often as oral antipsychotics.4,34
Many factors play a role in the underuse of LAIs. Clinicians may have inaccurate perceptions about the medications and their patients' attitudes toward them (Figure 3).35-40 Additionally, clinicians may think that they have clearly explained the treatment options to patients, but the conversation may be interpreted differently by patients. A survey37 of patients being treated for schizophrenia and having no prior experience with LAIs, as well as psychiatrists, highlighted the disconnect between patients and clinicians. Only 21% of the patients reported that they had been informed of LAI options by their psychiatrist. Yet, 75% of the psychiatrists surveyed said that they had informed their patients about different formulations of antipsychotics, including LAI options.
Patient attitudes toward LAIs are frequently positive.38 In a survey of patients with > 3 months of experience with an LAI formulation, LAIs were preferred, and 70% of patients felt better supported in their illness (compared with oral medication) because of regular contact with the clinician who administered their injection.40
What Can Clinicians Do to Improve Adherence?
The LAIs used to be considered appropriate for only a subgroup of patients with schizophrenia who had major nonadherence problems and frequent relapses.41 Recent guidelines,41,42 however, have noted the potential benefit of using second-generation LAIs following the first episode; LAIs have been found to be effective to prevent relapse in patients experiencing their first episode43 as well as in those who have already experienced multiple relapses.44,45 These agents should be "systematically proposed to any patients for whom maintenance antipsychotic treatment is indicated."41
Communication issues between clinicians and patients need to be overcome, noted Dr Kane. If clinicians are inadequately aware of data or are ambivalent about the message that LAIs are useful, then the dialogue will be ineffective. Clinicians should reflect on their own beliefs and recognize any negative assumptions about patient preferences. Clinicians with negative assumptions about LAIs will most likely present the option with a pessimistic tone that patients notice.39
Dr Kane stated that clinicians should consider the use of LAI formulations for any patient and start the conversation at the beginning of treatment. If the option of LAIs is introduced at a later date, it might be confusing or viewed as a negative response to a patient's hospitalization. Clinicians also need to make sure that their staff members and patients' family members understand why LAI formulations are being offered. A single team member who does not support the use of LAIs can undermine the treatment strategy with the patient.
Recent research showed that, even among first-episode and early-phase patients, the overwhelming majority of patients would consider the use of LAI formulations—only 14.4% of outpatients who were approached declined LAI treatment.46 Staff education, which was successfully provided for this research, has the potential to substantially enhance the use of LAI antipsychotics. Staff members were trained on the role of nonadherence in relapse and hospitalization and the rationale for using an LAI formulation in patients with early-phase psychosis.46 They also received education about shared decision-making, communication strategies, and patients' frequently asked questions; role-playing was used to develop their communication skills. Solutions were also devised to overcome logistical barriers to LAI use, and study prescribers received training on prescribing guidelines.
Dr Kane concluded that, if clinicians can employ these strategies for assessment, communication, and education, then far more patients could be engaged in treatment with LAI antipsychotics, which may provide enormous benefit to the patients, their families, and public health.
Case Practice Question
Discussion of the best response can be found at the end of the activity.
Case 1. John is a 33-year-old man who is diagnosed with schizophrenia and in his third hospitalization for psychosis. What should the clinical team consider in terms of preventing future relapses?
John has refused LAI antipsychotics in the past, but the options may not have been communicated in the best way.
John would be more likely to relapse if his oral medication is switched to an LAI than if he keeps the same regimen.
Nonadherence is probably not why John has had relapses, as he says he takes his tablets daily.
TREATING THE WHOLE PATIENT: INCORPORATING THE PHARMACOLOGY OF TREATMENTS FOR SCHIZOPHRENIA AND SPECIAL CONSIDERATIONS FOR COMORBID CONDITIONS
While acute treatment efficacy and early remission of symptoms are important, effective maintenance treatment is crucial in keeping patients with schizophrenia stable.47,48 Effective maintenance management of schizophrenia starts with efficacious and tolerable treatment. In general, efficacy differences among antipsychotics are relatively small, while tolerability differences are larger, which is true both for acute49,50 and maintenance51 treatment. Several LAI antipsychotics are available and differ based on starting dose, maintenance dose, and whether or not oral cotreatment is necessary at initiation (Table 1).52-61 They also differ in that first-generation LAIs are oil-based, while second-generation LAIs are water-based, which leads to less injection pain and reaction.
In his presentation, Dr Correll reviewed evidence on LAIs and described situations in which LAIs might be especially useful.
Evidence on Discontinuation and Relapse With LAI Antipsychotics
A large meta-analysis62 of randomized controlled trials (RCTs) was not able to demonstrate LAI superiority over oral agents, but this finding appears to be due to biased populations enrolled in RCTs.63 Patients in double-blind RCTs tend to be more adherent, tend to have better illness insight, and might not be as severely ill as patients in the "real world."64 Consistent with this interpretation, in meta-analyses of mirror image64 and cohort65 studies, which reflect more real-world patient populations, LAIs have been shown to prevent treatment discontinuation and reduce hospitalizations better than oral treatments.
One reason for the consistent results of LAI superiority over oral antipsychotics in 23 of the 25 meta-analyzed mirror image studies64 may be improved medication possession. A study66 of medication possession ratios based on pharmacy records reported that patients were in possession of oral medications only 40% and 42% of the time during a 12-month period, for commercially insured and Medicare-insured groups, respectively. However, when these patients were switched to LAIs for 12 months, the medication possession ratios rose to 67% and 68%.
A meta-analysis67 showed that maintenance treatment with either oral or LAI antipsychotics has a strong relapse-prevention effect, translating into in a number-needed-to-treat of 3 versus placebo; however, the injectable formulations were associated with a greater reduction in relapse than oral drugs (P = .03).
Unlike with oral medication, clinicians have clear information when a patient misses a dose of an LAI. Furthermore, the window of opportunity to get the patient back into care before a relapse is extended due to the long-acting nature of LAIs. A study68 indirectly compared relapse rates from separate RCTs, in which patients were switched to placebo following stabilization on 1 of 3 formulations of paliperidone: oral, once-monthly, and every 3 months. The duration until half of the patients relapsed was 59 days after the last dose of oral paliperidone treatment, 200 days after the last dose in patients who had received once-monthly paliperidone, and 479 days among the group that had received every-3-months paliperidone.
In the past, LAI antipsychotics were reserved for patients who had had multiple relapses, showed poor insight into the illness, and demonstrated nonadherence, but, as Dr Kane noted, guidelines now suggest considering LAIs as an initial treatment for any patient. Dr Correll stated that certain subgroups who would especially benefit from this change are those in the early stage of illness, who have substance abuse, and/or who are in contact with the legal system.43,69-75 Although comorbid depression76,77 and sleep disruption78-80 are common in patients with schizophrenia and negatively affect outcome,81 studies of LAIs in patients with these comorbidities are still lacking.
