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Psychiatric and Mental Health Commons™
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- Bipolar disorder (14)
- Epilepsy (11)
- Schizophrenia (7)
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- Sub-Saharan Africa (6)
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- Long-acting injectable antipsychotics (3)
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- Seizures (3)
- Stigma (3)
- Tardive dyskinesia (3)
- Treatment adherence (3)
- Cognition (2)
- Efficacy (2)
- Elderly (2)
- Expert consensus (2)
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- Global health (2)
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Articles 1 - 30 of 67
Full-Text Articles in Psychiatric and Mental Health
Development Of A Self-Management Tool For Individuals With Seizure Clusters: Trial Design And Methodological Report, Molly Mcvoy, Eytan Hirsch, Luisa Londono, Kari Colón-Zimmermann, Jin Seok Cho, Martha Sajatovic
Development Of A Self-Management Tool For Individuals With Seizure Clusters: Trial Design And Methodological Report, Molly Mcvoy, Eytan Hirsch, Luisa Londono, Kari Colón-Zimmermann, Jin Seok Cho, Martha Sajatovic
Faculty Scholarship
Background: Despite advances in anti-seizure medications (ASMs) for people with epilepsy (PWE), adverse outcomes, negative health events (NHEs), and breakthrough seizures remain common. Rescue medication (RM) can better manage repetitive seizures, but barriers to RM use persist. Self-management for PWE and a history of NHEs (SMART) is an evidence-based epilepsy self-management program aimed at reducing barriers and maximizing facilitators to self-care in high-risk PWE. Methods: This 2-phase, ongoing clinical trial adapts SMART to integrate RM support for PWE with repetitive seizures. Phase 1, now completed, used input from an advisory board (AB) of PWE, caregivers, and clinicians to adapt the …
Psychosocial Burden And Suicidality In Epilepsy: A Public Health Concern, Martha Sajatovic
Psychosocial Burden And Suicidality In Epilepsy: A Public Health Concern, Martha Sajatovic
Faculty Scholarship
The increased risk for psychosocial burden and suicidality in people with epilepsy compared to the general population is a well-established global public health concern. Suicidality risk is also increased in patients with functional seizures. The timely identification of patients at highest risk for psychosocial burden and self-harm is vital. This can pose a significant challenge for multidisciplinary clinicians caring for people with epilepsy. Early identification of social stressors and comorbid psychiatric contributors via screening are required to assist with the development of predictive models for self-harm in epilepsy; and subsequent options for treatment and the provision of adjunct supports in …
Psychological Distress Among Family Caregivers Of Persons With Alzheimer’S Disease And Related Dementias In Uganda, Martha Sajatovic
Psychological Distress Among Family Caregivers Of Persons With Alzheimer’S Disease And Related Dementias In Uganda, Martha Sajatovic
Faculty Scholarship
Background: Alzheimer's disease and related dementias (ADRD) present growing global health challenges, especially in aging populations, such as Uganda. In Uganda, familial caregiving, predominantly undertaken by female relatives, is the primary form of support provided to patients with ADRD. Cultural stigma around dementia and limited access to support services amplify caregivers' challenges. This study examined psychological distress, depression, and quality of life (QoL) among family caregivers of patients with ADRD in Wakiso District, Uganda. Methods: This cross-sectional study involved 90 caregivers from three sub-counties in Wakiso, selected through purposive sampling to capture diverse experiences. Participants included caregivers aged 18 years …
Administration Patterns Of Magnesium Sulphate For Women With Preeclampsia And Immediate Newborn Outcomes In Kawempe National Referral Hospital-Uganda: A Cohort Study, Christopher J. Burant, Shirley Moore, Carol Blixen, Martha Sajatovic
Administration Patterns Of Magnesium Sulphate For Women With Preeclampsia And Immediate Newborn Outcomes In Kawempe National Referral Hospital-Uganda: A Cohort Study, Christopher J. Burant, Shirley Moore, Carol Blixen, Martha Sajatovic
Faculty Scholarship
