A Prospective Study of Factors Influencing Adherence to a Continuous Neuroleptic Treatment Program in Schizophrenia Patients During 2 Years

Abstract

Dropout from prophylactic neuroleptic treatment is one major reason for relapse in schizophrenia patients. There is a lack of prospective studies on factors that predict medication adherence. We investigated factors suspected to predict dropout from continuous neuroleptic treatment in a 2-year prospective study involving 122 outpatients with a DSM-III-R diagnosis of schizophrenia. Forty-two (34.4%) were classified as patient-related dropouts. No significant difference between compliant patients and dropouts was found with regard to sociodemographic variables, except that compliant patients were significantly older. Also, no differences in psychopathology were seen at the beginning of treatment, but compliant patients had a longer duration of illness. Compliant patients had higher doses of neuroleptics in the initial stabilization phase and correspondingly showed more extrapyramidal signs. Physicians rated compliant patients from the beginning as more cooperative. These patients also showed significantly higher scores in positive treatment expectations. In a stepwise regression analysis, positive illness concepts, the global assessment of functioning (GAF), and the physicians' view of patients' cooperation predicted 19 percent of the variance. We concluded that the prediction of dropouts is insufficient and remains largely an unsolved problem. Future research should focus more on context factors in the search for clinically meaningful explanations of patient dropout from treatment.

Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review

“…The evidence suggests that sociodemographic factors such as gender [Acosta et al 2009;Linden et al 2001] and family/marital status [Acosta et al 2009;Linden et al 2001] do not influence adherence as the association between nonadherence and these variables were not significant in most studies. However, results were mixed concerning ethnicity [Aldebot and de Mamani, 2009;Valenstein et al 2004], level of education [Acosta et al 2009;Aldebot and de Mamani, 2009;Hudson et al 2004;Janssen et al 2006;Linden et al 2001;Loffler et al 2003] and age [Acosta et al 2009;Linden et al 2001;Valenstein et al 2004]. Lack of insight was significantly associated with nonadherence in all studies [Acosta et al 2009;Aldebot and de Mamani 2009;Loffler et al 2003;Olfson et al 2006] except one [Linden et al 2001].…”

“…A prospective study [Loffler et al 2003] which studied subjective reasons for noncompliance among patients with schizophrenia reported that patients with more severe symptoms were less likely to consider relapse prevention as an important factor for their compliance [odds ratio (OR) 0.34; p = 0.009]. In contrast, another prospective study [Linden et al 2001] reported no prognostic relation between symptom severity Weiden et al [2004] Cross-sectional The survey involved 48 leading experts on adherence problems Rating by experts on scale from 1 to 10: poor insight (7.2), distress associated with side effects (7.2), lack of/partial efficacy with continued symptoms (6.9), belief that the medications are no longer needed (6.7), ongoing substance use problems (6.6)…”

“…The author hypothesized that patients who refused to accept being ill may not believe that their symptoms are something that can be managed, and thus, may be less motivated to take steps to resolve their symptoms, such as taking medication. Only one prospective study [Linden et al 2001] reported no relation between adherence and lack of insight. The author states that this contrary finding may be due to the inclusion of more adherent patients which may, in turn, influence the overall findings concerning patient adherence.…”

Symptom severity, quality of sleep, and treatment adherence among patients suffering from schizophrenia and depression

“…Rates of treatment dropout are reported less often; the figures for this range from 20% to 56% in patients with schizophrenia. [12][13][14] In patients with depression, the severity of the disorder has been associated with treatment dropout in some studies, [15] but not in all. [16] Agreeing with Last et al [15] Leserman [17] indicated that patients with depression were less likely to adhere to a treatment program than patients without depression and experienced worse outcomes in health.…”

Cross-cultural adaptation to Brazil of Medication Adherence Rating Scale for psychiatric patients

“…Adherence to treatment refers to the degree of accordance between patient's behavior and professional's recommendations 6 . Approximately 20 to 50% of schizophrenic patients do not adhere to medication treatment [6][7][8][9][10] . Non-adherence rates ranges from 30 to 60% for patients with diagnostic of Schizophrenia, 51 to 69% for Major Depressive Disorder, 57% for Anxiety Disorders, 26 to 48% for Hyperactivity and Attention Deficit Disorder, and 35% for Substance Use Disorders 11 .…”