human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Poor adherence to antidepressant treatment is common , and results in increased disability and costs . Several factors are thought to influence patients ’ ability and willingness to adhere . So far , however , consensus is lacking regarding patient characteristics that predict nonadherence . The purpose of this study was to identify predictors of nonadherence to antidepressant treatment that can be ascertained at treatment start . Method The present study used data from a r and omized controlled trial with the main objective of study ing the effect of two different compliance-enhancing programs on treatment adherence  and treatment response in 1031 primary care patients with major depression . In this study , logistic regression analyses were performed to examine patient- and illness-related characteristics potentially associated with nonadherence . Results Nonadherence to antidepressant treatment  was predicted by age under 35 or over 64 years , presence of personality disorder , sensation-seeking personality traits , substance abuse , and absence of concomitant medications . Conclusion Certain patient- and illness-related characteristics may imply an increased risk of nonadherence to antidepressant treatment . Giving special attention to subjects with such characteristics may improve adherence Introduction Sub-optimal adherence constitutes a significant impediment to the management of severe mental illnesses ( SMIs ) as it negatively impacts on the course of the illness and the treatment outcome . In this study , the levels of adherence , prevalence and the predictors of sub-optimal adherence were assessed in a sub-Saharan African setting . Methods Three hundred and seventy ( 370 ) respondents with diagnoses of schizophrenia , bipolar disorder or severe depression were r and omly enrolled and interviewed at the out-patient department of the Federal Neuropsychiatric Hospital , Maiduguri in northeastern Nigeria . An anonymous sociodemographic question naire and a clinical proforma design ed by the authors ,  Oslo social support scale  and the  8-item Morisky Medication Adherence Scale ( MMAS-8 ) were used for data collection . Results The prevalence of sub-optimal adherence was 55.7 % . The independent predictors of sub-optimal adherence were ; seeking for traditional/ spiritual treatment ( Odds Ratio ( O.R. ) = 6.523 , 95 % C.I. = 3.773 - 11.279 , P = < 0.001 ) , male gender ( O.R. = 3.307 , 95 % C.I. = 1.907 - 5.737 , P = < 0.001 ) , low levels of insight ( O.R. = 1.753 , 95 C.I. = 1.220 - 2.519 , P = 0.002 ) , and low social support levels ( O.R. = 1.528 , 95 % C.I. = 1.097 - 2.129 , P = 0.012 ) . Conclusion Based on the outcome of the study , we recommend the development of psycho-educational programmes on adherence and the active involvement of the relations and significant others in the management of patients with SMIs in sub-Saharan Africa OBJECTIVE Since sustained treatment-adherence is often problematic and may limit clinical outcomes among bipolar disorder ( BPD ) patients , we sought risk factors to guide clinical prediction of nonadherence . METHODS Data were from a 2005 US national sample providing question naire responses by 131 r and omly selected prescribing psychiatrists and their adult BPD patients . We contrasted demographic and clinical factors in treatment-adherent versus nonadherent patients ( strictly defined as missing > or = 1 dose within 10 days ) in univariate analyses followed by multivariate logistic-regression modeling . RESULTS Of 429 DSM-IV BPD patients ( 79 % type-I ; 62 % women ; 17 % minorities ) , 34 % reported missing > or = 1 dose of  psychotropic medication within 10 days , 20 % missed entire daily doses at least once , and only 2.5 % missed all doses for 10 days . However , their prescribing psychiatrists considered only 6 % as treatment-nonadherent . Factors significantly associated with nonadherence in multivariate modeling ranked : alcohol-dependence > youth > greater affective morbidity > various side effects > or = comorbid obsessive-compulsive disorder > or = recovering from mania-hypomania . Unrelated were sex , diagnostic subtype , and other comorbidities . Since most patients received > or = 2 psychotropics , potential relationships between treatment-complexity and adherence were obscured . CONCLUSIONS Prevalent treatment-nonadherence among American BPD patients , and striking underestimation of the problem by prescribing clinicians may encourage increasingly complex treatment-regimens of untested value , but added expense , risk of adverse effects , and uncertain impact on treatment-adherence itself Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND In chronic diseases adherence is a problem . Little is known about adherence to antidepressants after the acute phase in recurrent depression . This study evaluates adherence to antidepressants in the continuation and maintenance phase in remitted recurrently depressed patients . METHODS We prospect ively assessed adherence to continuation and maintenance antidepressant use , the longest phase in antidepressant treatment , over 2 years and the association of adherence with future recurrence in 131 recurrently depressed patients remitted on