Increasing Treatment Adherence in Co-Occurring Disorders

描述：(申请人提供)： 这个应用程序是为“以患者为中心的研究生涯提供指导”的 发展奖“(K23)，研究共病患者的治疗依从性 精神和药物使用障碍(COD)，在布鲁斯J。 医学博士罗恩萨维尔和医学博士理查德·S·肖滕菲尔德。 在COD中的问题，特别是在抑郁障碍患者中 经常并限制了有效治疗所获得的最大利益， 尤其是那些具有改善这两种条件的潜力的情况(例如， 抗抑郁药)。因此，提高COD依从性的干预措施可以 优化治疗效果。它们也能适应新的治疗方法。 正在开发中的。虽然初步研究表明 依从性增强干预对非COD型患者有效， 对化学需氧量的系统评价很少。与开发新的 治疗内容，研究提高依从性的简要策略 现有的治疗方法是一种成本效益很高的方法，可以有很大的 而且很快就能得到回报。此K23应用程序的研究计划需要：1) 在9项正在进行的研究中评价遵守问题，2)完成一项新的 临床试验评价创新的黏附促进方法在一年中 双诊门诊。这项新的临床试验将采用 拆解设计，75例门诊伴发抑郁症患者 障碍和药物滥用/依赖(Codda)将随机分配到：1) 照常治疗(TAU)，一种提供药物管理的控制条件， 关于诊断和坚持的重要性的标准教育，以及 团体咨询，2)TAU+依从性反馈(TAU+AF)，患者接受 Tau Plus关于药物和咨询依从性的计算机化反馈，基于 药物事件监测系统(MEMS；加利福尼亚州弗里蒙特的Aprex公司)数据 和出勤记录，或3)TAU+激励增强型反馈(TAU+MEF)， TAU加激励强化疗法和应急管理 将添加到自动对焦中。主要结果衡量标准是：1)遵守 抗抑郁药物，根据MEMS上限和自我报告来衡量，2)比率 咨询出勤率；3)减少非法药物使用，包括 通过每周两次尿毒学检测来评估戒酒的效果 和自我报告。次要结果包括抑郁症的减少 症状学和再住院率。

DESCRIPTION: (Provided by Applicant): This application is for a "Mentored Patient-Oriented Research Career Development Award" (K23) to study treatment adherence in co-occurring psychiatric and drug use disorders (COD), under the mentorship of Bruce J. Rounsaville, M.D. and Richard S. Schottenfeld, M.D. Nonadherence is a critical issue in COD, especially among those with depressive disorders, as it occurs frequently and limits the maximal benefit achieved by efficacious treatments, particularly those with the potential to improve both conditions (e.g., antidepressants). Therefore, adherence-enhancing interventions for COD can optimize the efficacy of treatments. They are also adaptable to new treatments that are being developed. While preliminary studies indicate that adherence-enhancing interventions are efficacious for patients with non-COD, little systematic evaluation has occurred in COD. Compared to developing new contents for treatment, studying brief strategies to improve adherence to existing treatments is a highly cost-efficient approach that can have a large and rapid payoff. The research plan for this K23 application entails: 1) the evaluation of adherence issues in 9 ongoing studies and 2) completion of a new clinical trial evaluating innovative adherence-enhancing methods for COD in a dual-diagnosis outpatient clinic. This new clinical trial will employ a dismantling design, within which 75 outpatients with co-occurring depressive disorders and drug abuse/dependence (CODDA) will be randomly assigned to: 1) Treatment-as-Usual (TAU), a control condition offering medication management, standard education regarding diagnosis and the importance of adherence, and group counseling, 2) TAU+Adherence Feedback (TAU+AF), in which patients receive TAU plus computerized feedback on medication and counseling adherence, based on Medication Event Monitoring System (MEMS; Aprex Corporation, Fremont, CA) data and attendance records, or 3) TAU+Motivationally Enhanced Feedback (TAU+MEF), in which TAU plus Motivational Enhancement Therapy and Contingency Management will be added to AF. Primary outcome measures are: 1) rates of adherence to antidepressant medication, as measured by MEMS caps and self-report, 2) rates of counseling attendance, and 3) reductions in illicit drug use, including achievement of abstinence, as assessed by twice-weekly urine toxicology tests and self-report. Secondary outcomes include reductions in depressive symptomatology and rates of re-hospitalization.