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PubMed1978

Self-concept and completion of treatment for heroin and nonheroin drug abusers.

One hundred sixty-one veterans with a history of drug abuse were administered a battery of background questions as well as self-concept measures prior to entering a Substance Abuse Unit at the VA Hospital in Miami. Significant interaction effects were found whe a 2 X 2 analysis of variance was run using heroin/nonheroin as one factor and completer/dropout as the other. Nonheroin drug abusers who subsequently completed treatment entered the program with the lowest self-concepts, highest ideals (with respect to the self), and were most often high school dropouts. Nonheroin drug abusers who eventually dropped out of treatment entered with relatively high self-concepts, low ideals, and were more often high school graduates. On the other hand, heroin users showed the opposite trend. Heroin users who eventually completed treatment began with higher self-concepts, lower ideals, and more education than the heroin users who became dropouts. It is suggested that a generalized feeling of optimism and motivation surrounds the completer, while the dropout seems to lack such drive.

Adolescent↗
PubMedDate not supplied

Male and female drug abusers: social and psychological status 2 years after treatment in a therapeutic community.

A sample of male (N = 214) and female (N = 74) dropouts and graduates from the 1974 population in Phoenix House were followed 2 years after treatment. The sample was mainly opioid abusers, Black, and 19-26 years of age. A 4-h face-to-face interview traced social adjustment from 1 year pre- through all years posttreatment. Clients were retested with a psychological battery initially given at admission or during treatment. Results showed that success (no crime and no opioid use and/or no use of a nonopioid primary drug) was maintained throughout 2 years of follow-up by 38% of the males (dropouts 32.9%, graduates, 73.9%) and 42% of the females (dropouts 40.7%, graduates 50.0%); improvement (change from pretreatment status) occurred in over 59% of the males and 60% of the females; success and improvement increased by time in program for both sexes; psychological improvement during treatment and at follow-up was correlated with posttreatment success status. Among successes, the female improvement was significantly larger. The psychological improvement for women appears related to social-role factors that are modified during residency in the therapeutic community.

Adult↗
PubMed1996

Patient factors related to early attrition from an outpatient cocaine research clinic.

The dropout rates among cocaine abusers in outpatient treatment programs have averaged 55%. We sought to find patient predictor variables associated with early attrition. Dropouts were more likely to be African-American or Hispanic-American, younger, with an earlier onset of substance abuse. Among minorities, those with more education were less likely to drop out. Patients who were less educated and smoked or injected cocaine were particularly prone to discontinue treatment prematurely. The implications of these findings, and promising interventions for reducing the dropout problem, are discussed.

Adult↗
PubMed1982

Factors related to patient attrition from alcoholism treatment programs.

This study focused on an examination of a number of factors which might explain dropout from Veterans Administration inpatient alcoholism treatment programs. The investigation included 137 closed treatment groups that were used at this hospital over a 12-year span. These programs involved five different treatment modalities which varied in treatment length as well as in size of the treatment group. Program directors need to be aware that if their treatment approach involves closed treatment groups, the size of the group, its composition, and the length of the program can influence the dropout rate. According to these results the optimal group size is around five individuals and should not include a large percentage of individuals who are of high intelligence. Dropout rates declined as program length was shortened.

Adult↗
PubMed1985

Three therapeutic communities for drug abusers: differences in treatment environments.

Three therapeutic communities for drug abusers were compared using the Community Oriented Program Environments Scale (COPES) to determine whether the same principles of treatment could produce similar social environments. All three facilities were found to have similarly shaped profiles. Two of the facilities differed significantly from each other on only two subscales, with standard scores remaining within the same range. The third facility showed a depressed profile that differed significantly from the other facilities on five subscales and suggested a poorer quality of treatment environment. Further evidence for this interpretation came from a follow-up study of dropouts from the three facilities; it was found that the two facilities with similar scores had similar dropout rates, while the third facility with lower scores had a much higher dropout rate.