Background: Preeclampsia is the second leading cause of maternal death in Uganda. WHO recommends using magnesium sulphate (MgSO4) to prevent and treat preeclampsia with severe features (PEC) and eclampsia. MgSO4 is used to prevent eclampsia and treat women who experience an eclamptic convulsion to avoid severe maternal/infant illnesses and death. We set out to assess MgSO4 administration patterns in women with PEC or eclampsia and the immediate newborn outcomes of neonates. Methods: This was an analytical observational cohort study at Kawempe National Referral Hospital in Uganda. Two hundred ten pregnant mothers with PEC or eclampsia were recruited in the study …
Early Use Of Long-Acting Injectable Antipsychotics In Bipolar Disorder Type I: An Expert Consensus, Martha Sajatovic
Early Use Of Long-Acting Injectable Antipsychotics In Bipolar Disorder Type I: An Expert Consensus, Martha Sajatovic
Faculty Scholarship
Introduction: Long-acting injectable antipsychotics (LAIs) are not routinely offered to patients living with bipolar disorder type I (BP-I), despite widespread evidence that supports their benefits over oral antipsychotics, particularly in early disease. Methods: A round-table meeting of psychiatrists convened to discuss barriers and opportunities and provide consensus recommendations around the early use of LAIs for BP-I. Results: LAIs are rarely prescribed to treat BP-I unless a patient has severe symptoms, sub-optimal adherence to oral antipsychotics, or has experienced multiple relapses. Beyond country-specific accessibility issues (e.g., healthcare infrastructure and availability/approval status), primary barriers to the effective use of LAIs were identified …
Clinical Correlates Of Perceived Stigma Among People Living With Epilepsy Enrolled In A Self-Management Clinical Trial, Martha Sajatovic, Martha Sajatovic, Jessica Black, Jacqueline Krehel-Montgomery, Grace Mcdermott, Joy Yala, Richard Barigye, Clara Adeniyi, Farren Briggs
Clinical Correlates Of Perceived Stigma Among People Living With Epilepsy Enrolled In A Self-Management Clinical Trial, Martha Sajatovic, Martha Sajatovic, Jessica Black, Jacqueline Krehel-Montgomery, Grace Mcdermott, Joy Yala, Richard Barigye, Clara Adeniyi, Farren Briggs
Faculty Scholarship
Background and Purpose: Stigma is a pervasive barrier for people living with epilepsy (PLWE) and can have substantial negative effects. This study evaluated clinical correlates of perceived stigma in a research sample of PLWE considered to be at high risk due to frequent seizures or other negative health events. Methods: Analyses were derived from baseline data from an ongoing Centers for Disease Control and Prevention (CDC)-funded randomized controlled trial (RCT) testing an epilepsy self-management approach. Standardized measures assessed socio-demographics, perceived epilepsy stigma, epilepsy-related self-efficacy, epilepsy self-management competency, health literacy, depressive symptom severity, functional status, social support and epilepsy-related quality of …
Preferences For Attributes Of Oral Antipsychotic Treatments: Results From A Discrete-Choice Experiment In Respondents With Schizophrenia Or Bipolar I Disorder, Martha Sajatovic
Preferences For Attributes Of Oral Antipsychotic Treatments: Results From A Discrete-Choice Experiment In Respondents With Schizophrenia Or Bipolar I Disorder, Martha Sajatovic
Faculty Scholarship
Background: Antipsychotic medications are effective treatments for schizophrenia (SZ) and bipolar I disorder (BD-I), but when presented with different treatment options, there are tradeoffs that individuals make between clinical improvement and adverse effects. As new options become available, understanding the attributes of antipsychotic medications that are valued and the tradeoffs that individuals consider when choosing among them is important. Methods: A discrete-choice experiment (DCE) was administered online to elicit preferences across 5 attributes of oral antipsychotics: treatment efficacy (i.e., improvement in symptom severity), weight gain over 6 months, sexual dysfunction, sedation, and akathisia. Eligible respondents were aged 18–64 years with …
A 6-Month, Prospective, Randomized Controlled Trial Of Customized Adherence Enhancement Versus A Bipolar-Specific Educational Control In Poorly Adherent Adolescents And Young Adults Living With Bipolar Disorder, Jennifer B. Levin, Molly Mcvoy, Joy Yala, Jessica Black, Carla Conroy, Martha Sajatovic
A 6-Month, Prospective, Randomized Controlled Trial Of Customized Adherence Enhancement Versus A Bipolar-Specific Educational Control In Poorly Adherent Adolescents And Young Adults Living With Bipolar Disorder, Jennifer B. Levin, Molly Mcvoy, Joy Yala, Jessica Black, Carla Conroy, Martha Sajatovic
Faculty Scholarship