antidepressants . LIMITATIONS Self reported non-adherence . RESULTS Non-adherence ranged from 39.7 % to 52.7 % ; 20.9 % were always non-adherent , 48.4 % were intermittently non-adherent and 30.8 % were always adherent . Adherence rates did not significantly differ between intermittent and continuous antidepressant users ( 37.2 % vs. 25 % ) . Non-adherence predicted time to recurrence . CONCLUSION Non-adherence to continuation and maintenance antidepressant treatment in recurrent depression is frequent , like in other chronic diseases , and a potential risk of recurrence . Doctors continuously have to be aware of this problem and should keep on discussing it with their patients . Finally , as many patients do n't seem to be able or willing to take AD as prescribed , alternatives to prevent relapse deserve more attention INTRODUCTION . Compliance with antidepressant treatment is a very relevant factor in the outcome of depressive disorders . Poor compliance has been associated with worse outcome , increased rate of relapses and greater cost . This study has aim ed to describe adherence to antidepressant treatment in a sample of primary care patients with a diagnosis of depression in 2007 . METHODS . R and omized sampling was made of patients with depression and antidepressant treatment attended in two primary care teams . Their medical records were review ed to obtain the total number of prescriptions given to patients and the total number of prescriptions dispensed in the pharmacies . The difference between prescriptions written and collected was calculated . A difference of ± 2 was considered as good compliance . Results are shown as percentages . Comparisons were made with the chi-square , Student ’s T and ANOVA tests , where appropriate . RESULTS . The simple was made up of 212 patients . Mean age was 63.2 years ( SD 15.27 ) . In the sample , 66.5 % were treated with only one antidepressant and 24.1 % with two . The percentage of non-compliance was 33.96 % ( 95 % CI : 25.35–40.57 ) . Treatment-adherent patients have a lower percentage of long-term treatment with other drugs . The percentage of treatment-adherent women was higher than non-adherent ( p=0.015 ) . No differences were found in compliance among patients treated in the mental health center . CONCLUSIONS . One third of patients on antidepressant drug treatment were non-compliers because the drugs were not picked up properly from the pharmacies . We need to develop strategies to improve the therapeutic adherence of patients In low-income countries , clinicians must seek strategies to improve treatment adherence that are non-re source intensive and easily integrated into existing treatment structures . We conducted a prospect i ve observational cohort study to investigate the relationship of family engagement in treatment during hospitalisation with post-discharge appointment and medication adherence  in 81 patients from a Nigerian psychiatric hospital . After controlling for gender , diagnosis , mental state at discharge , and marital status , family involvement was significantly associated with appointment ( P=0.047 ) but not medication adherence ( P=0.590 ) . Studies are needed to determine whether interventions based on engaging families in treatment can improve post-discharge adherence in this setting OBJECTIVE Nonadherence to prescribed medications is a significant problem in the treatment of mood disorders . Previously proposed adherence models have not been sufficiently accurate in identifying patients who do not adhere to treatment . This study evaluated the importance of the social context in adherence by using a prospect i ve , longitudinal analysis . Specifically , this study evaluated the effects of caregivers ' causal beliefs about depression and their perceptions of stigma on three-month treatment adherence among patients with depression . METHODS Fifty patients with major depressive disorder and their primary caregivers were identified at a psychiatric hospital 's outpatient clinic .  Attributions for the causes of depression ( either cognitive and attitudinal or medical and biological ) and perceived stigma were assessed among caregivers at baseline , and patients ' adherence was evaluated three-months after treatment began . RESULTS Data were available for 47 patients at follow-up . Caregivers ' attribution of depression to cognitive and attitudinal problems significantly predicted patients ' decreased adherence . However , the degree of patients ' adherence was not predicted by caregivers ' attributions to medical and biological causes and caregivers ' perceived stigma . CONCLUSIONS The findings stress the importance of patients ' social environment in determining treatment adherence and the necessity of educating caregivers about the impact that their causal attributions have on patients ' behavior . Involving caregivers in treatment may improve their attitude toward patients with depression and , in doing so , enhance patients ' adherence and outcome BACKGROUND The electronic Schizophrenia Treatment Adherence Registry ( e-STAR ) is a prospect i ve , observational study of patients with schizophrenia design ed to evaluate long-term treatment outcomes in routine clinical practice . METHODS Parameters were assessed at baseline and at 3 month intervals for 2 years in patients initiated on risperidone long-acting injection ( RLAI ) ( n=1345 ) or a new oral antipsychotic ( AP ) ( n=277 ; 35.7 % and 36.5 % on risperidone and olanzapine , respectively ) in Spain .  