The full benefit of many effective medications will be achieved only if patients adhere to prescribed treatment regimens. Unfortunately, applying terms such as “noncompliant” and “nonadherent” to patients who do not consume every pill at the desired time can stigmatize them in their future relationships with health care providers. This article on medication adherence (or compliance) reviews strategies to assess and enhance this important aspect of patient care.

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Adherence to Medication

WRITING GROUP MEMBERS Emelia J. Benjamin, MD, SCM, FAHA Michael J. Blaha, MD, MPH Stephanie E. Chiuve, ScD Mary Cushman, MD, MSc, FAHA Sandeep R. Das, MD, MPH, FAHA Rajat Deo, MD, MTR Sarah D. de Ferranti, MD, MPH James Floyd, MD, MS Myriam Fornage, PhD, FAHA Cathleen Gillespie, MS Carmen R. Isasi, MD, PhD, FAHA Monik C. Jiménez, ScD, SM Lori Chaffin Jordan, MD, PhD Suzanne E. Judd, PhD Daniel Lackland, DrPH, FAHA Judith H. Lichtman, PhD, MPH, FAHA Lynda Lisabeth, PhD, MPH, FAHA Simin Liu, MD, ScD, FAHA Chris T. Longenecker, MD Rachel H. Mackey, PhD, MPH, FAHA Kunihiro Matsushita, MD, PhD, FAHA Dariush Mozaffarian, MD, DrPH, FAHA Michael E. Mussolino, PhD, FAHA Khurram Nasir, MD, MPH, FAHA Robert W. Neumar, MD, PhD, FAHA Latha Palaniappan, MD, MS, FAHA Dilip K. Pandey, MBBS, MS, PhD, FAHA Ravi R. Thiagarajan, MD, MPH Mathew J. Reeves, PhD Matthew Ritchey, PT, DPT, OCS, MPH Carlos J. Rodriguez, MD, MPH, FAHA Gregory A. Roth, MD, MPH Wayne D. Rosamond, PhD, FAHA Comilla Sasson, MD, PhD, FAHA Amytis Towfighi, MD Connie W. Tsao, MD, MPH Melanie B. Turner, MPH Salim S. Virani, MD, PhD, FAHA Jenifer H. Voeks, PhD Joshua Z. Willey, MD, MS John T. Wilkins, MD Jason HY. Wu, MSc, PhD, FAHA Heather M. Alger, PhD Sally S. Wong, PhD, RD, CDN, FAHA Paul Muntner, PhD, MHSc On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2017 Update

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Schizophrenia is a highly heritable disorder. Genetic risk is conferred by a large number of alleles, including common alleles of small effect that might be detected by genome-wide association studies. Here we report a multi-stage schizophrenia genome-wide association study of up to 36,989 cases and 113,075 controls. We identify 128 independent associations spanning 108 conservatively defined loci that meet genome-wide significance, 83 of which have not been previously reported. Associations were enriched among genes expressed in brain, providing biological plausibility for the findings. Many findings have the potential to provide entirely new insights into aetiology, but associations at DRD2 and several genes involved in glutamatergic neurotransmission highlight molecules of known and potential therapeutic relevance to schizophrenia, and are consistent with leading pathophysiological hypotheses. Independent of genes expressed in brain, associations were enriched among genes expressed in tissues that have important roles in immunity, providing support for the speculated link between the immune system and schizophrenia.

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Biological insights from 108 schizophrenia-associated genetic loci

Author(s): Writing Group Members; Mozaffarian, Dariush; Benjamin, Emelia J; Go, Alan S; Arnett, Donna K; Blaha, Michael J; Cushman, Mary; Das, Sandeep R; de Ferranti, Sarah; Despres, Jean-Pierre; Fullerton, Heather J; Howard, Virginia J; Huffman, Mark D; Isasi, Carmen R; Jimenez, Monik C; Judd, Suzanne E; Kissela, Brett M; Lichtman, Judith H; Lisabeth, Lynda D; Liu, Simin; Mackey, Rachel H; Magid, David J; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Muntner, Paul; Mussolino, Michael E; Nasir, Khurram; Neumar, Robert W; Nichol, Graham; Palaniappan, Latha; Pandey, Dilip K; Reeves, Mathew J; Rodriguez, Carlos J; Rosamond, Wayne; Sorlie, Paul D; Stein, Joel; Towfighi, Amytis; Turan, Tanya N; Virani, Salim S; Woo, Daniel; Yeh, Robert W; Turner, Melanie B; American Heart Association Statistics Committee; Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2016 Update: A Report From the American Heart Association

