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Patterns, predictors, and patient-reported reasons for antidepressant discontinuation in the WHO World Mental Health Surveys
- Alan E. Kazdin, Meredith G. Harris, Irving Hwang, Nancy A. Sampson, Dan J. Stein, Maria Carmen Viana, Daniel V. Vigo, Chi-Shin Wu, Sergio Aguilar-Gaxiola, Jordi Alonso, Corina Benjet, Ronny Bruffaerts, José Miguel Caldas-Almeida, Graça Cardoso, Elisa Caselani, Stephanie Chardoul, Alfredo Cía, Peter de Jonge, Oye Gureje, Josep Maria Haro, Elie G. Karam, Viviane Kovess-Masfety, Fernando Navarro-Mateu, Marina Piazza, José Posada-Villa, Kate M. Scott, Juan Carlos Stagnaro, Margreet ten Have, Yolanda Torres, Cristian Vladescu, Ronald C. Kessler
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- Journal:
- Psychological Medicine / Volume 54 / Issue 1 / January 2024
- Published online by Cambridge University Press:
- 14 September 2023, pp. 67-78
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- Article
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Background
Despite their documented efficacy, substantial proportions of patients discontinue antidepressant medication (ADM) without a doctor's recommendation. The current report integrates data on patient-reported reasons into an investigation of patterns and predictors of ADM discontinuation.
MethodsFace-to-face interviews with community samples from 13 countries (n = 30 697) in the World Mental Health (WMH) Surveys included n = 1890 respondents who used ADMs within the past 12 months.
Results10.9% of 12-month ADM users reported discontinuation-based on recommendation of the prescriber while 15.7% discontinued in the absence of prescriber recommendation. The main patient-reported reason for discontinuation was feeling better (46.6%), which was reported by a higher proportion of patients who discontinued within the first 2 weeks of treatment than later. Perceived ineffectiveness (18.5%), predisposing factors (e.g. fear of dependence) (20.0%), and enabling factors (e.g. inability to afford treatment cost) (5.0%) were much less commonly reported reasons. Discontinuation in the absence of prescriber recommendation was associated with low country income level, being employed, and having above average personal income. Age, prior history of psychotropic medication use, and being prescribed treatment from a psychiatrist rather than from a general medical practitioner, in comparison, were associated with a lower probability of this type of discontinuation. However, these predictors varied substantially depending on patient-reported reasons for discontinuation.
ConclusionDropping out early is not necessarily negative with almost half of individuals noting they felt better. The study underscores the diverse reasons given for dropping out and the need to evaluate how and whether dropping out influences short- or long-term functioning.
27 - Epilepsy genes: the search grows longer
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- By Antonio V. Delgado-Escueta, Comprehensive Epilepsy Program, UCLA and VA Greater Los Angeles Healthcare System, CA, USA, Marco T. Medina, Department of Neurology, Autonomous University, Tegucigalpa, Honduras, Maria Elisa Alonso, Department of Genetics National Institute of Neurology and Neurosurgery, Mexico City, Mexico, G. C. Y. Fong, Division of Neurology, University Department of Medicine, Queen Mary Hospital, Hong Kong
- Edited by Renzo Guerrini, University of London, Jean Aicardi, Hôpital Robert-Debré, Paris, Frederick Andermann, Montreal Neurological Institute & Hospital, Mark Hallett, National Institutes of Health, Baltimore
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- Book:
- Epilepsy and Movement Disorders
- Published online:
- 03 May 2010
- Print publication:
- 13 December 2001, pp 421-450
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- Chapter
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Summary
Introduction
This chapter initially reviews the new advances in molecular genetics of idiopathic epilepsies in infants, children, adolescents and adults and provides a progress report on the search for chromosomal loci of epilepsy syndromes. After presenting an overview on the molecular genetics of idiopathic epilepsies, this chapter focuses on phenotypes and genotypes of genetic epilepsies that are commonly mistaken for movement disorders.
Understanding the genotypes and phenotypes of movement disorders and epilepsies in infants, children and adolescents is important because some motor signs of idiopathic epilepsies of infants, children and adolescents are mistaken for movement disorders and some movement disorders of children and adolescents are mistaken for the epilepsies. Moreover, understanding the new advances in the molecular genetics of movement disorders and epilepsies is important because they provide us with more than a glimpse of the new practice of molecular neurology. The epilepsies have traditionally been classified and subtyped on the basis of clinical and neurophysiologic concepts. The complexity and variability of phenotype and overlapping clinical features limit the resolution of phenotype-based classification and confounds epilepsy nosology. Identification of tightly linked epilepsy DNA markers and discovery of epilepsy causing mutations provide a basis for refining the classification of epilepsies.
Table 27.1 lists some of the epilepsies commonly mistaken for movement disorders and Table 27.2 gives some descriptions used by the referring physicians that made them mistakenly suspect a movement disorder in patients with juvenile myoclonic epilepsy (JME). Patients initially diagnosed to have movement disorders were verified to have myoclonias and rapid spike-wave complexes on CCTV-EEG telemetry.