Hospitalization prior to therapy was assessed by a retrospective chart review . RESULTS At 24 months , treatment retention ( 81.8 % for RLAI versus 63.4 % for oral APs , p<0.0001 ) and reduction in Clinical Global Impression Severity scores ( -1.14 for RLAI versus -0.94 for APs , p=0.0165 ) were significantly higher with RLAI . Compared to the pre-switch period , RLAI patients had greater reductions in the number ( reduction of 0.37 stays per patient versus 0.2 , p<0.05 ) and days ( 18.74 versus 13.02 , p<0.01 ) of hospitalizations at 24 months than oral AP patients . CONCLUSIONS This 2 year , prospect i ve , observational study showed that , compared to oral antipsychotics , RLAI was associated with better treatment retention , greater improvement in clinical symptoms and functioning , and greater reduction in hospital stays and days in hospital in patients with schizophrenia . Improved treatment adherence , increased efficacy and reduced hospitalization with RLAI offer the opportunity of substantial therapeutic improvement in schizophrenia OBJECTIVES This study examined concurrent associations and predictors at first indication of nonadherence to antipsychotic medication four years after a first episode of psychosis . METHODS A prospect i ve cohort of 171 patients in urban Irel and with a first episode of psychosis was followed up four years after inception ( follow-up primary analysis , N=84 ; secondary analysis , N=104 ) . RESULTS At the four-year follow-up 76 % were adherent and 24 % were not . Nonadherence was concurrently associated with substance misuse ( p<.01 ) , increased symptomatology ( p<.01 ) , less insight ( p=.01 ) , lower global functioning ( p<.01 ) , and negative attitudes toward medication ( p<.01 ) . Compared with other patients , those who were nonadherent had more readmissions ( p=.01 ) . Predictors of future nonadherence were substance misuse ( p=.02 ) and duration of untreated psychosis ( p=.04 ) . CONCLUSIONS This prospect i ve investigation confirms previous cross-sectional studies . The association between longer duration of untreated psychosis and nonadherence warrants further research because it could be interpreted as further evidence of the importance of early intervention 
    Output:
    
agent
Individual patient ’s behaviors , lack of social support , clinical or treatment and illness-related , and health system factors influenced psychotropic medication non-adherence .
Conclusion Psychotropic medication non-adherence was high .
It was influenced by various factors operating at different levels .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Poor adherence to antidepressant treatment is common , and results in increased disability and costs . Several factors are thought to influence patients ’ ability and willingness to adhere . So far , however , consensus is lacking regarding patient characteristics that predict nonadherence . The purpose of this study was to identify predictors of nonadherence to antidepressant treatment that can be ascertained at treatment start . Method The present study used data from a r and omized controlled trial with the main objective of study ing the effect of two different compliance-enhancing programs on treatment adherence  and treatment response in 1031 primary care patients with major depression . In this study , logistic regression analyses were performed to examine patient- and illness-related characteristics potentially associated with nonadherence . Results Nonadherence to antidepressant treatment  was predicted by age under 35 or over 64 years , presence of personality disorder , sensation-seeking personality traits , substance abuse , and absence of concomitant medications . Conclusion Certain patient- and illness-related characteristics may imply an increased risk of nonadherence to antidepressant treatment . Giving special attention to subjects with such characteristics may improve adherence Introduction Sub-optimal adherence constitutes a significant impediment to the management of severe mental illnesses ( SMIs ) as it negatively impacts on the course of the illness and the treatment outcome . In this study , the levels of adherence , prevalence and the predictors of sub-optimal adherence were assessed in a sub-Saharan African setting . Methods Three hundred and seventy ( 370 ) respondents with diagnoses of schizophrenia , bipolar disorder or severe depression were r and omly enrolled and interviewed at the out-patient department of the Federal Neuropsychiatric Hospital , Maiduguri in northeastern Nigeria . An anonymous sociodemographic question naire and a clinical proforma design ed by the authors ,  Oslo social support scale  and the  8-item Morisky Medication Adherence Scale ( MMAS-8 ) were used for data collection . Results The prevalence of sub-optimal adherence was 55.7 % . The independent predictors of sub-optimal adherence were ; seeking for traditional/ spiritual treatment ( Odds Ratio ( O.R. ) = 6.523 , 95 % C.I. = 3.773 - 11.279 , P = < 0.001 ) , male gender ( O.R. = 3.307 , 95 % C.I. = 1.907 - 5.737 , P = < 0.001 ) , low levels of insight ( O.R. = 1.753 , 95 C.I. = 1.220 - 2.519 , P = 0.002 ) , and low social support levels ( O.R. = 1.528 , 95 % C.I. = 1.097 - 2.129 , P = 0.012 ) . Conclusion Based on the outcome of the study , we recommend the development of psycho-educational programmes on adherence and the active involvement of the relations and significant others in the management of patients with SMIs in sub-Saharan Africa OBJECTIVE Since sustained treatment-adherence is often problematic and may limit clinical outcomes among bipolar disorder ( BPD ) patients , we sought risk factors to guide clinical prediction of nonadherence . METHODS Data were from a 2005 US national sample providing question naire responses by 131 r and omly selected prescribing psychiatrists and their adult BPD patients . We contrasted demographic and clinical factors in treatment-adherent versus nonadherent patients ( strictly defined as missing > or = 1 dose within 10 days ) in univariate analyses followed by multivariate logistic-regression modeling . RESULTS Of 429 DSM-IV BPD patients ( 79 % type-I ; 62 % women ; 17 % minorities ) , 34 % reported missing > or = 1 dose of  psychotropic medication within 10 days , 20 % missed entire daily doses at least once , and only 2.5 % missed all doses for 10 days . However , their prescribing psychiatrists considered only 6 % as treatment-nonadherent . Factors significantly associated with nonadherence in multivariate modeling ranked : alcohol-dependence > youth > greater affective morbidity > various side effects > or = comorbid obsessive-compulsive disorder > or = recovering from mania-hypomania . Unrelated were sex , diagnostic subtype , and other comorbidities . Since most patients received > or = 2 psychotropics , potential relationships between treatment-complexity and adherence were obscured . CONCLUSIONS Prevalent treatment-nonadherence among American BPD patients , and striking underestimation of the problem by prescribing clinicians may encourage increasingly complex treatment-regimens of untested value , but added expense , risk of adverse effects , and uncertain impact on treatment-adherence itself Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND In chronic diseases adherence is a problem . Little is known about adherence to antidepressants after the acute phase in recurrent depression . This study evaluates adherence to antidepressants in the continuation and maintenance phase in remitted recurrently depressed patients . METHODS We prospect ively assessed adherence to continuation and maintenance antidepressant use , the longest phase in antidepressant treatment , over 2 years and the association of adherence with future recurrence in 131 recurrently depressed patients remitted on antidepressants . LIMITATIONS Self reported non-adherence . RESULTS Non-adherence ranged from 39.7 % to 52.7 % ; 20.9 % were always non-adherent , 48.4 % were intermittently non-adherent and 30.8 % were always adherent . Adherence rates did not significantly differ between intermittent and continuous antidepressant users ( 37.2 % vs. 25 % ) . Non-adherence predicted time to recurrence . CONCLUSION Non-adherence to continuation and maintenance antidepressant treatment in recurrent depression is frequent , like in other chronic diseases , and a potential risk of recurrence . Doctors continuously have to be aware of this problem and should keep on discussing it with their patients . Finally , as many patients do n't seem to be able or willing to take AD as prescribed , alternatives to prevent relapse deserve more attention INTRODUCTION . Compliance with antidepressant treatment is a very relevant factor in the outcome of depressive disorders . Poor compliance has been associated with worse outcome , increased rate of relapses and greater cost . This study has aim ed to describe adherence to antidepressant treatment in a sample of primary care patients with a diagnosis of depression in 2007 . METHODS . R and omized sampling was made of patients with depression and antidepressant treatment attended in two primary care teams . Their medical records were review ed to obtain the total number of prescriptions given to patients and the total number of prescriptions dispensed in the pharmacies . The difference between prescriptions written and collected was calculated . A difference of ± 2 was considered as good compliance . Results are shown as percentages . Comparisons were made with the chi-square , Student ’s T and ANOVA tests , where appropriate . RESULTS . The simple was made up of 212 patients . Mean age was 63.2 years ( SD 15.27 ) . In the sample , 66.5 % were treated with only one antidepressant and 24.1 % with two . The percentage of non-compliance was 33.96 % ( 95 % CI : 25.35–40.57 ) . Treatment-adherent patients have a lower percentage of long-term treatment with other drugs . The percentage of treatment-adherent women was higher than non-adherent ( p=0.015 ) . No differences were found in compliance among patients treated in the mental health center . CONCLUSIONS . One third of patients on antidepressant drug treatment were non-compliers because the drugs were not picked up properly from the pharmacies . We need to develop strategies to improve the therapeutic