Early-illness patients. A study43 of patients hospitalized between 2000 and 2007 with first-episode schizophrenia who were discharged on either oral or LAI treatments showed that the LAI treatment group had a 59% decreased risk for discontinuation and a 64% decreased risk for rehospitalization. A 12-month trial71 of patients with first-episode schizophrenia (N = 86) found that oral treatment was associated with an observed relapse rate of 33% compared with 5% in the group receiving the LAI. In fact, in survival analyses, the relapse rates were estimated to be 50% vs 8.5% if all patients had been followed for an entire year, and at the end of the study, only 33% of orally treated patients, compared with 95% of LAI treated patients, had "excellent" adherence. Finally, in a study of patients with a recent diagnosis of schizophrenia (within 1-5 years),69 LAI treatment reduced relapse risk by 29.4% versus oral treatment.
Patients with substance use or legal involvement. Substance abuse occurs more frequently in individuals with schizophrenia than in the general population and is associated with antipsychotic nonadherence.74 A mother described her son's current situation:
"My son is 21 and has been living with this horrible disease since he was 18. We have had 4 hospitalizations, each over a month in duration. We seem to be in a rut right now. He is non-med-compliant, refuses to go to treatment. . . . Before his hospitalization he was drinking heavily."82
A naturalistic 3-year study75 of patients treated for first-episode schizophrenia who had substance use disorder found that, despite worse prognostic factors in the group receiving LAIs (eg, history of homelessness), these patients fared better than those taking oral antipsychotics. The LAI group experienced a lower relapse rate (68% vs 77%) and a longer time to relapse (694 days vs 447 days).
A 15-month, open-label randomized study70 of patients with schizophrenia and a history of incarceration demonstrated a lower rate of treatment failure (arrest/incarceration, psychiatric hospitalization, suicide, treatment discontinuation or supplementation, or increased service use to prevent hospitalization) in the LAI treatment group (39.8%) than in the oral treatment group (53.7%).
Patients experiencing breakthrough psychosis. Patients with breakthrough psychotic symptoms while on LAI treatment need special care.72,83 Dr Correll recommended that clinicians should rule out or address medical illness or substance use, identify and address stressors, optimize nonpharmacologic treatments, and treat comorbidities that could contribute to the exacerbation. Clinicians must also review whether the LAI administration was properly handled. The medication could have been mixed improperly or not injected deeply enough, reducing the rate of distribution.
If doses have been missed or delayed, the patient's next injection could be scheduled earlier than usual while staying within the recommended interval.72 Clinicians could also increase LAI doses if not at the maximum. If doses are at the maximum, a possible solution is to add an extra oral dose of the same medication and monitor for 2-4 weeks. If the patient tolerates the extra dose and responds well, then his or her injection interval could be shortened (an off-label strategy).
The site of injection may also need to be moved because deltoid injections reach higher peak levels but result in a shorter half-life, while gluteal injections reach lower peak levels but result in a longer half-life.84-86 If the symptoms still persist, clinicians may consider switching from one LAI to another or implementing different oral treatment, possibly clozapine for treatment resistance.72
Discussion of the best responses can be found at the end of the activity.
Case 2. Jamal is a 24-year-old man with first-episode schizophrenia who has responded well to an oral second-generation antipsychotic. Which statement about next steps is most applicable?
Oral treatment that works will have the best chance to limit Jamal's risk of relapse.
Because Jamal has had only a first episode of schizophrenia, it is too early to start LAI treatment.
An LAI antipsychotic would have the best chance of reducing Jamal's relapse risk.
Case 3. Mateo is a 37-year-old man who has schizophrenia and is abusing marijuana and alcohol. During several inpatient stays, Mateo's schizophrenia stabilized, and he was unable to use drugs. After each discharge, he resumed his drug use and intermittent nonadherence with oral antipsychotics, leading to relapse. Mateo was recently involved in minor criminal activity, arrested, and briefly incarcerated. You need to devise a treatment plan; which statement reflects the most evidence-based strategy for Mateo?
Because Mateo uses alcohol and marijuana and has had problems with the law, an LAI antipsychotic will not be better than oral treatment for relapse prevention.
Relapse prevention with an LAI antipsychotic will most likely be more effective for Mateo than it would if the same LAI antipsychotic were prescribed for a patient without drug or alcohol use.
Relapse prevention with an LAI antipsychotic will most likely be similarly effective for Mateo as when the same LAI antipsychotic is prescribed for a patient without drug or alcohol use.
Relapse prevention with an LAI antipsychotic will most likely be less effective for Mateo than it would when prescribed for a patient without drug or alcohol use, but it may be more effective than the oral agents for Mateo.
When devising a treatment plan, it is very important to consider tolerability,87 which can affect the likelihood that patients will continue treatment. Dr Correll stated that clinicians should bear in mind that antipsychotic side effect differences are larger and easier to predict than efficacy differences.50
A survey of patients with schizophrenia ranked the 5 most commonly occurring adverse effects as weight gain, somnolence or insomnia, problems with concentration, memory loss, and disorganized thoughts.88 Relatives have reported that particularly unpleasant side effects for patients include sedation, weight gain, and extrapyramidal symptoms.89 A meta-analysis90 of RCTs that compared 119 adverse effects found no significant differences among LAI and oral versions of the same antipsychotics for 115 of them. Only 3 adverse effects occurred significantly more frequently with LAIs than with oral treatments: akinesia, higher low-density lipoprotein cholesterol, and anxiety. Prolactin change/hyperprolactinemia occurred significantly less frequently with LAIs than oral medications. Iatrogenic effects—including weight gain, hyperprolactinemia, diabetes, and extrapyramidal side effects—have been reported to reduce patients' medication adherence91 and quality of life.88,92
Risk of mortality. In a recent, 30-year Finnish study93 of mortality, the mean age at death was found to have increased among patients with schizophrenia, and the rate of suicide had decreased. However, a gap still exists, with the average age at death in the general population being 77.5 years and in those with schizophrenia being 70.1 years. Increases were found in deaths from cardiovascular diseases and cancer. In a Swedish study,94 the risk of death was found to be 56% lower among individuals with schizophrenia who were taking antipsychotics than among those taking no antipsychotics. The use of LAI antipsychotics was associated with a 33% lower risk of death compared with equivalent oral formulations.94
Offering LAIs
Dr Correll agreed with Dr Kane that prescribers appear to have misconceptions about attitudes their patients may have toward LAI treatment. In a survey of opinions about LAIs among patients and health professionals,95 the health professionals overestimated many concerns they believed their patients taking oral antipsychotics had about LAIs, including fear of pain at the injection site, embarrassment, reduced autonomy, and stigma. The only concern that patients had to a greater extent than imagined by clinicians was related to the amount of time they would be required to stay in the clinic for the mandatory observation after an injection of olanzapine pamoate.
