BACKGROUND: Little is known about the specific types of childhood trauma and their relationship to treatment-related issues in major depressive disorder (MDD). This study examined trauma experiences and treatment-related variables in outpatients with MDD at a psychiatric department of a university hospital in Korea.METHODS: First, 75 outpatients with MDD were compared to medical outpatients without MDD matched by age, sex, income, and educational qualifications. Both groups completed the Life Stressor Checklist-Revised, which assesses comprehensive life events. Second, treatment-related variables and medication compliance measured by the Compliance Rating Scale were investigated for the two-year period after the initial assessment.RESULTS: The MDD group had experienced a significantly higher number of lifetime traumas than the control group (p=0.003), including more frequent witnessing of family violence (p<0.001), adulthood physical assault by a family member (p<0.001), and childhood emotional abuse (CEA) (p<0.001). CEA was associated with early onset of the first depressive episode and premature termination of pharmacotherapy; childhood physical neglect was associated with premature termination and less time in therapy.CONCLUSION: Our findings support the important influence of childhood emotional trauma and its relationship to treatment retention.
Child ; Child Abuse ; Compliance ; Depressive Disorder, Major ; Domestic Violence ; Drug Therapy ; Follow-Up Studies ; Humans ; Korea ; Medication Adherence ; Outpatients ; Patient Dropouts

OBJECTIVETo study the efficacy of modified Wuzhuyu Decoction Granule (, MWDG) in the treatment of migraine patients with cold and stasis obstructing meridian syndrome.

METHODSThis study was a randomized, double-blind, placebo-controlled trial. A total of 78 migraine patients with cold and stasis obstructing meridian syndrome were recruited and randomly assigned by a ratio of 2:1 into a treatment group (51 cases) and a placebo group (27 cases). Patients in the treatment group were treated with MWDG while placebo granules were applied in the control group. The treatment course lasted for 12 weeks with a follow-up of 4 weeks. The primary outcome measures included frequency and days of migraine attacks and the secondary outcome measures were analgesics consumption and visual analogue scale (VAS) scores. All outcome assessments were conducted respectively at baseline, the 4th, 8th and 12th week, and the end of follow-up.

RESULTSIn the treatment group, significant decrease in frequency of migraine attacks were observed since the 4th week and that of analgesics consumption since the 8th week (both P<0.05). While, in the placebo group, significant decrease in frequency of migraine attacks were observed since the 8th week and that of analgesics consumption since the 12th week (both P<0.05). No significant decrease in days of migraine attacks and VAS scores of migraine pain were observed in both groups. Between the two groups, there were significant differences in VAS scores and intensity of pain appeared in the 8th week (P<0.05). However, no significant differences were found in days and frequency of migraine attacks and analgesics consumption (P>0.05).

CONCLUSIONSMWDG was probably effective in the treatment of migraine especially for alleviating pain intensity. Furthermore, MWDG could reduce the frequency of migraine attacks and analgesics consumption sooner than the placebo.

Adult ; Analgesics ; therapeutic use ; Demography ; Double-Blind Method ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Female ; Humans ; Male ; Meridians ; Migraine Disorders ; drug therapy ; Pain Measurement ; Patient Dropouts ; Placebos ; Syndrome ; Treatment Outcome

OBJECTIVE: In this study, we investigated the determinants of remission and discontinuation of paroxetine pharmacotherapy in outpatients with panic disorder (PD). METHODS: Subjects were 79 outpatients diagnosed with PD who took 10–40 mg/day of paroxetine for 12 months. The candidate therapeutic determinants included the serotonin transporter gene-linked polymorphic region and the −1019C/G promoter polymorphism of the serotonin receptor 1A as genetic factors, educational background and marital status as environmental factors, and early improvement (EI) at 2 weeks as a clinical factor were assessed. The Clinical Global Impression scale was used to assess the therapeutic effects of the pharmacotherapy. RESULTS: Cox proportional hazards regression was performed to investigate the significant predictive factors of remission and discontinuation. EI was only a significant predictive factor of remission. EI was a significant predictive factor of remission (hazard ratio [HR], 2.709; 95% confidence interval [CI], 1.177–6.235). Otherwise, EI and marital status were significant predictive factors of the discontinuation. EI (HR, 0.266; 95% CI, 0.115–0.617) and being married (HR, 0.437; 95% CI, 0.204–0.939) were considered to reduce the risk of treatment discontinuation. In married subjects, EI was a significant predictive factor of the discontinuation (HR, 0.160; 95% CI, 0.045–0.565). However, in unmarried subjects, EI was not a significantly predictive factor for the discontinuation. CONCLUSION: EI achievement appears to be a determinant of PD remission in paroxetine treatment. In married PD patients, EI achievement also appears to reduce a risk of discontinuation of paroxetine treatment.
Drug Therapy ; Humans ; Marital Status ; Marriage* ; Outpatients* ; Panic Disorder* ; Panic* ; Paroxetine* ; Patient Dropouts ; Remission Induction ; Serotonin ; Serotonin Plasma Membrane Transport Proteins ; Single Person ; Therapeutic Uses ; Treatment Outcome*

