Before I get into the meat of this article and answer the question about Osteen's status as a New Testament Christian minister, first we need to look into his background. Having pastored a Church near Houston, TX in the late 's to the mid 's I am well aware of Osteen's rise to celebrity status. The church he pastors was founded by his parents - John and Dodie Osteen in in a feed store on the outskirts of Houston.
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Abstract Nonadherence with medication occurs in all chronic medical disorders. Nonadherence lies on a spectrum, is often covert, and is underestimated by clinicians, but affects more than one third of patients with schizophrenia per annum.
It increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life. It results from multiple patient, clinician, illness, medication, and service factors, but a useful distinction is between intentional and unintentional nonadherence.
There is no gold standard approach to the measurement of adherence as all methods have pros and cons. Interventions to improve adherence include psychoeducation and other psychosocial interventions, antipsychotic long-acting injections, electronic reminders, service-based interventions, and financial incentives.
These overlap, all have some evidence of effectiveness, and the intervention adopted should be tailored to the individual. Psychosocial interventions that utilize combined approaches seem more effective than unidimensional approaches. There is increasing interest in electronic reminders and monitoring systems to enhance adherence, eg, Short Message Service text messaging and real-time medication monitoring linked to smart pill containers or an electronic ingestible event marker.
Financial incentives to enhance antipsychotic adherence raise ethical issues, and their place in practice remains unclear. Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive therapeutic alliance and good communication between the clinician and patient.
These elements remain essential for all patients, not least for the small minority where vulnerability and risk issue dictate that compulsory treatment is necessary to ensure adherence.
In the 4th century BC, Hippocrates observed that some patients did not take their prescribed treatments. Insoon after the introduction of antibiotics, it was observed that approximately one third of patients did not complete a 1-week course of oral penicillin for acute pharyngitis or otitis media. A range of alternative terms have been used, including treatment compliance and fidelity, but adherence is currently favored partly due to its neutrality.
In contrast, compliance implies an unequal power balance between the prescriber and patient. Medication adherence lies on a spectrum ranging from individuals who take no medication, despite agreeing with the prescribing clinician to do so, to those who take each dose precisely on time. In between these two extremes are patients who show varying degrees of adherence, taking some medication some of the time but not consistently as prescribed.
Problems with adherence can include taking excess medication, but this is less common, and this review is concerned with those who take less medication than prescribed. This cutoff has validity in predicting subsequent hospitalization across several chronic conditions, 5 although for individual patients the degree of nonadherence that affects health outcomes will vary and depend on multiple factors including the condition, its severity, the risk of recurrence, the relative effectiveness of the medication, and its dose and frequency of administration.
Although nonadherence is a problem throughout medicine, there are several factors that make it especially challenging in schizophrenia. These include lack of illness awareness a term encompassing insight, but also attitudes and beliefs about the nature of the illnessthe direct impact of symptoms including depression, cognitive impairment, and positive and negative symptomssocial isolation, comorbid substance misuse, stigma, and the increasing fragmentation of mental health services in many countries.
Not surprisingly, these multiple disadvantages for people with schizophrenia mean the prevalence of nonadherence in psychosis is at least as high if not higher than in many chronic medical disorders.
We consider the prevalence of nonadherence, its costs, and the factors that contribute. Next we review the assessment of nonadherence in research studies and clinical practice. We review a range of interventions to improve adherence, including basic strategies that should accompany prescribing, specific psychosocial interventions, antipsychotic long-acting injections LAIselectronic reminders, service interventions, and financial incentives.The Five Day Summit Climb ascends Mt.
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