Adult↗
PubMed1998

Efficacy and safety of neuroleptics in behavioral disorders associated with dementia.

BACKGROUND: Neuroleptics are commonly used to treat behavioral disorders associated with dementia. However, their safety and efficacy have not been well established in these patients. METHOD: A meta-analysis of randomized, controlled (either placebo or active drug), double-blind trials published since 1966 (N = 16; 499 treated, 112 active controls, and 123 placebo) was conducted. Data were collected on proportion of patients with clinically significant improvement, significant side effects, and dropout rates. RESULTS: Pooled mean percentages of patients who improved (95% CI): all neuroleptics, 64% (54% to 74%); low potency, 63% (54% to 72%); moderate potency, 70% (56% to 85%); moderate-high potency, 62% (49% to 75%); and high potency, 69% (49% to 90%). Thus, no differences in efficacy existed between different potencies of neuroleptics. Therapeutic effect (neuroleptic minus placebo) was only 26% (14% to 38%). Treatment-emergent side effects were more common for neuroleptics vs. placebo (mean difference = 25%, 13% to 37%), but pooled mean dropout rates were not different (mean difference = 4%, -7% to 14%). Neither weighting by clinical trial quality (3 raters; weighted agreement, 83% to 92%) nor exclusion of poor quality trials changed the results. CONCLUSION: Neuroleptics have small but significant efficacy over placebo in this population, and the efficacy rate is equivalent to the side effect rate. Comparing different neuroleptics shows they have similar efficacy, side effects, and dropout rates. Further study to determine more specific drug-responsive behaviors is needed to maximize benefits of these drugs.

Antipsychotic Agents↗
PubMed2004

Are illness concepts a powerful predictor of adherence to prophylactic treatment in bipolar disorder?

BACKGROUND: Predicting and preventing premature discontinuation of medication would substantially improve prophylactic treatment of bipolar disorder. Patients' concepts regarding illness proved to have an impact on noncompliance in a retrospective study of patients with affective or schizoaffective illness treated with lithium. The present study is the first to prospectively investigate the influence of illness concepts on adherence of bipolar patients to different medications. METHOD: 171 bipolar patients (DSM-IV) were randomly assigned to receive either lithium (N = 86) or carbamazepine (N = 85) and observed for a maintenance period of 2.5 years (Multi-center Study of Affective and Schizoaffective Psychoses). The total score and 7 dimensions of illness concepts and treatment expectations of the Illness Concept Scale (ICS) were calculated for 141 patients with completed questionnaires and used to predict time to dropout (Cox regression). Analyses were corroborated by further multivariate analyses with sex, age, and premorbid personality as covariates. RESULTS: With lithium treatment, but not carbamazepine treatment, the total ICS score at study entry was associated with a longer time to study dropout (p =.001 and p =.224, respectively). The relevant ICS subscales affecting time to dropout in patients treated with lithium were trust in medication, trust in the treating physician, and absence of negative treatment expectations. Multivariate analyses suggested that the impact of these variables on adherence to lithium was largely independent of sociodemographic, clinical, and psychological variables. Our data indicate that the stronger impact of illness concepts with lithium as compared with carbamazepine treatment might be related to the drugs' different side effect profiles. CONCLUSION: As trust in drug treatment and trust in the treating physician had a clear impact on adherence to prophylactic lithium, patients' illness concepts and treatment expectations might be promising targets for psychoeducation and psychotherapy in the treatment of bipolar disorder.

Adult↗
PubMed1999

School counselors' accuracy in identifying adolescents at risk for dropping out.

School counselors were asked to identify, using qualitative judgments alone, adolescents who they believed were at moderate risk for dropping out. These students were then administered a dropout prediction scale. Results indicated that the school counselors accurately identified potential dropouts. The paper concludes with a discussion of the ties between dropout identification and consultation with teachers.