PURPOSE: This study was designed to evaluate the efficacy of medical treatment of Peyronie's disease. MATERIALS AND METHODS: A total of 109 patients with Peyronie's disease who had been treated from January 2011 to December 2014 were retrospectively reviewed in this study. Forty-four patients (Group 1) were treated with 12 mg of potassium para-aminobenzoate daily. Sixty-five patients (Group 2) were treated with combination therapy: tamoxifen (20 mg) and acetyl-L-carnitine (300 mg) twice daily in addition to a phosphodiesterase type 5 inhibitor. Ability to perform sexual intercourse, pain during erection, size of plaque, and penile curvature angle were assessed. RESULTS: In Group 1, 30 of 44 patients (68.2%) discontinued treatment within 12 weeks, while 5 patients (7.7%) in Group 2 discontinued treatment. Pain during erection and plaque size were improved in both groups but showed no statistical difference due to the high dropout rate in Group 1. In both groups, penile curvature was improved, but demonstrated no statistical difference between the treatment groups. However, combination therapy demonstrated a better response rate in patients whose penile curvature angle was less than 30° (44.4% vs. 79.1%, p=0.048). The rate of successful sexual intercourse was significantly higher in Group 2 (42.8% vs. 78.3%, p=0.034). The number of patients who underwent surgical correction despite medical treatment was significantly higher in Group 1 (35.7% vs. 13.3%, p=0.048). CONCLUSIONS: Early medical combination therapy in Peyronie's disease may present better results in patients whose curvature angle is less than 30°.
4-Aminobenzoic Acid ; Acetylcarnitine ; Carnitine* ; Coitus ; Drug Therapy, Combination ; Humans ; Male ; Patient Dropouts ; Penile Induration* ; Potassium* ; Retrospective Studies ; Tamoxifen*

INTRODUCTIONStudies examining mental health treatment dropout have primarily focused on Western populations and less so on Asian samples. The current study explored the prevalence and correlates of mental health treatment dropout across the various healthcare sectors in Singapore.

MATERIALS AND METHODSData was utilised from the Singapore Mental Health Study (SMHS), a cross-sectional epidemiological survey conducted among an adult population (n = 6616) aged 18 years and above. Statistical analyses were done on a subsample of respondents (n = 55) who had sought treatment from the various treatment providers (i.e. mental health, medical, social services and religious healers) in the past 12 months. The World Mental Health (WMH) Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was used to determine diagnoses of mental disorders, chronic medical disorders and service utilisation.

RESULTSOf those who had received treatment, 37.6% had ended treatment prematurely, 23.2% had completed treatment and 39.2% were still in treatment. The religious and spiritual sector (83.1%) had the highest dropout, followed by the general medical sector (34.6%), mental health services sector (33.9%) and the social services sector (30%). Marital status emerged as the only sociodemographic factor that significantly predicted treatment dropout-with those who were married being significantly less likely to drop out than those who were single.

CONCLUSIONThe overall dropout rate across the various healthcare sectors was comparable to past studies. While the small sample size limits the generalisability of findings, the current study provides useful insight into treatment dropout in an Asian population.

Adolescent ; Adult ; Age Factors ; Asian Continental Ancestry Group ; statistics & numerical data ; Cross-Sectional Studies ; Educational Status ; Employment ; statistics & numerical data ; Female ; Health Services ; utilization ; Humans ; Income ; statistics & numerical data ; Male ; Marital Status ; statistics & numerical data ; Mental Disorders ; epidemiology ; therapy ; Mental Health Services ; utilization ; Middle Aged ; Patient Dropouts ; statistics & numerical data ; Prevalence ; Sex Factors ; Singapore ; epidemiology ; Social Work ; statistics & numerical data ; Spiritual Therapies ; utilization ; Surveys and Questionnaires ; Young Adult

