Baseline characteristics and initial treatment decisions for patients with schizophrenia at risk of treatment nonadherence

Abstract

In this year-long, prospective observational study, sociodemographic, clinical, and functional characteristics were assessed in outpatients with schizophrenia from Australia, Mexico, Romania, and Taiwan who were switched from their primary oral antipsychotic to another oral or depot antipsychotic at study entry because of physician-perceived nonadherence risks. Patients (N = 406) rated their quality of life and functioning level as low. Few patients (10.6%, 43/406) were switched to depot antipsychotics, with country-specific differences (P < 0.001). Although illness severity was similar between subgroups, the depot switch subgroup had: a documented history of nonadherence (32.6% versus oral: 4.7%); recent alcohol (48.8% versus 23.2%; P < 0.001) or illicit drug use (16.3% versus 5.0%; P = 0.010); recent depot antipsychotic (20.7% versus 7.5%; P = 0.030) and mood stabilizer use (51.7% versus 26.3%; P = 0.008); poorer attitudes towards medication (P = 0.004); and poorer illness awareness (P = 0.041). Findings indicate that even when a risk of nonadherence has been identified, few patients with schizophrenia receive depot antipsychotics, despite being prime candidates for depot therapy. Findings suggest physicians may select depot therapy based on previous nonadherence, substance use, recent depot antipsychotic and mood stabilizer use, poor attitudes towards medications, and poor illness awareness.

Ten year outcomes of outpatients with schizophrenia on conventional depot antipsychotics

“…Furthermore, a recent metaanalysis has shown that the efficacies of moderately low and standard doses are comparable in preventing relapse in schizophrenia (Uchida et al, 2011). In contrast, the findings in the present study suggest that when dose reduction is attempted, caution must be exercised in light of potential relapse for patients with severe psychopathology such as those who require depot antipsychotics for many reasons (Shi et al, 2007;Kelin et al, 2010). It was found that although the very low-dose treatment increased the chance of relapse, the low-dose treatment was as effective as the standard-dose treatment.…”

Treatment discontinuation and clinical outcomes in the 1-year naturalistic treatment of patients with schizophrenia at risk of treatment nonadherence

“…Figure 1 provides an overview of patient disposition at study entry, which has previously been reported in detail 21. Of the 440 patients considered to be at risk of nonadherence and who entered the study, 406 patients were enrolled (Australia, n = 64; Mexico, n = 40; Romania, n = 156; Taiwan, n = 146).…”

“…Patient sociodemographic characteristics at study entry have been reported in detail 21. Patients were in their late 30s (mean ± SD, 37.2 ± 10.2 years), mostly male (56.7%, 230/406), and had a mean ± SD BMI of 26.1 ± 5.56 kg/m 2 .…”

Medication discontinuation with depot and oral antipsychotics in outpatients with schizophrenia: comparison of matched cohorts from a 12-month observational study

“…This post hoc analysis used data from a 1‐year, prospective observational study that assessed all‐cause medication discontinuation in outpatients with schizophrenia who were considered by their physicians to be at risk of non‐adherence (25). The primary objective was to compare all‐cause medication discontinuation (any switch, augmentation or medication discontinuation) in matched cohorts of patients who were initiated on depot or oral antipsychotics at study entry.…”