Objective: Few studies have addressed medication adherence in adolescents and young adults (AYAs) with bipolar disorder (BD). This 6-month prospective randomized-controlled trial (RCT) tested customized adherence enhancement for adolescents and young adults (CAE-AYA), a behavioral intervention for AYAs versus enhanced treatment as usual (ETAU). Methods: Inclusion criteria were AYAs age 13–21 with BD type I or II with suboptimal adherence defined as missing ≥20% of medications. Assessments were conducted at Screening, Baseline, and weeks 8, 12 and 24. Primary outcome was past 7 day self-reported Tablets Routine Questionnaire (TRQ) validated by electronic pillbox monitoring (SimpleMed). Symptom measures included the Hamilton …
Excess Prevalence Of Preexisting Chronic Conditions In Older Adults With Incident Epilepsy, Siran M. Koroukian, Hannah L. Fein, Long Vu, Wyatt P. Bensken, Nicholas K. Schiltz, Martha Sajatovic
Excess Prevalence Of Preexisting Chronic Conditions In Older Adults With Incident Epilepsy, Siran M. Koroukian, Hannah L. Fein, Long Vu, Wyatt P. Bensken, Nicholas K. Schiltz, Martha Sajatovic
Faculty Scholarship
Objective: Prior studies have examined chronic conditions in older adults with prevalent epilepsy, but rarely among those with incident epilepsy. Identifying the chronic conditions with which older adults present at epilepsy incidence assists with the evaluation of disease burden in this patient population and informs coordinated care development. The aim of this study was to identify preexisting chronic conditions with excess prevalence in older adults with incident epilepsy compared to those without. Methods: Using a random sample of 4 999 999 fee-for-service Medicare beneficiaries aged >65 years, we conducted a retrospective cohort study of epilepsy incidence in 2019. Non-Hispanic Black …
Development Of An International Standard Set Of Outcomes And Measurement Methods For Routine Practice For Infants, Children, And Adolescents With Epilepsy: The International Consortium For Health Outcomes Measurement Consensus Recommendations, Martha Sajatovic
Faculty Scholarship
At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy, and their representatives to develop minimum sets of standardized outcomes and outcome measurement methods for clinical practice. Using modified Delphi consensus methods with consecutive rounds of online voting over 12 months, a core set of outcomes and corresponding measurement tool packages to capture the outcomes were identified for infants, children, and adolescents with epilepsy. Consensus methods identified 20 core outcomes. In addition …
Development Of An International Standard Set Of Outcomes And Measurement Methods For Routine Practice For Adults With Epilepsy: The International Consortium For Health Outcomes Measurement Consensus Recommendations, Martha Sajatovic
Faculty Scholarship
At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. Therefore, the International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy and their representatives to develop minimum sets of standardized outcomes and outcomes measurement methods for clinical practice that support patient–clinician decision-making and quality improvement. Consensus methods identified 20 core outcomes. Measurement tools were recommended based on their evidence of strong clinical measurement properties, feasibility, and cross-cultural applicability. The essential outcomes included many non-seizure outcomes: anxiety, depression, suicidality, memory and attention, sleep …
“So, Do Not Fear”: Religion And The Prevalence, Persistence, And Severity Of Anxiety Disorders Among Black Americans, Ann W. Nguyen, Nichole Cobb, Kedong Ding
“So, Do Not Fear”: Religion And The Prevalence, Persistence, And Severity Of Anxiety Disorders Among Black Americans, Ann W. Nguyen, Nichole Cobb, Kedong Ding
Faculty Scholarship
Background: There is a dearth of scholarship that explicates the effects of religious participation on anxiety disorders among Black Americans. A better understanding of the links between religious participation, a coping resource, and anxiety disorders among Black Americans remains essential, given Black Americans are less likely than their white counterparts to seek professional treatment for mental health problems, leading to greater unmet mental health needs. The aim of this study was to investigate whether religious participation is associated with the prevalence, persistence, and severity of anxiety disorders among Black adults. Methods: We used a national sample of Black adults (N …
