Drug attitude and other predictors of medication adherence in schizophrenia: 12 months of electronic monitoring (MEMS®) in the Swedish COAST-study

Brain, Cecilia; Allerby, Katarina; Sameby, Birgitta; Quinlan, Patrick; Joas, Erik; Karilampi, Ulla; Lindström, Eva; Eberhard, Jonas; Burns, Tom; Wærn, Margda

doi:10.1016/j.euroneuro.2013.09.001

Cited by 55 publications

(83 citation statements)

References 43 publications

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“…This suggests that although changes in attitude toward medication can change compliance to medication [51, 52], which results in alleviation of the psychotic symptoms, the attitude toward medication itself seems to mediate the effect of insight on personal-social function through in additional way independently of the improved psychotic symptoms, which is maybe specifically caused by the effect of the treatment combining antipsychotics with multiple psychosocial intervention.…”

Section: Discussionmentioning

confidence: 99%

Psychotic Symptoms and Attitudes toward Medication Mediate the Effect of Insight on Personal-Social Functions in Patients with Schizophrenia: One-Year Randomized Controlled Trial and Follow-Up

et al. 2018

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Aims: This study aimed to investigate the mediating pathway of 3 factors (psychotic symptoms, attitude toward medication, and cognitive processing speed) on the effect of insight on personal-social functioning in patients with schizophrenia. Methods: Chinese inpatients with schizophrenia (n = 168; mean age 18 ± 50 years) diagnosed according to the DSM-IV were randomly assigned to treatment with antipsychotic medication alone or combined treatment. Positive and Negative Syndrome Scale (PANSS), Drug Attitude Inventory (DAI), Assessment of Insight (SAI), and Social-Personal Performance Scale (PSPS) scores were evaluated at baseline and at 3, 6, and 12 months. Cognitive function was assessed at baseline. Multiple mediation analyses were conducted with baseline data, end point data, and changes-in-scale scores between baseline and the end point, respectively. Results: At baseline and at 12 months, only psychotic symptoms mediated the effect of insight on personal-social functioning. For changes-in-scale scores over the 12-month follow-up, in patients receiving treatment with medication alone, the effect of improved insight on improved personal-social function was mediated by psychotic symptoms only; in patients receiving a combined treatment, the effect of improved insight on improved personal-social functioning was mediated by both psychotic symptoms and attitudes toward medication, independently. Conclusions: The link between insight and personal-social functions is mainly mediated by psychotic symptoms. Psychosocial intervention improves the predicting effect of insight on personal-social function by improving both the attitude toward medication and psychotic symptoms independently.

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Section: Discussionmentioning

confidence: 99%

Psychotic Symptoms and Attitudes toward Medication Mediate the Effect of Insight on Personal-Social Functions in Patients with Schizophrenia: One-Year Randomized Controlled Trial and Follow-Up

et al. 2018

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“…Figure 4 summarizes some of the key factors associated with nonadherence based on previous studies 43,44. Poor adherence cannot simply be regarded as “difficult” behavior on behalf of the patient; rather, it can result from a range of factors that encompass the illness, medication, and organization of services, plus attributes of the clinician, patient, and caregivers.…”

Section: Factors Associated With Nonadherencementioning

confidence: 99%

“…Patients who hold a negative drug attitude, for example as assessed by the Drug Attitude Inventory,64 are more likely to show poor adherence 43,65. In contrast, patient demographic variables, including age, sex, social class, and ethnicity, do not show a consistent relationship with antipsychotic adherence 66.…”

Section: Factors Associated With Nonadherencementioning

confidence: 99%

Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies

Haddad¹,

Brain²,

Scott³

2014

PROM

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453

418

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Nonadherence with medication occurs in all chronic medical disorders. It is a particular challenge in schizophrenia due to the illness’s association with social isolation, stigma, and comorbid substance misuse, plus the effect of symptom domains on adherence, including positive and negative symptoms, lack of insight, depression, and cognitive impairment. Nonadherence lies on a spectrum, is often covert, and is underestimated by clinicians, but affects more than one third of patients with schizophrenia per annum. It increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life. It results from multiple patient, clinician, illness, medication, and service factors, but a useful distinction is between intentional and unintentional nonadherence. There is no gold standard approach to the measurement of adherence as all methods have pros and cons. Interventions to improve adherence include psychoeducation and other psychosocial interventions, antipsychotic long-acting injections, electronic reminders, service-based interventions, and financial incentives. These overlap, all have some evidence of effectiveness, and the intervention adopted should be tailored to the individual. Psychosocial interventions that utilize combined approaches seem more effective than unidimensional approaches. There is increasing interest in electronic reminders and monitoring systems to enhance adherence, eg, Short Message Service text messaging and real-time medication monitoring linked to smart pill containers or an electronic ingestible event marker. Financial incentives to enhance antipsychotic adherence raise ethical issues, and their place in practice remains unclear. Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive therapeutic alliance and good communication between the clinician and patient. These elements remain essential for all patients, not least for the small minority where vulnerability and risk issue dictate that compulsory treatment is necessary to ensure adherence.

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“…The interview guide was tested on one informant, and the pilot interview was included in the analysis because only minor changes were made. 29 and questions about current living habits (from the Swedish national guidelines for methods used in the prevention of disease). 30 When needed, these forms were filled out with the assistance of the interviewer.…”

Section: Data Collectionmentioning

confidence: 99%

Barriers, Benefits, and Strategies for Physical Activity in Patients With Schizophrenia

2014

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In accordance with patients' perceptions, there may be biopsychosocial determinants of physical activity behavior that are unique for this group of patients. Future studies should investigate whether physical activity interventions for patients with schizophrenia benefit from individual analyses of barriers and reward for physical activity in combination with the use of tailored strategies such as personal support and activity planning.

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Drug attitude and other predictors of medication adherence in schizophrenia: 12 months of electronic monitoring (MEMS®) in the Swedish COAST-study

Cited by 55 publications

References 43 publications

Psychotic Symptoms and Attitudes toward Medication Mediate the Effect of Insight on Personal-Social Functions in Patients with Schizophrenia: One-Year Randomized Controlled Trial and Follow-Up

Psychotic Symptoms and Attitudes toward Medication Mediate the Effect of Insight on Personal-Social Functions in Patients with Schizophrenia: One-Year Randomized Controlled Trial and Follow-Up

Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies

Barriers, Benefits, and Strategies for Physical Activity in Patients With Schizophrenia

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