Clinicians who offer LAIs may require training in communication. In a 2015 study,96 psychiatrists were recorded while offering LAIs to their patients. In 33 conversations, only 9% of the speech time was dedicated to explaining positive aspects of LAI treatment (eg, no need for daily medication); 91% of the time was spent on the modality ("a shot") or neutral aspects. Two-thirds of patients expressed either a neutral or positive response to the offer of LAI therapy (with 33% indicating a potential willingness to try it). When another physician trained in delivering a positive message about LAIs and their potential advantages went back a few days later to speak to the patients, as many as 96% stated that they were open to try.
Patients may hear "injection" and not understand what is meant, as the following qualitative study's comments indicate:
"A patient . . . feared that he might get ' addicted' to a[n] LAI as it was administered by an injection. This view related to him associating ' addiction' with injectable ' street drugs.' Another patient queried whether a[n] LAI needed to be injected daily ' like insulin.' "97
Dr Correll suggested that clinicians practice motivational interviewing by listening to and understanding the patient's values and fears. Clinicians should be nonjudgmental, respectful, collaborative, flexible, and empathic. The GAIN model98 to facilitate change is based on the LEAP communication model,99 in which the steps are Listen, Empathize, Agree, and Partner. The GAIN model can be used to discuss LAI antipsychotics with patients (Table 2).98 Dr Correll concluded that clinicians should identify patient goals and should help patients recognize the disparity between where they are now and where they would like to be ideally, with medication being one tool to help them reach their goals.
Acute and long-term objectives must be linked early in the treatment of schizophrenia. Maintenance therapy is pivotal in relapse prevention. Relapses are serious events that alter disease trajectory and are most often related to nonadherence, which can be prevented in many cases with LAI treatments. Long-acting injectable treatments are still underused. Presentation matters for LAI treatments to be accepted by patients and family members. Communication strategies can be improved with clinician/staff training. As always, the risk-benefit ratio of treatment must be considered when choosing among available options.
Clinical Points
Antipsychotic medication is critical in the prevention of relapse and rehospitalization.
Rates of nonadherence are enormously high among patients taking antipsychotic medication.
Long-acting formulations can be a very powerful strategy in helping to ensure that patients get the benefit of the medication they have been prescribed.
Patients should be offered the option of LAI antipsychotic treatment and should understand the logistics and the potential benefits of the regimen.
Communication strategies can be used to improve clinicians' dialogue with patients about LAI treatment
Discussion of Case Practice Questions
Case 1: Preferred response is a.
Clinicians may not communicate effectively with patients about LAI options, especially if they harbor negative opinions of the treatment modality or of patients' willingness to try LAIs. John's clinical team should use nonjudgmental questions and objective tools to assess whether John has a problem with adherence and, if so, offer education and patient-tailored interventions. He may be more willing to try an LAI now if his treatment team describes it in a positive way, answers his questions, and helps him understand that it might help him to avoid relapses and achieve his own, personalized goals.
Case 2: Preferred response is c.
See explanation below.
Case 3: Preferred response is d.
Guidelines now suggest considering the use of LAIs following the first episode of schizophrenia to reduce the risk of relapse (as in Case 2). Studies have also indicated benefits of LAIs versus oral treatment among patients who have substance abuse and contact with the legal system (as in Case 3).
Published online: September 17, 2019.
Disclosure of off-label usage: The chair has determined that, to the best of his knowledge, no investigational information about pharmaceutical agents that is outside US Food and Drug Administration-approved labeling has been presented in this article.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1 hour of Category I credit for completing this program.
Dr Kane is a consultant for and has received honoraria from Alkermes, Allergan, Genentech, Lundbeck, Intracellular Therapies, Janssen, Johnson & Johnson (J&J), Merck, Neurocrine, Otsuka, Pierre Fabre, Reviva, Roche, Sunovion, Takeda, and Teva; has received grant/research support from Otsuka, Lundbeck, and Janssen; is a member of the speakers/advisory boards for Alkermes, Intracellular Therapies, Lundbeck, Neurocrine, Otsuka, Pierre Fabre, Roche, Sunovion, Takeda, Teva, and Reviva; and is a stock shareholder of Vanguard Research Group and LB Pharma. Dr Correll is a consultant for and has received honoraria from Alkermes, Allergan, Angelini, Boehringer-Ingelheim, Gerson Lehrman Group, Indivior, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Merck, Neurocrine, Noven, Otsuka, Pfizer, Rovi, Servier, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva; has received grant/research support from Janssen and Takeda; is a member of the advisory boards for Alkermes, Allergan, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, Merck, Neurocrine, Noven, Otsuka, Sunovion, Supernus, Takeda, and Teva; is a stock shareholder of LB Pharma; and has received other financial support from Janssen and Otsuka (expert testimony) and UpToDate (royalties).
The faculty member(s) agreed to provide a balanced and evidence-based presentation and discussed the topic(s) and CME objective(s) during the planning sessions. The faculty's submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.
The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.
This CME activity is expired. For more CME activities, visit cme.psychiatrist.com.
Find more articles on this and other psychiatry and CNS topics:
1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497. PubMed CrossRef
2. Kane JM, Kishimoto T, Correll CU. Non-adherence to medication in patients with psychotic disorders: epidemiology, contributing factors and management strategies. World Psychiatry. 2013;12(3):216-226. PubMed CrossRef
3. World Health Organization. In: Sabaté E, ed. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003. WHO website. https://www.who.int/chp/knowledge/publications/adherence_full_report.pdf.
4. Kaplan G, Casoy J, Zummo J. Impact of long-acting injectable antipsychotics on medication adherence and clinical, functional, and economic outcomes of schizophrenia. Patient Prefer Adherence. 2013;7:1171-1180. PubMed CrossRef
5. Achtyes ED, Simmons A, Skabeev A, et al. 21 patient preferences concerning the efficacy and side-effect profile of schizophrenia medication: a survey of patients living with schizophrenia. CNS Spectr. 2019;24(1):184. PubMed CrossRef
6. Velligan DI, Weiden PJ, Sajatovic M, et al; Expert Consensus Panel on Adherence Problems in Serious and Persistent Mental Illness. The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry. 2009;70(suppl 4):1-46, quiz 47-48. PubMed CrossRef
7. Werner F-M, Covenas R. Long-term administration of antipsychotic drugs in schizophrenia and influence of substance and drug abuse on the disease outcome. Curr Drug Abuse Rev. 2017;10(1):19-24. PubMed CrossRef
8. Treatment plans: lessons learned. Family and Caregiver Schizophrenia Discussion Forum. https://family.schizophrenia.com/. Published May 2019. Accessed July 2, 2019.