Earlier Use Of Long-Acting Injectable Paliperidone Palmitate Once-Monthly Versus Oral Antipsychotics In Patients With Schizophrenia: An Integrated Patient-Level Meta Analysis Of The Prosipal And Pride Studies, Martha Sajatovic
Faculty Scholarship
Purpose: A previous integrated patient-level analysis demonstrated a significant benefit of implementing once-monthly injectable paliperidone palmitate (PP1M) earlier in the treatment course for schizophrenia. Earlier therapeutic interventions during the first 3–5 years after disease onset can positively impact long-term outcomes in schizophrenia. This present analysis evaluated the risk of relapse both overall and by different durations of illness (0–3 years, >3–5 years, and >5 years from diagnosis) in adult patients with schizophrenia who received PP1M or oral antipsychotics (OAPs). Patients and Methods: This analysis included integrated patient-level data from the Paliperidone Palmitate Research in Demonstrating Effectiveness (PRIDE) and Prevention of …
Crushing The Contents Of Valbenazine Capsules For Potential Addition To Soft Foods Or Administration Via Gastrostomy Tube, Martha Sajatovic
Crushing The Contents Of Valbenazine Capsules For Potential Addition To Soft Foods Or Administration Via Gastrostomy Tube, Martha Sajatovic
Faculty Scholarship
Purpose: One-capsule, once-daily valbenazine is approved for tardive dyskinesia and under evaluation for chorea associated with Huntington's disease, conditions in which patients often experience dysphagia. In vitro studies were conducted to assess the suitability of crushing the contents of valbenazine capsules (40 and 80 mg) for mixing with soft foods or liquids or administration via a gastrostomy tube (G-tube). Methods: In study 1, the dissolution of whole valbenazine capsules and crushed capsule contents were measured serially for 1 hour. In study 2, valbenazine recovery was evaluated after crushed contents were mixed with soft foods, buffer solutions (pH range, 1.2–6.8), and …
Demographic And Clinical Associations To Employment Status In Older-Age Bipolar Disorder: Analysis From The Gage-Bd Database Project, Amulya Mallu, Carol K. Chan, Kaylee Sarna, Joy Yala, Farren B.S. Briggs, Martha Sajatovic
Demographic And Clinical Associations To Employment Status In Older-Age Bipolar Disorder: Analysis From The Gage-Bd Database Project, Amulya Mallu, Carol K. Chan, Kaylee Sarna, Joy Yala, Farren B.S. Briggs, Martha Sajatovic
Faculty Scholarship
Objective: The current literature on employment in older adults with bipolar disorder (OABD) is limited. Using the Global Aging and Geriatric Experiments in Bipolar Disorder Database (GAGE-BD), we examined the relationship of occupational status in OABD to other demographic and clinical characteristics. Methods: Seven hundred and thirty-eight participants from 11 international samples with data on educational level and occupational status were included. Employment status was dichotomized as employed versus unemployed. Generalized linear mixed models with random intercepts for the study cohort were used to examine the relationship between baseline characteristics and employment. Predictors in the models included baseline demographics, education, …
Evidence-Supported Interventions For Reducing Secondary Stroke Risk In Sub-Saharan Africa: A Systematic Review, Alyssa M. Edwards, Christopher J. Burant, Shirley M. Moore, Carol Blixen, Maratha Sajatovic
Evidence-Supported Interventions For Reducing Secondary Stroke Risk In Sub-Saharan Africa: A Systematic Review, Alyssa M. Edwards, Christopher J. Burant, Shirley M. Moore, Carol Blixen, Maratha Sajatovic
Faculty Scholarship
The study set out to perform a systematic literature review of evidence-based interventions that target the reduction of secondary stroke risk in Africa. The review analyzed longitudinal intervention studies conducted in Sub-Saharan Africa, focusing on adult participants who had suffered a prior stroke. It encompassed publications and peer-reviewed papers sourced from reputable databases, including PubMed, Ovid, Cochrane, and Web of Science. Three randomized clinical trial (RCT) studies were included with sample sizes ranging from 16 to 400 participants, mean age ranged between 50 and 66 years, with 64.5% male participants. All studies applied multidisciplinary team interventions of enhanced patient follow-up …
Fibrinogen; A Predictor Of Injury Severity And Mortality Among Patients With Traumatic Brain Injury In Sub-Saharan Africa: A Cross-Sectional Observational Study, Michael Devereaux, Martha Sajatovic