adherence of patients In low-income countries , clinicians must seek strategies to improve treatment adherence that are non-re source intensive and easily integrated into existing treatment structures . We conducted a prospect i ve observational cohort study to investigate the relationship of family engagement in treatment during hospitalisation with post-discharge appointment and medication adherence  in 81 patients from a Nigerian psychiatric hospital . After controlling for gender , diagnosis , mental state at discharge , and marital status , family involvement was significantly associated with appointment ( P=0.047 ) but not medication adherence ( P=0.590 ) . Studies are needed to determine whether interventions based on engaging families in treatment can improve post-discharge adherence in this setting OBJECTIVE Nonadherence to prescribed medications is a significant problem in the treatment of mood disorders . Previously proposed adherence models have not been sufficiently accurate in identifying patients who do not adhere to treatment . This study evaluated the importance of the social context in adherence by using a prospect i ve , longitudinal analysis . Specifically , this study evaluated the effects of caregivers ' causal beliefs about depression and their perceptions of stigma on three-month treatment adherence among patients with depression . METHODS Fifty patients with major depressive disorder and their primary caregivers were identified at a psychiatric hospital 's outpatient clinic .  Attributions for the causes of depression ( either cognitive and attitudinal or medical and biological ) and perceived stigma were assessed among caregivers at baseline , and patients ' adherence was evaluated three-months after treatment began . RESULTS Data were available for 47 patients at follow-up . Caregivers ' attribution of depression to cognitive and attitudinal problems significantly predicted patients ' decreased adherence . However , the degree of patients ' adherence was not predicted by caregivers ' attributions to medical and biological causes and caregivers ' perceived stigma . CONCLUSIONS The findings stress the importance of patients ' social environment in determining treatment adherence and the necessity of educating caregivers about the impact that their causal attributions have on patients ' behavior . Involving caregivers in treatment may improve their attitude toward patients with depression and , in doing so , enhance patients ' adherence and outcome BACKGROUND The electronic Schizophrenia Treatment Adherence Registry ( e-STAR ) is a prospect i ve , observational study of patients with schizophrenia design ed to evaluate long-term treatment outcomes in routine clinical practice . METHODS Parameters were assessed at baseline and at 3 month intervals for 2 years in patients initiated on risperidone long-acting injection ( RLAI ) ( n=1345 ) or a new oral antipsychotic ( AP ) ( n=277 ; 35.7 % and 36.5 % on risperidone and olanzapine , respectively ) in Spain .  Hospitalization prior to therapy was assessed by a retrospective chart review . RESULTS At 24 months , treatment retention ( 81.8 % for RLAI versus 63.4 % for oral APs , p<0.0001 ) and reduction in Clinical Global Impression Severity scores ( -1.14 for RLAI versus -0.94 for APs , p=0.0165 ) were significantly higher with RLAI . Compared to the pre-switch period , RLAI patients had greater reductions in the number ( reduction of 0.37 stays per patient versus 0.2 , p<0.05 ) and days ( 18.74 versus 13.02 , p<0.01 ) of hospitalizations at 24 months than oral AP patients . CONCLUSIONS This 2 year , prospect i ve , observational study showed that , compared to oral antipsychotics , RLAI was associated with better treatment retention , greater improvement in clinical symptoms and functioning , and greater reduction in hospital stays and days in hospital in patients with schizophrenia . Improved treatment adherence , increased efficacy and reduced hospitalization with RLAI offer the opportunity of substantial therapeutic improvement in schizophrenia OBJECTIVES This study examined concurrent associations and predictors at first indication of nonadherence to antipsychotic medication four years after a first episode of psychosis . METHODS A prospect i ve cohort of 171 patients in urban Irel and with a first episode of psychosis was followed up four years after inception ( follow-up primary analysis , N=84 ; secondary analysis , N=104 ) . RESULTS At the four-year follow-up 76 % were adherent and 24 % were not . Nonadherence was concurrently associated with substance misuse ( p<.01 ) , increased symptomatology ( p<.01 ) , less insight ( p=.01 ) , lower global functioning ( p<.01 ) , and negative attitudes toward medication ( p<.01 ) . Compared with other patients , those who were nonadherent had more readmissions ( p=.01 ) . Predictors of future nonadherence were substance misuse ( p=.02 ) and duration of untreated psychosis ( p=.04 ) . CONCLUSIONS This prospect i ve investigation confirms previous cross-sectional studies . The association between longer duration of untreated psychosis and nonadherence warrants further research because it could be interpreted as further evidence of the importance of early intervention 
    Output:
    