STUDY DESIGN: Retrospective study. PURPOSE: We conducted a study to investigate the time course changes in bone metabolic markers after the administration of the anti-receptor activator of nuclear factor-kappa B ligand (RANKL) antibody and to assess drug compliance among osteoporotic patients. OVERVIEW OF LITERATURE: The anti-RANKL antibody is expected to provide an improvement in those with a bone metabolism disorder. However there are only a few clinical reports available on the effect of treatment. METHODS: We included 40 post-menopausal osteoporotic patients who received the anti-RANKL antibody. To determine the time course changes in the bone metabolic markers, we measured the serum tartrate-resistant acid phosphatase 5b (TRACP 5b; a bone resorption marker) and the serum N-terminal propeptide of type 1 collagen (P1NP; a bone formation marker) levels prior to and 1 month after administrating the anti-RANKL antibody. To evaluable drug compliance, we assessed the dropout rate during treatment and at 6 months after treatment. RESULTS: The average TRACP 5b level significantly decreased from 574.8 mU/dL before treatment to 153.2 mU/dL 1 month after treatment (p<0.05). There was no significant difference in the average P1NP level, which was 56.9 microG/L and 35.1 microG/L before and 1 month after treatment, respectively (p>0.05). As for drug compliance, we did not have any dropouts during the treatment or after 6 months (dropout rate: 0%). CONCLUSIONS: Our study suggests that anti-RANKL antibody treatment suppresses bone resorption and maintains bone formation.
Acid Phosphatase ; Bone Resorption ; Collagen Type I ; Compliance* ; Humans ; Metabolism ; Osteogenesis ; Osteoporosis* ; Patient Dropouts ; RANK Ligand ; Retrospective Studies

OBJECTIVETo examine the proportion and reasons of drop-out from antiretroviral therapy (ART) among 8 367 adult HIV-infected individuals in Dehong prefecture, Yunnan province.

METHODSAll adult HIV-infected patients receiving ART before September 30 of 2014 were examined for the situation of drop-out from ART.

RESULTSThe proportion of drop-out from ART among adult HIV-infected patients in Dehong prefecture was 14.4% (1 202/8 367). Results from the univariate logistic regression analyses indicated that drop-out from ART was significantly correlated with factors as: living area, gender, age, marital status, HIV transmission route, baseline CD4⁺ T cell counts and initial treatment regimen of the patients. After adjusted for potential confounding variables by multiple logistic regression model, drop-out from ART was significantly correlated with residential area, marital status, HIV transmission route, baseline CD4⁺ T cell count and initial treatment regimen of the patients. HIV-infected patients who were living in Mangshi city, Lianghe county or Yingjiang County, being married or living with partner, HIV infection through sexual contact, with baseline CD4⁺ T cell counts ≤ 200 cells/mm³, and ART included in the initial treatment regimen etc., were less likely to drop out from ART. The proportion of drop out from ART was significantly decreasing along with the increasing time of ART. Data from specific investigation revealed that among the 1 202 patients who dropped out from ART, 704 (58.6%) were lost to follow-up, 303 (25.2%) did not adhere to treatment, 74 (6.2%) moved out the region, 64 (5.3%) were Burmese that had returned to Burma, 29 (2.4%) stopped the treatment according to doctors' advice, 18 (1.5%) were incarcerated and 10 (0.8%) were under other reasons. Reasons for the drop-out varied, according to the situation of patients.

CONCLUSIONThe proportion of drop-out from ART varied significantly according to the characteristics of HIV-infected patients in Dehong prefecture that underscoring the needs for tailored responses to reduce drop-out of ART. Focus should be targeted on reducing the loss to follow-up and improving the treatment adherence.

Adult ; Anti-Retroviral Agents ; therapeutic use ; China ; HIV Infections ; drug therapy ; Humans ; Patient Dropouts ; statistics & numerical data