Adolescent↗
PubMedDate not supplied

[Refusal of treatment].

UNLABELLED: The 25-50% of the outpatients who ask for medical assistance give up the treatment before the end for several reasons. The immediate consequences are the waste of economic and assistance resources, professional insatisfaction, phenomena like revolving door and bad results in prescribed treatments. These patients usually come back in the medium or long term. The authors considered to review the material published between 1992-1998 on the variables associated to the phenomena of noncompliance and dropout, as well as the strategies proposed by the different authors to face this problem. METHOD: A search was performed for original and review articles on the issue in the Medline database between 1992-1997. The key words used were: dropout, appointments, schedules, non attendance, premature termination, non compliance, medication compliance and their links with the key words: psychiatry, psychotherapy and mental disorder. The bibliographic references were classified according to the type of article, author, country of origin, journal and year. In relation with the contents, one classification has been carried out according to approach strategies, and another according to variables associated to dropout and non compliance. RESULTS: 144 bibliographic references were identified after the search on the Medline database. The selection for revision included 24 original articles, 5 review articles and a letter to the editor as a comment to a previous article. The total number of different journals was 27, and the authors were from 6 different nationalities.

Humans↗
PubMedDate not supplied

[An immunisation coverage survey in the Kouilou area of Congo-Brazzaville].

An internal review of the expanded program of immunisation undertaken on the basis of daily data collected over the past five years from 1993 to 1997 in the region of Kouilou revealed a weak coverage level for all the antigens, associated with a strong dropout rate. In August 1999, a vaccination coverage survey was carried out on three strata of the Kouilou area in order to determine the proportion of children vaccinated by antigens. The method used is that of sampling clusters. It concerned 663 children aged between 12 and 23 months chosen among 30 urban, 30 periurban and 30 rural clusters. The BCG scar was found in 82.8% children while 71.8% had received the third dose of VIP-OPV. Some 62.6% were immunised against measles. Within the region, the coverage rates varied from 87.9 to 57.1% for BCG; 80.3 to 41% for DTP-OPV3 and 7.3 to 41% for measles. A considerable variation of dropout rates was observed at area level: 8.9 to 14.7% for DTP-OPV3 and 9 to 11% for measles immunisation. The average interval observed between VPT-OVP 1 and VPT-OVP 2 was, respectively, 6.1 and 6.2 weeks in urban areas against 6.4 and 6.9 weeks in periurban areas. On the other hand in rural zones, the interval was of 7.6 weeks between VPT-OVP and DPT-OPV2 and of 10.1 weeks between DPT-OVP2 and DPT-OVP3. The median interval was of 5 weeks for the different DPT-OVP doses in all the strata. The vaccination card was found in 90% of cases in urban areas, 96% in urban zones and 55% in rural zones. The coverage level attained per antigen is satisfactory, but remains to be strengthened. Dropout rates are high enough and they should be corrected. Follow-up actions should focus on raising a strong awareness for vaccination in rural areas. Besides, the vaccination of target populations living in remote areas by way of mobile and outreach strategies could improve the immunisation coverage rate.

Congo↗
PubMedDate not supplied

[Motivational factors in psychotherapy of eating disorders].

AIM: We examined changes in general psychopathology during psychotherapy of patients with eating disorders. We were also interested in distinguishing motivational characteristics of completers and dropouts with anorexia and bulimia nervosa. METHOD: All subjects completed two self-descriptive measures: Motivational Inventory and Hopkins Symptoms Checklist (HSCL-72). Questionnaires were completed three times: during the qualification visit, at admission and two weeks before discharge. RESULTS: It was observed that general psychopathology among patients with anorexia nervosa and bulimia nervosa decreased. Comparing to completers with bulimia nervosa completers with anorexia nervosa had a higher level of activity factor before the treatment. Dropouts with anorexia nervosa differed from completers in decreased level of threat factor and activity factor. Completers with bulimia contrasted markedly with statistically meaningful decrease of the Body Mass Index. CONCLUSIONS: The efficacy of cognitive-behavioural-social psychotherapy of patients with eating disorders seems to be confirmed by large decrease of general psychopathology. Dropouts with anorexia seem to have poorer insight concerned with lower need of health activity.

