Dynamics between insight and medication adherence in first-episode psychosis: Study of 3-year trajectories

Abstract

Background: While specialized early intervention programs represent the gold standard in terms of optimal management of first episode psychosis (FEP), poor medication adherence remains a predominant unmet need in the treatment of psychosis. In this regard, an interaction between insight and adherence in FEP patients has been hypothesized but has been challenged by multiple pitfalls. Methods: Latent profile analysis and trajectory modelling techniques were used to evaluate insight and adherence of 331 FEP patients engaged at the beginning, middle and end of a three-year specialized early psychosis program. A Bayesian model comparison approach was used to compare scores of clinical, functional and socio-economic outcomes at the end point of the study. Results: Nearly one-third of the patients maintain a high level of insight and adherence during the entire program. At the end of the 3-year follow-up, more than three-quarters of patients are considered adherent to their medication. Patients with low levels of insight and adherence at the beginning of the program improve first in terms of adherence and then of insight. Furthermore, patients with high levels of insight and adherence are most likely to reach functional recovery and to experience an increase in environmental quality of life. Conclusions: Latent FEP subpopulations can be identified based on insight and adherence. Medication adherence was the first variable to improve but a gain in insight possibly plays a role in the reinforcement of adherence.

Risk and protective factors for recovery at 3-year follow-up after first-episode psychosis onset: a multivariate outcome approach

“…To operationalize the composite measure of recovery at discharge, six clinical, functional and contextual variables previously used to define recovery in patients with psychosis [ 29 – 32 ] and having been identified as important determinants of recovery in the TIPP sample [ 33 , 34 ], were selected from the available assessments, and subsequently included in the LCA (see ‘ Statistical analysis ’ section). This led to creating a multimodal measure of positive outcomes at 3-year follow-up.…”

“…For the analysis, this variable was dichotomized into fully aware of the disorder or not. Previous analyses in TIPP showed its importance in patients’ recovery [ 33 ]; (iv) Functional level. The Social and Occupational Functioning Assessment Scale (SOFAS) was administered to provide a measure about social and occupational functioning [ 26 ].…”

Physical activity influences adherence to pharmacological treatments in patients with severe mental disorders: results from the multicentric, randomized controlled LIFESTYLE trial

“…Patients’ adherence to medications is significantly reduced by lack of insight ( Novick et al, 2015 ), negative beliefs about the efficacy of the medications, concerns about side effects, costs of medications, low educational level, and belonging to ethnic minority ( Lemay et al, 2018 ). In particular, several studies have highlighted that lower insight is associated with lower adherence and a worse therapeutic relationship ( Novick et al, 2015 ; Elowe et al, 2022 ; Okobi et al, 2022 ). Healthcare system factors mainly include polypharmacy (particularly in older adults) and care fragmentation provided by different healthcare professionals ( Aggarwal et al, 2020 ).…”

Role of Clinical Insight at First Month in Predicting Relapse at the Year in First Episode of Psychosis (FEP) Patients

“…Related to medication non-adherence and service engagement are the concepts of psychotic relapse and rehospitalization, where clinical insight seems to exert a crucial role [ 20 ]. Studies have shown that lack of insight at hospital discharge after a FEP affects the way that patients understand the seriousness of their illness and the importance of medication adherence, which are factors that influence compliance and quality of life as well as relapse and rehospitalization in the first year [ 18 , 24 , 25 , 26 ].…”