9. Stephenson JJ, Tunceli O, Gu T, et al. Adherence to oral second-generation antipsychotic medications in patients with schizophrenia and bipolar disorder: physicians' perceptions of adherence vs pharmacy claims. Int J Clin Pract. 2012;66(6):565-573. PubMed CrossRef
10. Byerly MJ, Thompson A, Carmody T, et al. Validity of electronically monitored medication adherence and conventional adherence measures in schizophrenia. Psychiatr Serv. 2007;58(6):844-847. PubMed CrossRef
11. Kane JM, Leucht S, Carpenter D, et al; Expert Consensus Panel for Optimizing Pharmacologic Treatment of Psychotic Disorders. The Expert Consensus Guideline series, optimizing pharmacologic treatment of psychotic disorders: introduction: methods, commentary, and summary. J Clin Psychiatry. 2003;64(suppl 12):5-19. PubMed
12. Velligan DI, Weiden PJ, Sajatovic M, et al. Assessment of adherence problems in patients with serious and persistent mental illness: recommendations from the Expert Consensus Guidelines. J Psychiatr Pract. 2010;16(1):34-45. PubMed CrossRef
13. Jaeger S, Pfiffner C, Weiser P, et al. Adherence styles of schizophrenia patients identified by a latent class analysis of the Medication Adherence Rating Scale (MARS): a six-month follow-up study. Psychiatry Res. 2012;200(2-3):83-88. PubMed CrossRef
14. Zemmour K, Tinland A, Boucekine M, et al; French Housing First Study Group. Validation of the Medication Adherence Rating Scale in homeless patients with schizophrenia: Results from the French Housing First experience. Sci Rep. 2016;6(1):31598. PubMed CrossRef
15. Brain C, Sameby B, Allerby K, et al. Twelve months of electronic monitoring (MEMS) in the Swedish COAST-study: a comparison of methods for the measurement of adherence in schizophrenia. Eur Neuropsychopharmacol. 2014;24(2):215-222. PubMed CrossRef
16. Kane JM. Attitudinal barriers to prescribing LAI antipsychotics in the outpatient setting: communicating with patients, families, and caregivers. J Clin Psychiatry. 2014;75(12):e33. PubMed CrossRef
17. Kane JM. Schizophrenia. N Engl J Med. 1996;334(1):34-41. PubMed CrossRef
18. Weiden PJ, Kozma C, Grogg A, et al. Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiatr Serv. 2004;55(8):886-891. PubMed CrossRef
19. Correll CU. Recognition of patients who would benefit from LAI antipsychotic treatment: how to assess adherence. J Clin Psychiatry. 2014;75(11):e29. PubMed CrossRef
20. Zipursky RB, Menezes NM, Streiner DL. Risk of symptom recurrence with medication discontinuation in first-episode psychosis: a systematic review. Schizophr Res. 2014;152(2-3):408-414. PubMed CrossRef
21. Morken G, Widen JH, Grawe RW. Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia. BMC Psychiatry. 2008;8(1):32. PubMed CrossRef
22. Robinson D, Woerner MG, Alvir JM, et al. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry. 1999;56(3):241-247. PubMed CrossRef
23. Andreasen NC, Liu D, Ziebell S, et al. Relapse duration, treatment intensity, and brain tissue loss in schizophrenia: a prospective longitudinal MRI study. Am J Psychiatry. 2013;170(6):609-615. PubMed CrossRef
24. Emsley R, Chiliza B, Asmal L. The evidence for illness progression after relapse in schizophrenia. Schizophr Res. 2013;148(1-3):117-121. PubMed CrossRef
25. Takeuchi H, Siu C, Remington G, et al. Does relapse contribute to treatment resistance? antipsychotic response in first- vs second-episode schizophrenia. Neuropsychopharmacology. 2019;44(6):1036-1042. PubMed CrossRef
26. Herings RM, Erkens JA. Increased suicide attempt rate among patients interrupting use of atypical antipsychotics. Pharmacoepidemiol Drug Saf. 2003;12(5):423-424. PubMed CrossRef
27. Schizophrenia and Related Disorders Alliance of America. Member Stories. SARDAA website. https://sardaa.org/schizophrenia-alliance/member-stories/. Published 2018. Accessed February 27, 2018.
28. Greene M, Yan T, Chang E, et al. Medication adherence and discontinuation of long-acting injectable versus oral antipsychotics in patients with schizophrenia or bipolar disorder. J Med Econ. 2018;21(2):127-134. PubMed CrossRef
29. Yoshimatsu K, Elser A, Thomas M, et al. Recovery-oriented outcomes associated with long-acting injectable antipsychotics in an urban safety-net population [published online May 17, 2019]. Community Ment Health J. PubMed CrossRef
30. Parro-Torres C, Ros-Cucurull E, Arques-Egea S. 12 impact of aripiprazole long-acting injectable (ALAI) initiation on hospitalizations and visits to emergency. CNS Spectr. 2019;24(1):179-180. PubMed CrossRef
31. Marcus SC, Zummo J, Pettit AR, et al. Antipsychotic adherence and rehospitalization in schizophrenia patients receiving oral versus long-acting injectable antipsychotics following hospital discharge. J Manag Care Spec Pharm. 2015;21(9):754-768. PubMed CrossRef
32. Nielsen RE, Hessellund KB, Valentin JB, et al. Second-generation LAI are associated to favorable outcome in a cohort of incident patients diagnosed with schizophrenia. Schizophr Res. 2018;202:234-240. PubMed CrossRef
33. Tiihonen J, Mittendorfer-Rutz E, Majak M, et al. Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29,823 patients with schizophrenia. JAMA Psychiatry. 2017;74(7):686-693. PubMed CrossRef
34. Patel MX, Taylor M, David AS. Antipsychotic long-acting injections: mind the gap. Br J Psychiatry suppl. 2018;195(S52):s1-s4. PubMed CrossRef
35. Heres S, Hamann J, Kissling W, et al. Attitudes of psychiatrists toward antipsychotic depot medication. J Clin Psychiatry. 2006;67(12):1948-1953. PubMed CrossRef
36. Patel MX, Haddad PM, Chaudhry IB, et al. Psychiatrists' use, knowledge and attitudes to first- and second-generation antipsychotic long-acting injections: comparisons over 5 years. J Psychopharmacol. 2010;24(10):1473-1482. PubMed CrossRef
37. Jaeger M, Rossler W. Attitudes towards long-acting depot antipsychotics: a survey of patients, relatives and psychiatrists. Psychiatry Res. 2010;175(1-2):58-62. PubMed CrossRef
38. Walburn J, Gray R, Gournay K, et al. Systematic review of patient and nurse attitudes to depot antipsychotic medication. Br J Psychiatry. 2001;179(4):300-307. PubMed CrossRef