Adult↗
PubMed1991

Subject attrition in prevention research.

Subject attrition threatens the internal validity of substance abuse prevention studies because differences in the rate of attrition and the substance use behavior of remaining subjects in the different conditions could account for any differences found in substance use rates. Attrition threatens the external validity of prevention studies because, to the extent that study dropouts are different from remaining subjects, the results of the study may not be generalizable to study dropouts. Analysis of these threats to the validity of prevention studies should be routinely conducted. However, studies of alcohol and drug abuse prevention have generally failed to report or analyze subject attrition. Smoking prevention studies have more frequently reported attrition, and they have recently begun to analyze the degree to which attrition may affect the internal and external validity of the study. Evidence thus far suggests that differences in attrition across conditions do occur occasionally. The evidence is substantial that study dropouts are systematically more likely to smoke, to use other substances, and to score highly on other risk-taking measures.

Alcoholism↗
PubMed1976

Interim report on clinic intake and safety data collected from 17 NIDA-funded naltrexone studies.

In 17 studies of naltrexone, a totoal of 1,536 patients had been logged in as potential study subjects as of February 29, 1976. Of these, 883 had been started on study medication, including 107 on placebo as controls. A relatively high rate of attrition was seen in all studies over the first two months of study medication; this attrition rate tended to flatten out at about the fourth month. Of the 883 subjects beginning study medication, 47 (5.3%) were subsequently terminated for medical reasons. The data available on 45 of these subjects indicate equivalent percentages, both with respect to the total number of dropouts in the two study medication groups (naltrexone: 39 of 676, or 5.0%; placebo: 6 of 107, or 5.6%) and to the number of dropouts which the clinic reported as "possibly drug-related" (naltrexone: 6 out of 676, or 0.9%; placebo: 1 of 107, or 0.9%). However, one of the "possibly drug-related" dropouts developed idiopathic thrombocytopenic purpura after the administration of naltrexone for approximately 13 months during four separate treatment admissions. Statistical review of the data and subsequent analyses of the five double-blind, placebo-controlled studies administered by the National Academy of Sciences revealed no significant medication-group differences with respect to the physical/psychiatric or laboratory data. A review of the symptom data and analyses indicates that the frequency of occurrences of certain of the gastrointestinal tract symptoms recorded was somewhat higher in those subjects treated with naltrexone. Specific symptoms involved included "Loss of Appetite", "Abdominal Pain or Cramps", "Nausea or Vomiting", and "Constipation". However, the relative severity of these symptoms for all subjects experiencing any symptomatology was not statistically differentiable with respect to study medication group.

Clinical Trials as Topic↗
PubMed1993

Personality traits and early discontinuation from clinical trials in anxious patients.

Patients who discontinue early from clinical trials frequently give ambiguous or no reasons for leaving the study. Using Cloniger's Tridimensional Personality Questionnaire, we examined the potential role of personality traits in early discontinuation in patients with panic disorder and generalized anxiety disorder. Early dropouts and completers were comparable at baseline on demographic and clinical variables but differed significantly on the Tridimensional Personality Questionnaire. For panic disorder and generalized anxiety disorder patients combined, early dropouts scored higher on total novelty seeking, as well as on the novelty-seeking traits of both disorderliness/dislike of regimentation and impulsiveness. There was no significant interaction between dropout status and diagnosis for this finding, indicating it applied equally to both groups. This study suggests that personality traits involving novelty seeking may contribute to early discontinuation from clinical trials, independent of side effects, lack of efficacy, or at baseline, significantly worse symptoms of anxiety.

