Effects of motivational interviewing-based adherence therapy for schizophrenia spectrum disorders: a randomized controlled trial

Abstract

BackgroundNon-adherence to antipsychotic medication is commonly found in schizophrenia and other psychotic disorders, thus forming a major obstacle to long-term maintenance treatment and contributing to high relapse rates. With limited evidence on the success of interventions in enhancing medication adherence, this controlled trial was designed to test and evaluate the effectiveness of an adherence therapy (AT) for outpatients with schizophrenia spectrum disorders, based on a motivational interviewing approach over a six-month follow-up period.MethodsA single-blind, randomized controlled trial with a repeated-measures, two parallel groups design was conducted in a random sample of 114 participants with schizophrenia spectrum disorders in one community psychiatric nursing service. After pre-test, the participants were randomly assigned to either an eight-session course of AT plus usual care or usual psychiatric care (n = 57 per group). The main outcomes, including medication adherence, symptom severity, insight into treatment, hospitalization rate, and functioning, were measured at baseline and immediately and six months post-intervention.ResultsA total of 110 participants completed this trial and thus the attrition rate was 3.5 %. Results of repeated-measures analysis of variance followed by Helmert’s contrasts test indicated that the AT participants reported significantly greater improvements in their insight into illness and/or treatment, psychosocial functioning, symptom severity, number of re-hospitalizations, and medication adherence (F = 5.01 to 7.45, P = 0.007 to 0.030) over six months follow-up, when compared with usual care.ConclusionsMotivational interviewing-based AT for people with schizophrenia can be effective to reduce symptom severity and re-hospitalizations, and improve medication adherence, functioning, and insight into illness and/or treatment over a medium term (six months) period of follow-up. Further study on the effects of AT in people with psychotic disorders in terms of diverse sociodemographic and illness characteristics, and a longer term (for example, over 12 months) follow-up period is recommended.Trial registrationThe trial was registered at Clinicaltrials.gov (identifier: NCT01780116) on 6 July 2014.

Randomized controlled trial of cognitive-motivational therapy program (PIPE) for the initial phase of schizophrenia: Maintenance of efficacy at 5-year follow up✰

“…This study has produced promising results in terms of relapses (measured by number of rehospitalizations and length of stays), and these promising tendencies remain visible 5 years out. The results of some other studies of relapses are coherent with those collected in this trial (Bechdolf & Pohlmann, 2012a;Chien, Mui, Cheung, & Gray, 2015;Sellwood et al, 2001;Sivec & Montesano, 2012, Turkington et al, 2008. However, other prior research has not found significant results for this variable either 9 months (Barrowclough et al, 2014) or 18 months (Kuipers et al, 1998; from the start of treatment.…”

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

“…Drake et al 164 found that cognitive therapy which followed cognitive remediation was linked to greater improvements in clinical insight in psychosis. Motivational interviewing 165,166 and mindfulness based interventions [167][168][169] have also been linked to improved insight relative to treatment as usual.…”

Conceptualising a model to guide nursing and midwifery in the community guided by an evidence review

“…In terms of preventative mental health care, motivational interviewing by community psychiatric nurses was effective for young adults [58]. Community Psychiatric nurses also had positive psychological outcomes in promoting improvements in functional cognitive ability, mental health scores, depressive symptomology, and self-perceived quality of health in older persons with cognitive decline [59, 60].…”