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Psychotic disorders—most notably schizophrenia and bipolar disorder with psychotic features—affect approximately 2% of Americans. These disorders are extremely manageable with psychotropic medications—to relieve symptoms such as hallucinations and delusions—and behavioral therapy, such as social skills training and hygiene maintenance.
However, individuals with psychotic disorders have the lowest level of medication compliance, as compared to individuals with mood or anxiety disorders. Antipsychotic medications can have extremely negative side effects, including uncontrollable twitching of the face or limbs, blurred vision, and weight gain, among others. They also must be taken frequently, and at high doses, in order to be effective. While relatively little is known about the reasons for noncompliance, studies do suggest that in Schizophrenia, age of schizophrenia diagnosis and medication compliance is positively correlated. Evidence also suggests that medication noncompliance is disproportionally prevalent in individuals of a low socioeconomic status (SES) due to issues such as homelessness, lack of insurance benefits, and lack of familial or social support.
Researchers were interested to see how drug education might affect compliance or noncompliance with psychotropic medications based on patient socioeconomic status. In a study of 1200 mentally ill individuals in the Los Angeles metro area, researchers measured baseline psychotropic medication compliance, then provided patients with a free educational seminar on drug therapy, and then measured psychotropic medication compliance six months later. The one-day, 8-hour seminar included information on positive effects of psychotropic medication, side effects of psychotropic medication, psychotropic medication interactions with other substances such as alcohol and non-prescribed drugs, and information on accessing MediCare benefits. Compliance was measured by number of doses of prescribed psychotropic medication that the patients took in a week, over the course of 12 weeks, as compared to the number of doctor-recommended doses per week. Compliance was measured using a self-report questionnaire.
Results indicated that post-seminar, mentally ill patients from middle or upper class backgrounds (Upper and Middle SES) were significantly more compliant with their psychotropic medication regimens than prior to the seminar. However, no significant differences were found in patients at or below the poverty level (Lower SES). Table 1 displays psychotropic medication compliance by SES and disorder.
Table 1 Psychotropic Medication Compliance by Socioeconomic Status (SES) and Disorder
1. What is one "positive" symptom of schizophrenia?
2. Bipolar disorder involves periods of mania and depression, and for some, episodes of hypomania. Hypomania, a state that is less severe than mania, is characterized by "feeling good/high" and increased well-being and productiveness. Which of the mechanisms is most likely involved with the hypomanic episodes experienced by individuals diagnosed with bipolar disorder?
3. What is the incidence of psychotic disorders in the American population?
4. Based on the design of the study described in the passage, what limits the researchers' abilities to draw conclusions about the causal relationship between socioeconomic status and psychotropic medication compliance?
5. Which of the following graphs would best illustrate the relationship between age of schizophrenia diagnosis and medication compliance described in the passage?
6. If the experiment described in the passage were repeated, but instead of testing how drug education affects compliance, researchers measured how incentives affect compliance in low SES schizophrenics. The low SES schizophrenia group was broken into two groups. Group A received an incentive every time they took their medication for seven consecutive days while Group B received an incentive every two weeks, regardless of compliance level. Based on operant conditioning principles, what results should the researchers see?
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