Objective To evaluate the efficacy of "compliance therapy" for improving adherence to prescribed drug treatment among patients with schizophrenia. Design Randomised controlled trial. Setting Urban catchment area psychiatric service. Participants 94 consecutive admissions of patients with schizophrenia, 56 agreed to participate. Intervention Compliance therapy and non-specific counselling, each consisting of 5 sessions lasting 30-60 minutes. Main outcome measures Compliance with drug treatment at one year; attitudes to treatment, symptomatology, insight, and quality of life at one year; length of "survival" in the community, bed days, and rehospitalisation rates at two years. Results Compliance therapy did not confer a major advantage over non-specific therapy in improving compliance at one year (43% (12/28) v 54% (15/28), difference − 11% (95% confidence interval − 37% to 15%) or in any of the secondary outcome measures-symptomatology, attitudes to treatment, insight, global assessment of functioning, and quality of life. Conclusion Compliance therapy may not be of benefit to patients with schizophrenia. Attitudes to treatment at baseline predicted adherence one year later and may be a clinically useful tool.

These data emphasise the complexity of factors that influence whether a person adheres to his medication regimen. Furthermore, they suggest that these factors may vary within the same person over time.

True seasonal patterns are present in schizophrenia incidence, but their consistency with other published studies and wider significance, is difficult to ascertain because of different methods used in dating incidence of disorder.

The study identified opportunities for improving policy and practice, particularly in relation to reducing the amount of coercion experienced by people on CTOs and improving flexibility of service delivery.

Although a relationship between insight and symptomatology in schizophrenia has been repeatedly demonstrated, the influence of psychological variables such as coping mechanisms and attributional style is less clear. We evaluated health attributions, subjective resources for coping, symptomatology, general cognitive functioning, and insight among 38 consecutive admissions with DSM-III-R schizophrenia from a geographically defined catchment area. Health attributions accounted for a significant amount of insight even after symptom severity was accounted for and together predicted 32% of variation in insight scores. This study emphasizes the multifactorial nature of insight and the importance of psychological variables in addition to symptomatology.

Rates of CTOs and readmissions varied across services and further research is warranted to identify factors associated with these increased rates. Additionally, the very high rate of CTOs in the catchment areas warrants further examination.

ResumenObjetivo:Identificar clínicamente predictores de la observancia de la medicación entre personas con esquizofrenia.Método:Evaluamos los niveles de cumplimiento de la medicación neuroléptica entre 32 admisiones consecutivas con esquizofrenia del DSM-III-R procedentes de un área de captación definida geográficamente utilizando una entrevista de cumplimiento. Evaluamos también los síntomas, el insight, el estado neurológico y la memoria.Resultados:Menos del 25% de las admisiones consecutivas comunicaron un cumplimiento completo. Las actitudes hacia los fármacos eran el mejor predictor del cumplimiento regular; los síntomas, el mejor predictor del incumplimiento, y la memoria, el mejor predictor del cumplimiento parcial de la medicación neuroléptica.Conclusiones:Estos datos ponen de relieve la complejidad de los factores que influyen en que una persona observe su régimen de medicación. Además, indican que estos factores pueden variar dentro de la misma persona con el tiempo.