OBJECTIVE: Although clinical guidelines recommend that antidepressant treatment should be continued for at least 4 to 9 months, naturalistic studies show that the average length of treatment is shorter than 6 months and that dropout rates are high. But factors leading patients to discontinuation of therapy are not well understood yet. In this study, we investigated factors associated with adherence to antidepressant in Korean patients with depressive disorder. METHODS: Patients who were diagnosed as depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders-4th edition criteria and took prescribed antidepressants were included in this study. Medical records of 194 patients were reviewed retrospectively. To find adherence to antidepressant treatment, we calculated Medication Possession Ratio at 2 wks, 4 wks, 8 wks, 12 wks, 24 wks after their 1st visit. Patient-related factors, illness-related factors including measurement scales (Beck Depression Inventory, Patient Health Questionnare-15, Global Assessment of Recent Stress Scale scores), and treatment-related factors were compared between adherent group and non-adherent group using chi-square test or student t-test. Multivariate logistic regression was used to predict factors associated with adherence to antidepressant treatment. RESULTS: Analyzing data of 194 patients, 106 patients (54.6%), and 82 patients (42.3%) were adherent group at 12 wks and 24 wks, respectively. In patient-related factors, old age and low education periods were significantly associated with adherent group. In illness-related factors and treatment-related factors, none of the factors showed a significant difference between groups. In multivariate logistic regression, old age was significantly associated with sustained adherence at 12 wks. CONCLUSION: We found some factors associated with adherence to antidepressant treatment. Old age was associated with sustained adherence to antidepressant. To enhance adherence to antidepressant, our findings suggest that outpatient education program is needed. And social policy is also essential to reduce stigma in psychiatric department especially among young patients.
Antidepressive Agents ; Depression ; Depressive Disorder* ; Education ; Humans ; Logistic Models ; Medical Records ; Outpatients* ; Patient Dropouts ; Public Policy ; Retrospective Studies ; Weights and Measures

PURPOSE: This study was designed to determine the factors affecting completion of critical pathway for elective gastrectomy. METHODS: Since 2008, a critical pathway has been applied for elective gastrectomy at Chosun University Hospital. We retrospectively analyzed 252 patients who underwent elective gastrectomies from January 2009 to April 2013. The completion rate was determined, and risk factors for patient dropout were examined. RESULTS: The completion rate of the critical pathway was 45.6% (115/252). Mean length of stay was 11.7 +/- 8.6 days (8-59 days). Readmission rates were 4.4% (11/252). Causes of failure for clinical pathway were systemic complications (21/137, 15.3%), intra-abdominal complications (44/137, 32.8%), patient factors (41/137, 29.9%), and wound complications (30/137, 21.9%). There were no significant differences between the two groups in age, sex, American Society of Anesthesiologists (ASA) score, operation time, readmission, and underlying disease (P > 0.05). Body mass index (P = 0.008) and pathologic stage (P = 0.001) were significantly different between the two groups. In multivariate analysis, the conventional approach (odds ratio, 2.0), and total gastrectomy (odds ratio, 5.3) were determined to be independent risk factors to drop the critical pathway. But there were no significant differences between total and distal gastrectomy groups in age, gender, underlying diseases, ASA score, readmission, operation time, and cause of dropout (P > 0.05). CONCLUSION: We concluded that total gastrectomy may not be suitable for the critical pathway. We suggest that the critical pathway for elective distal gastrectomy is divided 2 subgroups, according to the surgical approach.
Body Mass Index ; Critical Pathways* ; Gastrectomy ; Humans ; Length of Stay ; Multivariate Analysis ; Patient Dropouts ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms* ; Wounds and Injuries

For the treatment of multidrug-resistant (MDR) tuberculosis, maintenance of appropriate antituberculous agents is essential because of its low cure rate and high dropout rate. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced systemic hypersensitivity response resulting in cessation of causative agents. In cases of second-line antituberculous agent-induced DRESS, it is extremely difficult to find other replacement medications to cure MDR tuberculosis. A 53-year-old male who had taken the second-line antituberculous agents (cycloserine, streptomycin, p-aminosalicylic acid, and prothionamide) as well as pyrazinamide for 5 weeks experienced DRESS syndrome accompanying hepatic coma. His symptoms improved with discontinuation of antituberculous agents and administration of high-dose methylprednisolone for 1 month. To resume the antituberculous medication, second-line antituberculous agents were administered one by one using a rapid desensitization protocol. While kanamycin, levofloxacin, and cycloserine were successfully readministered, p-aminosalicylic acid- and prothionamide-induced cutaneous hypersensitivity symptoms were relatively mild compared to previous reactions. Herein, we report a case of successfully treated MDR tuberculosis having a history of fatal DRESS syndrome to antituberculous agents using the rapid desensitization protocol.
Aminosalicylic Acid ; Antitubercular Agents ; Cycloserine ; Desensitization, Immunologic ; Drug Hypersensitivity Syndrome* ; Hepatic Encephalopathy ; Humans ; Hypersensitivity ; Kanamycin ; Levofloxacin ; Male ; Methylprednisolone ; Middle Aged ; Patient Dropouts ; Pyrazinamide ; Streptomycin ; Tuberculosis ; Tuberculosis, Multidrug-Resistant