Adult↗
PubMed1997

Predictors of patient retention in a newly established methadone maintenance treatment programme.

AIMS: To identify predictors of patient retention in methadone maintenance. DESIGN: Prospective study. SETTING: Methadone maintenance treatment programme newly established in Geneva, Switzerland. PARTICIPANTS: All patients who initiated treatment between February 1991 and January 1995. MEASUREMENTS: Baseline patient characteristics, dose of methadone, year of enrollment and retention in treatment. FINDINGS: Overall, 111 patients contributed 164.4 person-years of follow-up. The retention rate was 84% after 12 months. In multivariate analysis, the risk of dropping out was significantly higher for patients who had been using opioids for < or = 7 years (relative hazard (RH) 3.0, 95% confidence interval (CI) 1.2-7.4), and for patients who had no stable income at baseline (RH 3.3, 95% CI 1.2-9.1). Dropouts were less frequent at the highest doses of methadone (65-110 mg/day, RH 1.0) than at middle doses (45-60 mg/day, RH 2.0, 95% CI 0.7-5.5) but, quite unexpectedly, dropouts were least likely at the lowest doses (15-40 mg/day, RH 0.5, 95% CI 0.1-1.8). Dropouts were more likely among patients who enrolled in the first (RH 6.2, 95% CI 2.3-16.7) and second (RH 1.9, 95% CI 0.6-5.6) years of the programme, compared with subsequent years (RH 1.0). CONCLUSIONS: Patients who have a long history of drug use and who have a stable income were more likely to stay in methadone maintenance treatment. Independent of patient characteristics, retention improved dramatically in the first years of programme functioning, suggesting that patient retention is a sensitive indicator of programme performance.

Adolescent↗
PubMed1999

Physical Symptoms Distress Index: a sensitive tool to evaluate the impact of pharmacological agents on quality of life.

OBJECTIVES: To examine whether the degree of stress associated with adverse physical side effects correlates with overall quality of life (QOL) and compliance rates. To determine if instruments used to assess QOL can detect differences between treatments that have no known central nervous system effects. PATIENTS AND METHODS: This randomized, double-blind, parallel group study evaluated 180 to 480 mg of controlled onset, extended release (COER)-verapamil (n = 259) or 30 to 120 mg/d of nifedipine gastrointestinal therapeutic system (GITS) (n = 269) in men and women between 21 and 80 years of age with stages 1 to 3 hypertension. A battery of questions evaluating psychological well-being and a physical symptom distress index was administered after a 4-week placebo washout (baseline) and after 10 weeks of treatment or at dropout. RESULTS: Both treatments effectively lowered blood pressure, and there were no significant between-group differences in psychosocial QOL. A difference in the level of physical symptom distress was detected between treatments (P = .002; multivariate analysis of variance), with 7 significant univariate treatment effects, all favoring COER-verapamil, being noted-pedal edema, polyuria, rapid heart beat or palpitations, hives, muscle cramps, abdominal cramps, and headaches. Constipation-related distress increased significantly (P = .001) but to a similar extent with both treatments. The difference in symptom distress tended to predict compliance as there were more withdrawals in the nifedipine GITS group (n = 85) vs COER-verapamil group (n = 64) (P = .08). CONCLUSIONS: Patient-assessed physical symptom distress is a sensitive, simple technique to evaluate the effect of antihypertensive medications on QOL and tolerability, as shown by its ability to detect the improvement associated with COER-verapamil. Depending on the agents involved, the Physical Symptom Distress Index may more closely predict dropout rates than the traditional psychosocial instruments, as suggested by the lower dropout rate in the COER-verapamil group. Thus, in studying treatment effects on QOL, both the distress of physical symptoms and the impact of psychosocial factors should be evaluated.

Adult↗
PubMed2001

Long-term effects of an early childhood intervention on educational achievement and juvenile arrest: A 15-year follow-up of low-income children in public schools.