39. Iyer S, Banks N, Roy M-A, et al. A qualitative study of experiences with and perceptions regarding long-acting injectable antipsychotics, part I: patient perspectives. Can J Psychiatry. 2013;58(suppl 1):14S-22S. PubMed CrossRef
40. Caroli F, Raymondet P, Izard I, et al. Opinions of French patients with schizophrenia regarding injectable medication. Patient Prefer Adherence. 2011;5:165-171. PubMed CrossRef
41. Llorca PM, Abbar M, Courtet P, et al. Guidelines for the use and management of long-acting injectable antipsychotics in serious mental illness. BMC Psychiatry. 2013;13(1):340. PubMed CrossRef
42. Remington G, Addington D, Honer W, et al. Guidelines for the pharmacotherapy of schizophrenia in adults. Can J Psychiatry. 2017;62(9):604-616. PubMed CrossRef
43. Tiihonen J, Haukka J, Taylor M, et al. A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Am J Psychiatry. 2011;168(6):603-609. PubMed CrossRef
44. Kirson NY, Weiden PJ, Yermakov S, et al. Efficacy and effectiveness of depot versus oral antipsychotics in schizophrenia: synthesizing results across different research designs. J Clin Psychiatry. 2013;74(6):568-575. PubMed CrossRef
45. Leucht C, Heres S, Kane JM, et al. Oral versus depot antipsychotic drugs for schizophrenia: a critical systematic review and meta-analysis of randomised long-term trials. Schizophr Res. 2011;127(1-3):83-92. PubMed CrossRef
46. Kane JM, Schooler NR, Marcy P, et al. Patients with early-phase schizophrenia will accept treatment with sustained-release medication (long-acting injectable antipsychotics): results from the recruitment phase of the PRELAPSE Trial. J Clin Psychiatry. 2019;80(3):18m12546. PubMed CrossRef
47. Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatry. 2018;17(2):149-160. PubMed CrossRef
48. Carbon M, Correll CU. Clinical predictors of therapeutic response to antipsychotics in schizophrenia. Dialogues Clin Neurosci. 2014;16(4):505-524. PubMed
49. Zhu Y, Li C, Huhn M, et al. How well do patients with a first episode of schizophrenia respond to antipsychotics: a systematic review and meta-analysis. Eur Neuropsychopharmacol. 2017;27(9):835-844. PubMed CrossRef
50. Leucht S, Cipriani A, Spineli L, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet. 2013;382(9896):951-962. PubMed CrossRef
51. Kishimoto T, Hagi K, Nitta M, et al. Long-term effectiveness of oral second-generation antipsychotics in patients with schizophrenia and related disorders: a systematic review and meta-analysis of direct head-to-head comparisons. World Psychiatry. 2019;18(2):208-224. PubMed CrossRef
52. Lauriello J, Perkins DO. Enhancing the treatment of patients with schizophrenia through continuous care. J Clin Psychiatry. 2019;80(1):AL18010AH2C. PubMed CrossRef
53. Fluphenazine decanoate [package insert]. Rockford, IL: Mylan Institutional LLC; 2018.
54. Haloperidol decanoate [package insert]. Rockford, IL: Mylan Institutional LLC; 2019.
55. Risperidone long-acting injection [package insert]. Titusville, NJ: Janssen Pharmaceuticals, Inc; 2007.
56. Risperidone extended-release injectable suspension, for subcutaneous use [package insert]. North Chesterfield, VA: Indivior Inc; 2018.
57. Olanzapine pamoate [package insert]. Indianapolis, IN: Elly Lilly and Company; 2018.
58. Paliperidone palmitate injection [package insert]. Titusville, NJ: Janssen Pharmaceuticals, Inc; 2019.
59. Paliperidone palmitate injection, suspension, extended release [package insert]. Titusville, NJ: Janssen Pharmaceuticals, Inc; 2018.
60. ARISTADA (aripiprazole lauroxil) extended-release injectable suspension, for intramuscular use [package insert]. Waltham, MA: Alkermes, Inc; 2018.
61. ARISTADA INITIO (aripiprazole lauroxil) extended-release injectable suspension, for intramuscular use [package insert]. Waltham, MA: Alkermes, Inc; 2018.
62. Kishimoto T, Robenzadeh A, Leucht C, et al. Long-acting injectable vs oral antipsychotics for relapse prevention in schizophrenia: a meta-analysis of randomized trials. Schizophr Bull. 2014;40(1):192-213. PubMed CrossRef
63. Kane JM, Kishimoto T, Correll CU. Assessing the comparative effectiveness of long-acting injectable vs oral antipsychotic medications in the prevention of relapse provides a case study in comparative effectiveness research in psychiatry. J Clin Epidemiol. 2013;66(suppl):S37-S41. PubMed CrossRef
64. Kishimoto T, Nitta M, Borenstein M, et al. Long-acting injectable versus oral antipsychotics in schizophrenia: a systematic review and meta-analysis of mirror-image studies. J Clin Psychiatry. 2013;74(10):957-965. PubMed CrossRef
65. Kishimoto T, Hagi K, Nitta M, et al. Effectiveness of long-acting injectable vs oral antipsychotics in patients with schizophrenia: a meta-analysis of prospective and retrospective cohort studies. Schizophr Bull. 2018;44(3):603-619. PubMed CrossRef
66. Offord S, Wong B, Mirski D, et al. Healthcare resource usage of schizophrenia patients initiating long-acting injectable antipsychotics vs oral. J Med Econ. 2013;16(2):231-239. PubMed CrossRef
67. Leucht S, Tardy M, Komossa K, et al. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet. 2012;379(9831):2063-2071. PubMed CrossRef
68. Weiden PJ, Kim E, Bermak J, et al. Does half-life matter after antipsychotic discontinuation? a relapse comparison in schizophrenia with 3 different formulations of paliperidone. J Clin Psychiatry. 2017;78(7):e813-e820. PubMed CrossRef
69. Schreiner A, Aadamsoo K, Altamura AC, et al. Paliperidone palmitate versus oral antipsychotics in recently diagnosed schizophrenia. Schizophr Res. 2015;169(1-3):393-399. PubMed CrossRef
70. Alphs L, Benson C, Cheshire-Kinney K, et al. Real-world outcomes of paliperidone palmitate compared to daily oral antipsychotic therapy in schizophrenia: a randomized, open-label, review board-blinded 15-month study. J Clin Psychiatry. 2015;76(5):554-561. PubMed CrossRef
71. Subotnik KL, Casaus LR, Ventura J, et al. Long-acting injectable risperidone for relapse prevention and control of breakthrough symptoms after a recent first episode of schizophrenia: a randomized clinical trial. JAMA Psychiatry. 2015;72(8):822-829. PubMed CrossRef