Fibrinogen; A Predictor Of Injury Severity And Mortality Among Patients With Traumatic Brain Injury In Sub-Saharan Africa: A Cross-Sectional Observational Study, Michael Devereaux, Martha Sajatovic
Faculty Scholarship
Studies show that fibrinogen concentrations <2 g/L in patients with traumatic brain injury (TBI) is associated with increased mortality. However, little is known regarding fibrinogen levels and TBI severity as well as mortality in sub-Saharan Africa despite shouldering a high burden of TBI. We therefore set out to determine whether fibrinogen levels are associated with TBI severity and outcome. To determine the sensitivity and specificity of fibrinogen levels and the association with severity and mortality among TBI patients at Mulago Hospital. We prospectively enrolled 213 patients with TBI aged between 13 and 60 years of age and presenting within 24 hours of injury. Patients with preexisting coagulopathy, concurrent use of anticoagulant or antiplatelet agents, preexisting hepatic insufficiency, diabetes mellitus and who were pregnant were excluded. Fibrinogen levels were determined using the Clauss fibrinogen assay. Logistic regression analyses were conducted to identify the association between fibrinogen level and 7-day outcomes. Majority of the patients were male (88.7%) and nearly half were aged 30 or less (48.8%). Fibrinogen levels <2 g/L were observed in 35.1% of the study participants. The average time spent in the study was 3.7 ± 2.4 days. The sensitivity and specificity using fibrinogen <2 g/L was 56.5% and 72.9% respectively. Fibrinogen levels predict TBI severity with an AUC = 0.656 (95% CI 0.58-0.73: P = .000) Fibrinogen levels <2 g/L (hypofibrinogenemia) were independently associated with severe TBI. (Adjusted odds ratio 2.87 CI, 1.34-6.14: P = .007). Levels above 4.5 g/L were also independently associated with injury severity (adjusted odds ratio 2.89, CI 1.12-7.48: P < .05) Fibrinogen levels more than 4.5 g/L were independently associated with mortality (OR 4.5, CI; 1.47-13.61, P < .05). The fibrinogen level is a useful tool in predicting severity including mortality of TBI. Fibrinogen levels may be used as an additional tool to screen TBI patients for injury severity especially among patients with Glasgow coma scale scores of <14.
Blood Pressure Variability And Early Neurological Outcomes In Acute And Subacute Stroke In Southwestern Uganda, Shirley M. Moore, Martha Sajatovic
Blood Pressure Variability And Early Neurological Outcomes In Acute And Subacute Stroke In Southwestern Uganda, Shirley M. Moore, Martha Sajatovic
Faculty Scholarship
Background: Greater blood pressure variability has detrimental effects on clinical outcome after a stroke; its effects are controversial and have not been evaluated in Sub-Saharan Africa (SSA). Methods: We conducted a prospective study of patients with CT head confirmed ischemic and hemorrhagic strokes admitted to a tertiary hospital within 7 days of onset of unilateral neurological deficits. Blood pressure variability indices, standard deviation (SD) and coefficient of variation (CV) of systolic and diastolic blood pressure between day 0 and day 7, were calculated with a subsequent modified Rankin Scale (mRS) score on day 14 post-stroke. Linear regression was performed to …
Aggressive End-Of-Life Care Across Gradients Of Cognitive Impairment In Nursing Home Patients With Metastatic Cancer, Siran M. Koroukian, Sara L. Douglas, Long Vu, Hannah L. Fein, Nicholas K. Schiltz, Jennifer Cullen, Cynthia Owusu, Martha Sajatovic, Johnie Rose
Aggressive End-Of-Life Care Across Gradients Of Cognitive Impairment In Nursing Home Patients With Metastatic Cancer, Siran M. Koroukian, Sara L. Douglas, Long Vu, Hannah L. Fein, Nicholas K. Schiltz, Jennifer Cullen, Cynthia Owusu, Martha Sajatovic, Johnie Rose
Faculty Scholarship
Background: Studies examining end-of-life (EOL) care in older cancer patients are scarce, and prior studies have not accounted for gradients of cognitive impairment (COG-I). We examine EOL care patterns across COG-I gradients, hypothesizing that greater COG-I severity is associated with lower odds of receiving aggressive EOL care. Methods: Using data from the linked Surveillance Epidemiology and End Results (SEER) -Medicare -Minimum Data Set (MDS) 3.0, we identified patients with nursing facility stays (NFS) and who died with metastatic cancer from 2013 to 2017. Markers of aggressive EOL care were: cancer-directed treatment, intensive care unit admission, >1 emergency department visit, or …