March 5, 2019 e1 WRITING GROUP MEMBERS Emelia J. Benjamin, MD, ScM, FAHA, Chair Paul Muntner, PhD, MHS, FAHA, Vice Chair Alvaro Alonso, MD, PhD, FAHA Marcio S. Bittencourt, MD, PhD, MPH Clifton W. Callaway, MD, FAHA April P. Carson, PhD, MSPH, FAHA Alanna M. Chamberlain, PhD Alexander R. Chang, MD, MS Susan Cheng, MD, MMSc, MPH, FAHA Sandeep R. Das, MD, MPH, MBA, FAHA Francesca N. Delling, MD, MPH Luc Djousse, MD, ScD, MPH Mitchell S.V. Elkind, MD, MS, FAHA Jane F. Ferguson, PhD, FAHA Myriam Fornage, PhD, FAHA Lori Chaffin Jordan, MD, PhD, FAHA Sadiya S. Khan, MD, MSc Brett M. Kissela, MD, MS Kristen L. Knutson, PhD Tak W. Kwan, MD, FAHA Daniel T. Lackland, DrPH, FAHA Tené T. Lewis, PhD Judith H. Lichtman, PhD, MPH, FAHA Chris T. Longenecker, MD Matthew Shane Loop, PhD Pamela L. Lutsey, PhD, MPH, FAHA Seth S. Martin, MD, MHS, FAHA Kunihiro Matsushita, MD, PhD, FAHA Andrew E. Moran, MD, MPH, FAHA Michael E. Mussolino, PhD, FAHA Martin O’Flaherty, MD, MSc, PhD Ambarish Pandey, MD, MSCS Amanda M. Perak, MD, MS Wayne D. Rosamond, PhD, MS, FAHA Gregory A. Roth, MD, MPH, FAHA Uchechukwu K.A. Sampson, MD, MBA, MPH, FAHA Gary M. Satou, MD, FAHA Emily B. Schroeder, MD, PhD, FAHA Svati H. Shah, MD, MHS, FAHA Nicole L. Spartano, PhD Andrew Stokes, PhD David L. Tirschwell, MD, MS, MSc, FAHA Connie W. Tsao, MD, MPH, Vice Chair Elect Mintu P. Turakhia, MD, MAS, FAHA Lisa B. VanWagner, MD, MSc, FAST John T. Wilkins, MD, MS, FAHA Sally S. Wong, PhD, RD, CDN, FAHA Salim S. Virani, MD, PhD, FAHA, Chair Elect On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

Mental Health Service Delivery and Suicide Risk

Dear Editor, While sigma and negative attitudes towards people with mental illness were common both in the general population and among well trained professionals, little was known between providers with different professional backgrounds. This study was to compare the attitudes towards people with mental illness among psychiatrists and nurses in a large psychiatric hospital in Guangzhou, China. This was an exploratory survey study using a standardized self-report questionnaire among psychiatrists (n = 120) and psychiatric nurses (n = 162). The questionnaire including 43 dichotomous (yes/ no) questions and was a modified version of FABI (Fear and Behavioral Intentions toward the mentally ill). Varimax rotation was used to identify orthogonal factors and weighted factor scores were calculated. Biopsychosocial explanation of the causes of mental illness and de-stigmatized attitudes towards mental illness (especially with regard to dangerousness) were significantly associated with psychiatric professional background (P < 0.001 and P = 0.008, respectively). Psychiatrists more strongly endorsed beliefs in the biopsychosocial causation of mental illness than the nurses. In contrast, nurses scored lower on a factor reflecting the belief that people with mental illness are not dangerous and are not a nuisance in society. This difference most likely reflects the different roles of psychiatrists and nurses in the care of acutely ill patients. Research identified alarming rates of violence against psychiatric nurses (Bimenyimana et al., 2009; Yarovitsky and Tabak, 2009). While psychiatrists are responsible for clinical evaluation and treatment planning, nurses are responsible for the day to day, hands-on management of inpatients who are often disruptive, and at times threatening or even violent, towards them. People who have more knowledge about mental illness have been found to be less likely endorses of negative or stigmatizing attitudes (Angermeyer et al., 2011). Therefore, additional educational and supportive efforts should be developed to promote positive attitudes toward people with mental illness among nurses.

Comparison of attitudes of the psychiatrists and nurses towards patients with mental illness in a Chinese psychiatric hospital: Implications for training.

(2003). Coordination of medical care and opioid dependence treatment in primary care: A case report. Substance Abuse: Vol. 24, No. 1, pp. 43-46.

Coordination of medical care and opioid dependence treatment in primary care: a case report.

Client satisfaction with a new group-based model of case management for supported housing services

Atypical antipsychotic medications vary in cost with limited evidence of differences in effectiveness. Administrative prescription review has been proposed as a way of encouraging use of less expensive medication when there is no specific clinical justification for using more expensive medication. This study examined data from a national GAO survey of 876 veterans affairs (VA) psychiatrists, and national administrative data on the proportion of veterans actually receiving atypical antipsychotic medications. The proportion of psychiatrists in each region reporting that they did not feel free to prescribe expensive drugs when indicated was negatively correlated with the proportion of patients who filled prescriptions for clozapine, the most expensive atypical. The proportion reporting review procedures for prescribing olanzapine was significantly and negatively correlated with the proportion of veterans actually receiving prescriptions for olanzapine and, positively associated with the proportion prescribed risperidone. Nondirective administrative review procedures in VA are significantly associated with actual prescribing patterns and may generate modest cost savings in the prescription of atypical antipsychotic medication.

Robert A. Rosenheck

Papers

Mental Health Service Delivery and Suicide Risk

Comparison of attitudes of the psychiatrists and nurses towards patients with mental illness in a Chinese psychiatric hospital: Implications for training.

Coordination of medical care and opioid dependence treatment in primary care: a case report.

Client satisfaction with a new group-based model of case management for supported housing services

Administrative prescription review procedures and use of atypical antipsychotic medications in the Department of Veterans Affairs.