CONTEXT: Most studies of the long-term effects of early childhood educational interventions are of demonstration programs rather than large-scale public programs. Previous studies of one of the oldest federally funded preschool programs have reported positive effects on school performance, but effects on educational attainment and crime are unknown. OBJECTIVE: To determine the long-term effectiveness of a federal center-based preschool and school-based intervention program for urban low-income children. DESIGN, SETTING, AND PARTICIPANTS: Fifteen-year follow-up of a nonrandomized, matched-group cohort of 1539 low-income, mostly black children born in 1980 and enrolled in alternative early childhood programs in 25 sites in Chicago, Ill. INTERVENTIONS: The Chicago Child-Parent Center (CPC) Program (n = 989 children) provides comprehensive education, family, and health services and includes half-day preschool at ages 3 to 4 years, half- or full-day kindergarten, and school-age services in linked elementary schools at ages 6 to 9 years. The comparison group (n = 550) consisted of children who participated in alternative early childhood programs (full-day kindergarten): 374 in the preschool comparison group from 5 randomly selected schools plus 2 others that provided full-day kindergarten and additional instructional resources and 176 who attended full-day kindergartens in 6 CPCs without preschool participation. MAIN OUTCOME MEASURES: Rates of high school completion and school dropout by age 20 years, juvenile arrests for violent and nonviolent offenses, and grade retention and special education placement by age 18 years. RESULTS: Relative to the preschool comparison group and adjusted for several covariates, children who participated in the preschool intervention for 1 or 2 years had a higher rate of high school completion (49.7 % vs 38.5%; P =.01); more years of completed education (10.6 vs 10.2; P =.03); and lower rates of juvenile arrest (16.9% vs 25.1%; P =.003), violent arrests (9.0% vs 15.3%; P =.002), and school dropout (46.7% vs 55.0%; P =.047). Both preschool and school-age participation were significantly associated with lower rates of grade retention and special education services. The effects of preschool participation on educational attainment were greater for boys than girls, especially in reducing school dropout rates (P =.03). Relative to less extensive participation, children with extended program participation from preschool through second or third grade also experienced lower rates of grade retention (21.9% vs 32.3%; P =.001) and special education (13.5% vs 20.7%; P =.004). CONCLUSIONS: Participation in an established early childhood intervention for low-income children was associated with better educational and social outcomes up to age 20 years. These findings are among the strongest evidence that established programs administered through public schools can promote children's long-term success.

Adolescent↗
PubMed1999

Hyperoxia causes decreased expression of vascular endothelial growth factor and endothelial cell apoptosis in adult retina.

Mice or humans with photoreceptor degenerations experience permeability and dropout of retinal capillaries. Loss of photoreceptors results in decreased oxygen usage and thinning of the retina with increased oxygen delivery to the inner retina. To investigate the possibility that increased tissue oxygen plays a role in the vascular damage, we exposed adult mice to hyperoxia, which also increases oxygen in the retina. After 1, 2, or 3 weeks of hyperoxia, there was a statistically significant decrease in retinal vascular density that was not reversible, and endothelial cell apoptosis was demonstrated by TUNEL staining. Mice exposed to hyperoxia and mice with photoreceptor degeneration both showed decreased expression of VEGF in the retina. After complete or near-complete degeneration of photoreceptors, there was increased expression of VEGF in RPE cells, which may explain the association of photoreceptor degeneration and neovascularization in or around the RPE. Increased expression of VEGF in photoreceptors of transgenic mice failed to prevent hyperoxia-induced retinal capillary dropout. These data suggest that increased oxygen in the retina, either by increased inspired oxygen or by photoreceptor degeneration, results in endothelial cell death and dropout of capillaries. Decreased expression of VEGF may be a contributing factor, but the situation may be more complicated for mature retinal vessels than it is for immature vessels, because VEGF replacement does not rescue mature retinal vessels, suggesting that other factors may also be involved.

Animals↗