Welcome to the outcomes survey only for attendees of the symposium titled: Identifying Solutions to the Challenge of Nonadherence in Schizophrenia, on April 5, 2013 in Chicago, IL. Upon completion, you will be provided a summary of your responses, an explanation of the correct answers, and an option to download the slides from the live meeting. Demographics and Practice Change Questions Answer on a scale of 5, 4, 3, 2, 1 5=Strongly agree 1=Strongly disagreeThe information presented has helped me improve my care of patients with schizophrenia. *54321After participating in this program, I feel more confident in managing patients with schizophrenia. *54321On average, how many patients (overall) do you see in a given month? *A. <25B. 25 to 50C. 51 to 75D. 76 to 100E. >100On average, how many patients with schizophrenia do you see each month? *A. 1 to 5B. 6 to 10C. 11 to 15D. 16 to 20E. >20F. I don't currently see patients with schizophreniaDid you change one or more aspects of your practice as a result of your participation in this activity? *YesNoPlease provide us with a brief description of how you did so. *What barriers did you encounter in incorporating best practices learned in this activity into clinical practice or quality improvement initiatives at your institution?*What mechanisms did you identify to overcome these barriers?* Knowledge Questions In patients with schizophrenia:*A. Longer duration of untreated psychosis is associated with poorer recovery after initiation of treatmentB. Suicide risk is greatest later in course of illnessC. Therapy interruptions have not been linked to more suicide attemptsD. Time to remission is unaffected by history of successive relapsesAdherence with schizophrenia medication:*A. Is defined as patient’s attitude toward taking medicationB. Can be measured with a gold-standard cutpointC. Is defined as patient taking >50% of medicationD. Is frequently overestimatedIn patients who are nonadherent with schizophrenia medications:*A. Direct effects on outcomes are more important than indirect effectsB. Early alliance with physician improves later adherenceC. Risk factors can be identified early and will remain unchanged over timeD. Weight gain is not a major contributorThe best intervention for a patient who is unable (rather than unwilling) to adhere with schizophrenia therapy is: *A. Strengthening perceived benefits of therapyB. Minimizing perceived costs of therapyC. Explaining “medical model” of benefits to patientD. Employing self-monitoring toolsMeta-analyses on the efficacy of second-generation antipsychotics (SGAs) have shown that:*A. SGAs are similar in terms of overall efficacyB. SGAs are a homogeneous class of drugsC. SGAs are a heterogeneous class of drugsD. Evidence is insufficient to draw comparisonsLong-acting injectable antipsychotics: *A. Result in less-predictable plasma levels, making it more difficult to differentiate between poor response and nonadherenceB. Are subject to first-pass metabolism, resulting in a poorer relationship between dose and blood level than with oral medicationsC. Eliminate uncertainty with regard to the patient’s adherence statusD. Are associated with a lower degree of patient acceptance than oral medications Case-Based Questions Helga is a 29-year-old white female with a 4-year history of schizophrenia. Her symptoms are characterized by auditory hallucinations and paranoid delusions. She has been admitted to an inpatient facility 3 times over the past 18 months. Her most recent admission was precipitated after she became agitated and struck her mother. During prior inpatient admissions, Helga has shown response to risperidone, olanzapine, and aripiprazole. She became nonadherent to her medications within a few weeks after discharge. She is refusing to attend a clubhouse program. Helga’s mother states that she cannot live with her anymore unless she is taking her antipsychotic medication regularly. The clubhouse staff has reached out to Helga, but with little success. When stable, she has worked 20 hours per week as an indoor messenger at a large law firm. How would you approach this situation?*A. Place patient in a long-term locked facilityB. Treat patient with oral disintegrating tabletsC. Treat patient with long-acting injectable atypical antipsychoticD. Treat patient with long-acting injectable typical antipsychotic Case-Based Questions continuedAlthough the use of either an oral disintegrating table or a long-acting injectable atypical antipsychotic would be appropriate at this point, in the actual case the clinician elected to first try an oral disintegrating tablet to address the adherence problem after consulting with the patient and her mother. The nursing inpatient staff assures that the patient is not “cheeking” the medication. The patient responds to the medication and is discharged 10 days later. On follow-up 2 weeks later, the patient is doing well but notes a 6-pound weight gain. Helga’s mother observes her taking her medication each evening. However, Helga states that she objects to her mother “watching over her” and needs her “independence.” The clubhouse staff reports that Helga is less and less involved. Three weeks later, Helga’s mother calls you stating that her daughter has begun acting erratically again. Helga has refused to take her oral medication for the past week, stating, “I’m my own boss.” Her mother states that Helga can’t live with her anymore. Her mother has called the police, and Helga has been admitted through the emergency room on an involuntary hold for grave disability. How would you treat Helga now?A. Long-term inpatient hospitalizationB. Trial of long-acting typical antipsychoticC. Trial of clozapineD. Trial of long-acting atypical antipsychoticE. Family therapy meeting involving patient and her mother