Incidence Of Aggressive End-Of-Life Care Among Older Adults With Metastatic Cancer Living In Nursing Homes And Community Settings, Siran M. Koroukian, Sara L. Douglas, Long Vu, Hannah L. Fein, Richa Gairola, Nicholas K. Schiltz, Jennifer Cullen, Cynthia Owusu, Martha Sajatovic, Johnie Rose
Incidence Of Aggressive End-Of-Life Care Among Older Adults With Metastatic Cancer Living In Nursing Homes And Community Settings, Siran M. Koroukian, Sara L. Douglas, Long Vu, Hannah L. Fein, Richa Gairola, Nicholas K. Schiltz, Jennifer Cullen, Cynthia Owusu, Martha Sajatovic, Johnie Rose
Faculty Scholarship
Importance: Nearly 10% of the 1.5 million persons residing in nursing homes (NHs) have received or will receive a diagnosis of cancer. Although aggressive end-of-life (EOL) care is common among community-dwelling patients with cancer, little is known about such patterns of care among NH residents with cancer. Objective: To compare markers of aggressive EOL care between older adults with metastatic cancer who are NH residents and their community-dwelling counterparts. Design, Setting, and Participants: This cohort study used the Surveillance, Epidemiology, and End Results database linked with the Medicare database and the Minimum Data Set (including NH clinical assessment data) for …
Cognitive Functioning And Prevalence Of Seizures Among Older Persons In Uganda: A Hospital-Based, Cross-Sectional Study, Martha Sajatovic
Cognitive Functioning And Prevalence Of Seizures Among Older Persons In Uganda: A Hospital-Based, Cross-Sectional Study, Martha Sajatovic
Faculty Scholarship
There is limited data on the prevalence of seizures and dementia among older persons in Uganda. We evaluated cognitive functioning, and the prevalence and factors associated with seizures among older persons attending an outpatient medical clinic in Uganda. We randomly selected older adults (60 years and above) attending Kiruddu National Referral Hospital medical outpatient clinics between October 2020 and March 2021. We excluded individuals with a history of head injury, brain tumors, mental retardation, co-morbidity with HIV and patients who have had recent brain surgery. Cognitive functioning was assessed using the Identification for Dementia in Elderly Africans (IDEA) tool. We …
Pre Covid-19 Pandemic Use Of Telemedicine For Adherence Promotion In Patients With Psychotic Disorders: A Literature Review, Alyssa M. Edwards, Jordan C. Petitt, Sanjana Kumar, Jennifer B. Levin, Martha Sajatovic
Pre Covid-19 Pandemic Use Of Telemedicine For Adherence Promotion In Patients With Psychotic Disorders: A Literature Review, Alyssa M. Edwards, Jordan C. Petitt, Sanjana Kumar, Jennifer B. Levin, Martha Sajatovic
Faculty Scholarship
Introduction: Given the increasing use of telepsychiatry and to serve as a reference point informing future research, our team evaluated the literature on the use of telepsychiatry for medication adherence promotion prior to the COVID-19 pandemic among patients with psychotic disorders. Methods: A search of PubMed, Cochrane, Web of Science, CINAHL, and PsycINFO was conducted using PRISMA guidelines to identify telepsychiatry interventions to enhance medication adherence in patients with primary psychotic disorders. Both quantitative and qualitative data were extracted from the identified articles including study characteristics, interventions, and outcomes. Results: In total, 230 articles were obtained through electronic literature search, …
A Randomized Controlled Trial Of Customized Adherence Enhancement (Cae-E): Study Protocol For A Hybrid Effectiveness-Implementation Project, Jennifer B. Levin, Farren Briggs, Carol Blixen, Douglas Einstadter, Jeffrey M. Albert, Celeste Weise, Edna Fuentes-Casiano, Kristin A. Cassidy, Martha Sajatovic
A Randomized Controlled Trial Of Customized Adherence Enhancement (Cae-E): Study Protocol For A Hybrid Effectiveness-Implementation Project, Jennifer B. Levin, Farren Briggs, Carol Blixen, Douglas Einstadter, Jeffrey M. Albert, Celeste Weise, Edna Fuentes-Casiano, Kristin A. Cassidy, Martha Sajatovic
Faculty Scholarship
Background: Mood-stabilizing medications are a cornerstone of treatment for people with bipolar disorder, though approximately half of these individuals are poorly adherent with their medication, leading to negative and even severe health consequences. While a variety of approaches can lead to some improvement in medication adherence, there is no single approach that has superior adherence enhancement and limited data on how these approaches can be implemented in clinical settings. Existing data have shown an increasing need for virtual delivery of care and interactive telemedicine interventions may be effective in improving adherence to long-term medication. Methods: Customized adherence enhancement (CAE) is …