72. Correll CU, Sliwa JK, Najarian DM, et al. Practical considerations for managing breakthrough psychosis and symptomatic worsening in patients with schizophrenia on long-acting injectable antipsychotics. CNS Spectr. 2018;1-17. PubMed CrossRef
73. Lynn Starr H, Bermak J, Mao L, et al. Comparison of long-acting and oral antipsychotic treatment effects in patients with schizophrenia, comorbid substance abuse, and a history of recent incarceration: an exploratory analysis of the PRIDE study. Schizophr Res. 2018;194:39-46. PubMed CrossRef
74. Koola MM, Wehring HJ, Kelly DL. The potential role of long-acting injectable antipsychotics in people with schizophrenia and comorbid substance use. J Dual Diagn. 2012;8(1):50-61. PubMed CrossRef
75. Abdel-Baki A, Thibault D, Medrano S, et al. Long-acting antipsychotic medication as first-line treatment of first-episode psychosis with comorbid substance use disorder [published online ahead of print May 24, 2019]. Early Interv Psychiatry. PubMed CrossRef
76. Hou C-L, Ma X-R, Cai M-Y, et al. Comorbid moderate-severe depressive symptoms and their association with quality of life in Chinese patients with schizophrenia treated in primary care. Community Ment Health J. 2016;52(8):921-926. PubMed CrossRef
77. van Rooijen G, Vermeulen JM, Ruhé HG, et al. Treating depressive episodes or symptoms in patients with schizophrenia. CNS Spectr. 2019;24(2):239-248. PubMed CrossRef
78. Chung K-F, Poon YPY, Ng T-K, et al. Correlates of sleep irregularity in schizophrenia. Psychiatry Res. 2018;270:705-714. PubMed CrossRef
79. Monti JM, Torterolo P, Pandi Perumal SR. The effects of second generation antipsychotic drugs on sleep variables in healthy subjects and patients with schizophrenia. Sleep Med Rev. 2017;33:51-57. PubMed CrossRef
80. Baglioni C, Nanovska S, Regen W, et al. Sleep and mental disorders: a meta-analysis of polysomnographic research. Psychol Bull. 2016;142(9):969-990. PubMed CrossRef
81. Siu M-W, Chong CS-Y, Lo WT-L. Prevalence and clinicians' awareness of psychiatric comorbidities among first-episode schizophrenia. Early Interv Psychiatry. 2018;12(6):1128-1136. PubMed CrossRef
82. Unable to live with my son. Family and Caregiver Schizophrenia Discussion Forum. https://family.schizophrenia.com/t/unable-to-live-with-my-son/7794. Published May 20, 2019. Accessed June 24, 2019.
83. Rubio JM, Taipale H, Correll CU, et al. Psychosis breakthrough on antipsychotic maintenance: results from a nationwide study [published online ahead of print June 13, 2019]. Psychol Med. PubMed CrossRef
84. Rossenu S, Cleton A, Hough D, et al. Pharmacokinetic profile after multiple deltoid or gluteal intramuscular injections of paliperidone palmitate in patients with schizophrenia. Clin Pharmacol Drug Dev. 2015;4(4):270-278. PubMed CrossRef
85. Yin J, Collier AC, Barr AM, et al. Paliperidone palmitate long-acting injectable given intramuscularly in the deltoid versus the gluteal muscle: are they therapeutically equivalent? J Clin Psychopharmacol. 2015;35(4):447-449. PubMed CrossRef
86. Ravenstijn P, Samtani M, Russu A, et al. Paliperidone palmitate long-acting injectable given intramuscularly in the deltoid versus the gluteal muscle. J Clin Psychopharmacol. 2016;36(6):744-745. PubMed CrossRef
87. Correll CU. What are we looking for in new antipsychotics? J Clin Psychiatry. 2011;72(suppl 1):9-13. PubMed CrossRef
88. McIntyre RS. Understanding needs, interactions, treatment, and expectations among individuals affected by bipolar disorder or schizophrenia: the UNITE global survey. J Clin Psychiatry. 2009;70(suppl 3):5-11. PubMed CrossRef
89. Angermeyer MC, Matschinger H. Attitude of family to neuroleptics [German]. Psychiatr Prax. 1999;26(4):171-174. PubMed
90. Misawa F, Kishimoto T, Hagi K, et al. Safety and tolerability of long-acting injectable versus oral antipsychotics: a meta-analysis of randomized controlled studies comparing the same antipsychotics. Schizophr Res. 2016;176(2-3):220-230. PubMed CrossRef
91. Dibonaventura M, Gabriel S, Dupclay L, et al. A patient perspective of the impact of medication side effects on adherence: results of a cross-sectional nationwide survey of patients with schizophrenia. BMC Psychiatry. 2012;12(1):20. PubMed CrossRef
92. Briggs A, Wild D, Lees M, et al. Impact of schizophrenia and schizophrenia treatment-related adverse events on quality of life: direct utility elicitation. Health Qual Life Outcomes. 2008;6(1):105. PubMed CrossRef
93. Tanskanen A, Tiihonen J, Taipale H. Mortality in schizophrenia: 30-year nationwide follow-up study. Acta Psychiatr Scand. 2018;138(6):492-499. PubMed CrossRef
94. Taipale H, Mittendorfer-Rutz E, Alexanderson K, et al. Antipsychotics and mortality in a nationwide cohort of 29,823 patients with schizophrenia. Schizophr Res. 2017;S0920-9964(17)30762-4. PubMed
95. Cahling L, Berntsson A, Bröms G, et al. Perceptions and knowledge of antipsychotics among mental health professionals and patients. BJPsych Bull. 2017;41(5):254-259. PubMed CrossRef
96. Weiden PJ, Roma RS, Velligan DI, et al. The challenge of offering long-acting antipsychotic therapies: a preliminary discourse analysis of psychiatrist recommendations for injectable therapy to patients with schizophrenia. J Clin Psychiatry. 2015;76(6):684-690. PubMed CrossRef
97. Das AK, Malik A, Haddad PM. A qualitative study of the attitudes of patients in an early intervention service towards antipsychotic long-acting injections. Ther Adv Psychopharmacol. 2014;4(5):179-185. PubMed CrossRef
98. Lasser RA, Schooler NR, Kujawa M, et al. A new psychosocial tool for gaining patient understanding and acceptance of long-acting injectable antipsychotic therapy. Psychiatry (Edgmont). 2009;6(4):22-27. PubMed
99. Amador X. LEAP Foundation For Research To Practice. LFRP website. https://lfrp.org/about-leap. Published 2018. Accessed July 3, 2019.
Quick Links: Schizophrenia and Schizoaffective Disorders
View This PDF >
DOWNLOAD CHECKED REFERENCES
Hide Abstract
Management of Neuropsychiatric Disturbances in Huntington's Disease: A Literature Review and Case Report
Huntington's disease can cause severe neuropsychiatric symptoms that worsen as the disea...
