Risk Factors for Medication Non-Adherence in Patients with First Episode Schizophrenia and Related Disorders; A Prospective Five Year Follow-Up

Abstract

Introduction: The goal of this study is to assess, prospectively, the relative contribution of baseline variables to long-term medication adherence in patients with a first episode of schizophrenia.

Methods: Consecutively admitted patients suffering from a first episode of schizophrenia or related disorders were investigated. Subjective experience, attitudes towards treatment, insight, interaction with members of staff, involuntary admission, substance abuse, and severity of psychopathology were independently assessed at first admission and related to medication adherence during five year follow up.

Results: Standard multiple regression analysis revealed that hostility and uncooperativeness (p=0.007) and involuntary admission (p=0.02) were associated with the level of adherence during 5 year follow-up after admission.

Discussion: In first episode schizophrenia and related disorders, the initial interaction with staff and involuntary admission partly predicts long-term adherence to antipsychotic medication. Ameliorating these initial interactions might have long-term consequences on medication adherence. Involuntary admitted patients need intensive outpatient care.

References

• 1 Day JC, Bentall RP, Roberts C, Randall F, Rogers A, Cattell D, Healy D, Rae, Power C. Attitudes toward antipsychotic medication: the impact of clinical variables and relationships with health professionals.  Arch Gen Psychiatry. 2005;  62 717-724
• 2 Fenton WS, Blyer CR, Heinssen RK. Determinants of medication compliance in schizophrenia: Empirical and clinical findings.  Schizophrenia Bulletin. 1997;  23 636-651
• 3 Haan L, Weisfelt M, Dingemans PMAJ, Linszen DH, Wouters L. Psychometric properties of the subjective well-being under neuroleptics scale (SWN) and the Subjective Deficit Syndrome Scale (SDSS).  Psychopharmacology. 2002;  162 24-28
• 4 Kay SR, Opler LA, Fishbein A. Positive and Negative Syndrome Scale (PANSS) rating manual. Social and Behavioral Sciences Documents, San Rafael, California 1987
• 5 Keith SJ, Kane JM. Partial compliance and patient consequences in schizophrenia: our patients can do better.  J Clin Psychiatry. 2003;  64 1308-1315
• 6 Kluge M, Wehmeier PM, Dittmann RW, Langer F, Czekalla J, Lehmann M, Kessler FH, Beyenburg S, Naber D. A simple switching strategy for inadequately treated patients with schizophrenia to olanzapine: changes in psychopathology and subjective well-being.  Pharmacopsychiatry. 2005;  38 6-12
• 7 Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV. Prevalence of and risk factors for medication non-adherence in patients with schizophrenia: a comprehensive review of recent literature.  J Clin Psychiatry. 2002;  63 892-909
• 8 MacGrath BM, Tempier RP. Patients' opinions of olanzapine and risperidone following long-term treatment: results from a cross-sectional survey.  Pharmacopsychiatry. 2005;  38 147-157
• 9 Miner CR, Rosenthal RN, Hellerstein DJ, Muenz LR. Prediction of compliance with outpatient referral in patients with schizophrenia and psychoactive substance use disorders.  Arch Gen Psychiatry. 1997;  54 706-712
• 10 Naber D. A self-rating to measure subjective effects of neuroleptic drugs. Relationships to objective psychopathology, quality of life, compliance and other clinical variables.  International Clin Psychopharmacol. 1994;  12 133-138
• 11 Nose M, Barbui C, Tansella M. How often do patients with psychosis fail to adhere to treatment programmes? A systematic review.  Psychol Med. 2003;  33 1149-1160
• 12 Perkins DO. Predictors of noncompliance in patients with schizophrenia.  J Clin Psychiatry. 2002;  63 1121-1128
• 13 Perkins DO, Johnson JL, Hamer RM, Zipursky RB, Keefe RS, Centorrhino F, Green AI, Glick IB, Kahn RS, Sharma T, Tohen M, MacEvoy JP, Weiden PJ. Lieberman JA, HGDH Research Group . Predictors of antipsychotic medication adherence in patients recovering from a first psychotic episode.  Schizophr Res. 2006;  83 53-63
• 14 Rettenbacher MA, Hofer A, Eder U, Hummer M, Kemmler G, Weiss EM, Fleischhacker WW. Compliance in schizophrenia: psychopathology, side effects, and patients' attitudes toward the illness and medication.  J Clin Psychiatry. 2004;  65 1211-1218
• 15 Spitzer RL, Williams JBW. Classification of mental disorders. In Comprehensive Textbook of Psychiatry, 4th edn. Edited by Kaplan HJ, Sadock BJ Baltimore, Williams & Wilkins 1985 9
• 16 Tattan TM, Creed FH. Negative symptoms of schizophrenia and compliance with medication.  Schizophr Bull. 2001;  27 149-155
• 17 Weiden P, Rapkin B, Mott T. et al . Rating of medication influences (ROMI) Scale in schizophrenia.  Schizophrenia Bull. 1994;  20 2

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