Using Mhealth To Improve Adherence And Reduce Blood Pressure In Individuals With Hypertension And Bipolar Disorder (Itab-Cv): Study Protocol For A 2-Stage Randomized Clinical Trial, Jennifer B. Levin, Farren Briggs, Mahboob Rahman, Kurt C. Stange, Douglas Einstadter, Celeste Weise, Carla Conroy, Joy Yala, Ethan Radatz, Martha Sajatovic
Using Mhealth To Improve Adherence And Reduce Blood Pressure In Individuals With Hypertension And Bipolar Disorder (Itab-Cv): Study Protocol For A 2-Stage Randomized Clinical Trial, Jennifer B. Levin, Farren Briggs, Mahboob Rahman, Kurt C. Stange, Douglas Einstadter, Celeste Weise, Carla Conroy, Joy Yala, Ethan Radatz, Martha Sajatovic
Faculty Scholarship
Background: Cardiovascular disease in individuals with mental health conditions such as bipolar disorder is highly prevalent and often poorly managed. Individuals with bipolar disorder face significant medication adherence barriers, especially when they are prescribed multiple medications for other health conditions including hypertension. Poor adherence puts them at a disproportionate risk for poor health outcomes. As such, there is a need for effective interventions to improve hypertension medication adherence, particularly in patients that struggle with adherence due to mental health comorbidity. Methods: This 5-year project uses a 2-stage randomized controlled trial design to evaluate a brief, practical adherence intervention delivered via …
A Mixed-Methods, Cross-Sectional Study Of Perceived Stigma Among Ugandans With Epilepsy, Carol Blixen, Martha Sajatovic
A Mixed-Methods, Cross-Sectional Study Of Perceived Stigma Among Ugandans With Epilepsy, Carol Blixen, Martha Sajatovic
Faculty Scholarship
Background: Epilepsy is associated with stigma and negatively impacts the lives of people living with epilepsy (PLWE) and their immediate families. More understanding of the stigma and discrimination experienced by PLWE in sub-Saharan Africa is needed. Methods: In a cross-sectional, mixed methods study, forty- eight PLWE who met the study inclusion criteria were enrolled. In depth interviews and focus group discussions were conducted and were audiotaped and transcribed verbatim. Analysis was conducted using a thematic, constant comparative approach with an emphasis on dominant themes. Perceived stigma was measured using the Kilifi epilepsy stigma score. Associations between socio-demographic factors and Kilifi …
Long-Term Safety And Efficacy Of Deutetrabenazine In Younger And Older Patients With Tardive Dyskinesia, Martha Sajatovic
Long-Term Safety And Efficacy Of Deutetrabenazine In Younger And Older Patients With Tardive Dyskinesia, Martha Sajatovic
Faculty Scholarship
Objectives: To assess long-term safety and efficacy of deutetrabenazine in younger (<55 years) and older (≥55 years) adult participants with tardive dyskinesia (TD). Design: Three-year, single-arm, open-label extension (OLE) study enrolling participants who completed the 12-week, pivotal ARM-TD or AIM-TD studies. Setting: Seventy-six centers in the United States and Europe. Participants: A total of 337 participants with TD (119 younger and 218 older). Intervention: Deutetrabenazine was initiated at 12 mg/day and titrated once weekly by 6 mg/day using a response-driven dosing regimen until adequate dyskinesia control was reached or a clinically significant adverse event occurred. Measurements: This post hoc analysis assessed change and percent change from baseline in total motor Abnormal Involuntary Movement Scale (AIMS) score, response rates for ≥50% AIMS improvement, Clinical Global Impression of Change (CGIC), Patient Global Impression of Change (PGIC), and safety in younger and older participants with TD. Results: After 3 years of open-label treatment, mean deutetrabenazine dose was ∼39.5 mg/day in both groups. Mean±SE changes from baseline in total motor AIMS score were –6.7 ± 0.62 and –6.5 ± 0.47 in younger and older participants, respectively (percent changes: –61.4% ± 4.10% and –54.6% ± 3.01%); 76% of younger and 62% of older participants achieved ≥50% AIMS response. Most younger and older participants achieved treatment success per CGIC (67% and 76%) and PGIC (64% and 63%). Deutetrabenazine was generally well tolerated in both groups. Conclusions: Deutetrabenazine treatment was associated with sustained improvements in total motor AIMS score, treatment success, and improved quality of life, and was well tolerated in younger and older adults with TD in this 3-year OLE study.