Joshua A. Jay & more
Acute Psychosis Precipitated by Lacosamide
A patient with chronic epilepsy was started on lacosamide and developed paranoid delusions...
Shixie Jiang & more
Young-Adult Social Outcomes of Attention-Deficit/Hyperactivity Disorder
ADHD that persisted into young-adulthood was associated with poorer outcomes in terms of e...
Lucy Riglin & more
Effects of Electroconvulsive Therapy on Functional Outcomes Among Medicare Patients With Comorbid Depression and Dementia: A Nationwide 1-Year Follow-Up Study
Limited data suggest a role for electroconvulsive therapy (ECT) in treating behavioral and...
Samuel T. Wilkinson & more
Sign-up to stay
up-to-date today!
ADHD that persisted into young-adulthood was associated with poorer outcomes in terms of education, employment, and emotional...
MedFair.com US Patent No. 684794
About Psychiatrist.com
About The Journal of Clinical Psychiatry
About The Primary Care Companion
for CNS Disorders
About CME Institute
Hello Pop
Baclofen, a French Exception, Seriously Harms Alcohol Use Disorder Patients Without Benefit To the Editor: Dr Andrade's analysis of the Bacloville trial in a recent Clinical and Practical Psychopharmacology column, in which he concluded that "individualized treatment with high-dose baclofen (30-300 mg/d) may be a useful second-line approach in heavy drinkers" and that "baclofen may be particularly useful in patients with liver disease," deserves comment.1 First, Andrade failed to recall that the first pivotal trial of baclofen, ALPADIR (NCT01738282; 320 patients, as with Bacloville), was negative (see Braillon et al2). Second, Dr Andrade should have warned readers that Bacloville's results are most questionable, lacking robustness. Although he cited us,3 he overlooked the evidence we provided indicating that the Bacloville article4 was published without acknowledging major changes to the initial protocol, affecting the primary outcome. Coincidentally (although as skeptics, we do not believe in coincidence), the initial statistical team was changed when data were sold to the French pharmaceutical company applying for the marketing authorization in France. As Ronald H. Coase warned, "If you torture the data long enough, it will confess."


Look two, I really like these little styling challenges, remember if you think of anything your having trouble wearing in different ways ket me know!
I love these flowers, with the high waisted jeans as I think they make the tshirt look a little rockabilly.
I'd wear this outfit anywhere, literally anywhere.


Body: Coupe Exterior: SILVER Doors: 2 Engine: 5.0L DOHC SMPI 4-Valve Aluminum 10-Cyl Engine Drive: Four Wheel Drive Fuel: Gas VIN #: ZHWGU11M94LA01205 MPG*: 9 City / 15 Hwy Mileage: 24529 Your Lamborghini Dealership in Palm Beach, FL The finest new and pre-owned exotic supercars await you at Lamborghini Palm Beach. Here you will find an exceptional selection of pristine exotics and the VIP customer service experience you deserve. Our team of experts are here to help you every step of the way. Whether you are looking for a particular exotic or you just want to explore financing options, you will find personalized, world-class assistance every step of the way. In fact, it's our tailored, straightforward approach and incredible selection of exotics that continues to bring our customers back for their second, third and fourth sports car. Here you will find all of the newest Lamborghini models straight from the factory, including the Huracan, Aventador and 580-2. We also carry a variety of pre-owned Lamborghini models and exotics from a variety of other brands, including Aston Martin, Jaguar, Maserati, Mercedes-Benz, Land Rover, Porsche and much more. Truly, you never know what gem you will find in the Lamborghini Palm Beach inventory. Come see for yourself why customers come from all over the area to shop with us, including Boca Raton, Palm Beach, Jupiter, Hillsboro Beach, Cocoa Beach, Delray Beach, Wellington, and Juno Beach, FL. Join the Lamborghini Palm Beach family today!


#1 Cloud Service used by Medical Billers, Law Firms, Paralegals, and Business Consultants!
CaseMail enables Medical Billing companies to easily mail their clients' lien notices and all other medical notices via Certified Mail, First Class, FedEx, or eSignature directly from their computers. CaseMail allows you to upload and merge any Word or PDF documents. No Documents to Print – No Envelopes to Stuff – No Trips to the Post Office!
CaseMail's Unified Legal Communication platform converts Postal Mail into a paperless process with web-based tracking and delivery verification with On-Demand e-Signature management.
With a few simple clicks you can upload and mail any one-off legal document or thousands of legal notices either by postal mail, e-mail or e-signature.


So… yesterday happened. Good or bad – awesome or awful -invigorating or trying – it happened. Chances are it was the latter of each of those choices. And here you are today needing to follow that up.
I know you. You are a great teacher. You are going to make a choice and you are going to set a goal – you will make today at least a little bit better than yesterday…and knowing you, it will probably be a lot of bit better!
You can't let your yesterdays determine your todays…but you can use them as an inspiration to drive you to better things each day. And that is what we have to do as teachers in order to survive!
No day will be perfect, that's for sure. We are normally pretty far from that. But everyday can be just a little better than the day before…and this is a pretty realistic goal.
Smile at yesterday or brush it off. Pick yourself up and look today square in the eyes and determine to make it better. And then the only thing left to do is to be the amazing you that you are and let your awesome show!
Today will be better today, Teacher! You've got this. You are a great teacher, and every day is a better one for those kiddos in your classroom. Today will be great because you're a great teacher! You rock! Keep on teaching!
PS…So writing these on my phone is hard…to find out why I have to, see yesterday's post. For you chance to help me get back on my normal posting an encouraging feet, please check this out: http://www.gofundme.com/dearteacherlt. Thanks!
Previous Post Dear Teacher/Love Teacher EMERGENCY!! Help Me!


This SESE Learning Resource section provides a learning and research resource to compliment the 3/4 class and 5/6 class primary school SESE History, English and creative writing curriculum, and helps you research your local history, local folklore and local heritage.
What was school like during the 1950s?
Hear James and Kathleen McTague speak about their school days at Clogher National School in Co. Leitrim. Their school was built in 1882 but closed in 1971 when there was not enough children left in the area to keep the school open. Where did they all go?
Look at the gallery of photographs below. What differences can you see between schools in the past and your school? What has stayed the same?
What clothes did the children wear? Did they wear uniforms?
Were the schools very small? Why were they small?
Why did they have fireplaces?
How old are the schools in the photographs? Did you parent or grandparents go to a small school?
Is there an old school in your area?
Task: Look at the two photographs above. It is the year 2216 (200 hundred years from now). Your school has long since become an abandoned building. Your classroom is still there. A photographer arrives to take some photos, to show the children of 2216 what a classroom two hundred years ago looked like.
Can you sketch what you think it will be like? What aspects have remained/disappeared/decayed. What strange objects (like the sheep and cars are now inside your classroom? Look at the classroom that has been used as a workshop in the meantime. What might your classroom be used as in a few hundred years?
