Determinants of adherence to treatment in first-episode psychosis: a comprehensive review

Abstract

Objective: To conduct a comprehensive review of current evidence on factors for nonadherence to treatment in individuals with first-episode psychosis (FEP). Methods: MEDLINE, LILACS, PsycINFO, and SciELO databases were searched with the keywords first episode psychosis, factor, adherence, nonadherence, engagement, disengagement, compliance, and intervention. References of selected studies were consulted for relevant articles. Results: A total of 157 articles were screened, of which 33 articles were retained for full review. The factors related to nonadherence were: a) patient-related (e.g., lower education level, persistent substance use, forensic history, unemployment, history of physical abuse); b) environment-related (e.g., no family involved in treatment, social adjustment difficulties); c) medication-related (e.g., rapid remission of negative symptoms when starting treatment, therapeutic alliance); and d) illness-related (e.g., more positive symptoms, more relapses). Treatment factors that improve adherence include a good therapeutic alliance and a voluntary first admission when hospitalization occurs. Conclusion:The results of this review suggest that nonadherence to treatment in FEP is multifactorial. Many of these factors are modifiable and can be specifically targeted in early intervention programs. Very few studies have assessed strategies to raise adherence in FEP.

eHealth in the future of medications management: personalisation, monitoring and adherence

“…With regards to the patient, barriers to effective medicines management in chronic illnesses are multifactorial; medication adherence can be intentional or unintentional [11–14]. Unintentional non-adherence arises due to several inter-related factors, including inability to keep up with medication dosing schedules, long duration and complexity of medication regimens, miscommunication, and capacity limitations such as physical disabilities and financial constraints [11, 14].…”

“…Unintentional non-adherence arises due to several inter-related factors, including inability to keep up with medication dosing schedules, long duration and complexity of medication regimens, miscommunication, and capacity limitations such as physical disabilities and financial constraints [11, 14]. Intentional non-adherence is a more complex problem and involves patients choosing not to take their medications as prescribed due to various behavioural, attitudinal and socioeconomic reasons [11, 15].…”

First‐episode psychosis: Ongoing mental health service utilization during the stable period for adolescents

“…6,36 Many factors have been found to be associated with disruption to ongoing psychiatric service utilization for youth with major psychiatric disorders. [37][38][39] Individuals with schizophrenia who disengage from treatment tend to be younger, males, ethnic/racial minorities, socially isolated, have earlier onset of psychosis, a co-occurring substance-use disorder and/or additional psychiatric disorders. 34 Other variables consistently found in the literature to influence discontinuation of medication and psychosocial treatment for FEP are symptom severity, [40][41][42][43][44][45] longer duration of untreated psychosis, 40,46-48 poorer insight, 41,42,47,49,50 substance use 47,51 and lack of involvement of a family member.…”

“…Sustained psychiatric treatment has been shown to improve functioning and decrease both clinical symptoms and relapse for individuals experiencing FEP and adherence to medication and psychosocial treatment is important to improve the course of the illness . Many factors have been found to be associated with disruption to ongoing psychiatric service utilization for youth with major psychiatric disorders . Individuals with schizophrenia who disengage from treatment tend to be younger, males, ethnic/racial minorities, socially isolated, have earlier onset of psychosis, a co‐occurring substance‐use disorder and/or additional psychiatric disorders .…”

Medication adherence in first‐episode psychosis patients in Singapore

“…For instance, research has indicated that non-adherence was associated with younger individuals and males (Hui et al, 2006;Kampman et al, 2002). Studies examining FEP have similarly found younger individuals to be more non-adherent (Leclerc et al, 2015). On the other hand, a meta-analysis concluded that age, gender, ethnicity, marital status, education level and family involvement were not reliable predictors of medication adherence (Lacro, Dunn, Dolder, Leckband, & Jeste, 2002).…”