An Interventional Pilot Of Customized Adherence Enhancement Combined With Long-Acting Injectable Antipsychotic Medication (Cae-L) For Poorly Adherent Patients With Chronic Psychotic Disorder In Tanzania, Christopher J. Burant, Carol E. Blixen, Kristin A. Cassidy, Jennifer B. Levin, Martha Sajatovic
An Interventional Pilot Of Customized Adherence Enhancement Combined With Long-Acting Injectable Antipsychotic Medication (Cae-L) For Poorly Adherent Patients With Chronic Psychotic Disorder In Tanzania, Christopher J. Burant, Carol E. Blixen, Kristin A. Cassidy, Jennifer B. Levin, Martha Sajatovic
Faculty Scholarship
Background: Chronic psychotic disorders (CPD) impose a particularly significant burden in resource-limited settings. Combining long-acting antipsychotic medication (LAI) with a customized adherence enhancement intervention (CAE-L) has potential to advance care. Methods: Nineteen adults ≥ age 18 with CPD who self-reported missing ≥20% of antipsychotic medication within the last month were stabilized on oral haloperidol prior to transitioning to monthly haloperidol decanote for 25 weeks. Outcome evaluations were conducted at baseline and Week 25. Primary outcomes were oral medication adherence assessed via the Tablet Routines Questionnaire (TRQ) and LAI injection frequency. Secondary outcomes included CPD symptoms measured by the Brief Psychiatric …
Directly Observed Weekly Fluoxetine For Major Depressive Disorder Among Hemodialysis Patients: A Single-Arm Feasibility Trial, Kelley M. Kauffman, Jacqueline Dolata, Maria Figueroa, Douglas Gunzler, Anne Huml, Julie Pencak, Martha Sajatovic, Ashwini R. Sehgal
Directly Observed Weekly Fluoxetine For Major Depressive Disorder Among Hemodialysis Patients: A Single-Arm Feasibility Trial, Kelley M. Kauffman, Jacqueline Dolata, Maria Figueroa, Douglas Gunzler, Anne Huml, Julie Pencak, Martha Sajatovic, Ashwini R. Sehgal
Faculty Scholarship
Rationale & Objective: Major depressive disorder (MDD) is common among hemodialysis patients, but treatment can add to their pill burden and may be limited by nonadherence. We sought to investigate the value of directly observed, once-weekly fluoxetine dosing in MDD. Study Design: Feasibility trial of adult hemodialysis patients with untreated MDD. The diagnosis of MDD was determined using the Mini International Neuropsychiatric Interview. Setting & Participants: 16 patients at 15 hemodialysis facilities in Northeast Ohio. Intervention: Patients were initially prescribed 20 mg of fluoxetine once daily for 2 weeks to assess their tolerance. The patients took this daily fluoxetine unobserved …
A Randomized Controlled Trial Of Self-Management For People With Epilepsy And A History Of Negative Health Events (Smart) Targeting Rural And Underserved People With Epilepsy: A Methodologic Report, Farren Briggs, Kristin Cassidy, Carol Blixen, Martha Sajatovic
A Randomized Controlled Trial Of Self-Management For People With Epilepsy And A History Of Negative Health Events (Smart) Targeting Rural And Underserved People With Epilepsy: A Methodologic Report, Farren Briggs, Kristin Cassidy, Carol Blixen, Martha Sajatovic
Faculty Scholarship
Background: Many people living with epilepsy (PLWE) reside in rural communities, and epilepsy self-management may help address some of the gaps in epilepsy care for these communities. A prior randomized control trial of a remotely delivered, Web-based group format 12-week self-management program (SMART) conducted in Northeast Ohio, a primarily urban and suburban community, demonstrated improved outcomes in negative health events such as depression symptoms and quality of life. However, there is a paucity of research addressing the needs of PLWE in rural settings. Methods: The present study leverages collaboration between investigators from 2 mid-western US states (Ohio and Iowa) to …
Bipolar I And Bipolar Ii Subtypes In Older Age: Results From The Global Aging And Geriatric Experiments In Bipolar Disorder (Gage-Bd) Project, Farren Briggs, Martha Sajatovic, Kaylee Sarna, Joy Yala
Bipolar I And Bipolar Ii Subtypes In Older Age: Results From The Global Aging And Geriatric Experiments In Bipolar Disorder (Gage-Bd) Project, Farren Briggs, Martha Sajatovic, Kaylee Sarna, Joy Yala
Faculty Scholarship
Objectives: The distinction between bipolar I disorder (BD-I) and bipolar II disorder (BD-II) has been a topic of long-lasting debate. This study examined differences between BD-I and BD-II in a large, global sample of OABD, focusing on general functioning, cognition and somatic burden as these domains are often affected in OABD. Methods: Cross-sectional analyses were conducted with data from the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) database. The sample included 963 participants aged ≥50 years (714 BD-I, 249 BD-II). Sociodemographic and clinical factors were compared between BD subtypes including adjustment for study cohort. Multivariable analyses were conducted …