Write 6 facts about what school must have been like back then, using the clues you find in the photos.
describing what a typical school day is like.


A reception will follow in the Life Story Center.
Dennis Corbin lived a life of purpose, taking nothing for granted and always thinking of others ahead of himself. A devoted family man, Dennis was an amazing husband and father: in whatever they did, he supported his family 100 percent. An honorable and hardworking man, he was well known and respected at Western Michigan University as well as within the entire Kalamazoo community. Dennis had a great sense of humor and took everything in stride with a contagious zest for life that had no equal. Life will never be the same without him here, but he leaves behind a timeless legacy that countless others will proudly carry on.
Born on May 16th, 1954 to Robert and Marie (Wyczalek) Corbin in Sacramento, California, Dennis was the fourth of five children. He was raised in Flint, Michigan with his siblings, Lynn, Greg, Brad, and Tracy. His father served as a Captain in the U.S. Air Force, and passed away in a plane crash while serving the country when Dennis was only four years old. Despite the hardships of being a single mother, Marie raised Dennis and his siblings to be amazing people.
From a young age, Dennis was an active and athletic person who was engaged in his community in many ways. He developed a passion for cars early on, which inspired his love for working with his hands. He attended Flint Northwestern High School, where he played center on the football team, was a member of the golf team, and played upright bass in the school orchestra. After graduating from high school in 1972, Dennis attended Kalamazoo College, where he played football for three years. Even to this day, he could still long snap with the best of them. Dennis then transferred to Central Michigan University, where he earned a degree in athletic training and physical education. He continued his education at the University of Arizona, earning a master's degree in athletic training in 1979.
Dennis was endlessly devoted to his wife, Gayle, the love of his life. They met in high school, when Gayle was a senior and he was a junior. As Dennis would often joke, she was a year older than him, but about a billion years smarter. They were wed on February 3rd, 1978, and recently celebrated their 40th wedding anniversary in Chicago with their children. Together, Dennis and Gayle moved from Flint to Tucson, Arizona while Dennis completed his master's degree. They next moved to Bowling Green, Ohio, where Dennis worked for three years at Bowling Green State University as an assistant athletic trainer. It was during this time that Dennis and Gayle renovated their first of many houses together, and welcomed their first dog, Phoebe, into their lives. In 1982, they moved to Kalamazoo, where Dennis began his tenure at Western Michigan University after being hired as head athletic trainer. Over the decades, though Dennis's title changed many times, his dedication to promoting student-athlete welfare and his commitment to the Bronco nation was unwavering. He worked with every sports program at WMU, and was able to be a mentor and have a positive impact on thousands of student-athletes during his 36 years of service to the WMU athletic department.
Dennis was extremely dedicated to his family. In 1983, he and Gayle were blessed with the birth of their daughter, Natalie, and in 1986, they welcomed their son, Nick. They raised their children in a true partnership, demonstrating what a healthy, loving, and equal relationship looked like. He built his life around being a good father, even choosing to live close to work in order to take his children to school in the morning, and come home for lunch and family dinners between athletic events. Dennis regularly took Natalie and Nick to WMU games—Natalie will often brag that she attended her first Western game at 2 weeks old, and Nick enjoyed spending time with his Dad on the sidelines of home football games. Dennis supported his children in every way. He was notorious for his loud (or, as he would call it, "obnoxious") cheering from the sidelines during Natalie and Nick's high school soccer and football games. Dennis was always there for his children when they needed him, as a mentor, as a support network, and as a role model. He raised them to value toughness, emotional vulnerability, kindness, generosity, and hard work. Dennis's role as a father figure extended beyond his children, as he provided guidance and mentorship to many of the young people who came into his life during his years at WMU. His ability to connect with and support people was truly a gift.
Beyond his family and work, Dennis was also a passionate car fanatic, skilled handyman, and avid pick-up basketball player. He also enjoyed camping; he and Gayle traveled to places including Yellowstone National Park, the U.P. and Arkansas in their small trailer. Dennis enjoyed reading mysteries, and a wide range of music. He was also notorious for occasionally busting out ridiculous dance moves, his affinity for Diet Coke and cookies, and his goofy yet understated sense of humor. He also enjoyed caring for the family's schnauzers—after Phoebe, they welcomed Daphne, followed by Sophie and Raven. He was very skilled with his hands—though completely self-taught, he could tackle nearly any project around the house, and was always willing to help his children and friends with their own home improvement projects. He enjoyed nothing more than maintaining and detailing his cars, and made sure his children knew how to properly wax their own vehicles, too. Unbeknownst to some, Dennis had an odd love of Black Friday shopping. He enjoyed the mission of heading out to score deals and secure the hard-to-find hot ticket items as gifts —it was just one of the many ways Dennis cared for others. He was always generous, and was a firm believer in paying it forward. Most importantly, he didn't want credit for it. Dennis was the epitome of humility in the spirit of serving others.
Dennis was diagnosed with cancer in 2013, and overcame several rounds of remission and reoccurrence. Through it all, he remained as dedicated and hardworking as ever, and took every step to ensure his loved ones would always be taken care of. In fall of 2017, it was discovered that his cancer had metastasized to his brain, and he successfully underwent radiation treatment. In his final months, Dennis was leading an active and full life, and feeling exceptionally well. On March 6th, Dennis suffered a massive stroke unexpectedly. He held on until the next day and passed peacefully with his family by his side.
Dennis had a profound impact on all who met him. His door was always open, and he always had time to support and care for his family, his friends, students, or colleagues. Deeply loved and admired, he will be forever missed by those too numerous to count.
Dennis R. Corbin, of Kalamazoo, died March 7, 2018, in Kalamazoo. Surviving are his wife of 40 years, Gayle Corbin; 2 children: Natalie Corbin (Christopher Gronberg) and Nick (Sarah) Corbin; 4 siblings: Lynn (Ron) Slade, Greg Corbin, Brad Corbin, and Tracy (Dale) Jones; brother-in-law, Jim Bitzinger; and many nieces and nephews. Cremation will take place. Services will be held Monday, March 12, 4 p.m. at the Betzler Life Story Funeral Home, 6080 Stadium Dr. Kalamazoo (269) 375-2900 followed by a reception in the Life Story Center. Please visit Dennis' personal web page at www.BetzlerFuneralHome.com, where you can archive a favorite memory or photo and sign his online guestbook before coming to the funeral home. In lieu of flowers, memorial contributions may be made to the Western Michigan University Gary Fund or West Michigan Cancer Center.


Not sure what to get that special someone that loves fishing? Let us help you. Choose from an assortment of clothing and gifts that every fisherman will appreciate. Still not sure what to get? Take the guess work out of shopping and give the gift of a Capt Harry's Gift Card.