Gaps in Use of Antipsychotics After Discharge by First-Admission Patients With Schizophrenia, 1989 to 1996

Abstract

The authors examined gaps in the use of antipsychotic medications during the one-year period after discharge in an epidemiological sample of 189 first-admission patients with schizophrenia between July 1989 and January 1996. Sixty-three percent of the patients had one or more such gaps, and 51 percent had gaps of 30 days or longer, with an average total time off medication of about seven months. Most gaps occurred soon after discharge, and 73 percent were initiated by the patient. These data, which were obtained before the widespread use of atypical antipsychotic agents, provide a benchmark against which to examine the impact of the newer medications on adherence and continuity of treatment in the critical early stages of schizophrenia.

Antipsychotic treatment patterns and hospitalizations among adults with schizophrenia

“…Despite this evidence, research on outpatient utilization spanning 1987−1997 shows that it rarely is continuous in a given year (dosReis et al 2002;McCombs et al 1999;Menzin et al 2003;Mojtabai et al 2002;Vanelli et al 2001;Velligan et al 2003;Williams et al 1999). Only 12−30% of individuals received continuous antipsychotic treatment over a one year period (McCombs et al 1999;Williams et al 1999).…”

“…Prescription refills over a nine-month period in 1998−1999 indicate that approximately 30% of individuals discontinue antipsychotic medication within three months after initiating treatment (Vanelli et al 2001). Following hospital discharge, 37% of adults with schizophrenia discontinue medication within one month (Mojtabai et al 2002), rising to 60% at three months (Velligan et al 2003). Continuous outpatient use ranges from four to seven months (dosReis et al 2002;McCombs et al 1999;Menzin et al 2003).…”

Transcutaneous noninvasive vagus nerve stimulation (tVNS) in the treatment of schizophrenia: a bicentric randomized controlled pilot study

“…This might explain the lacking efficacy of our intervention and also raises questions about the feasibility of self-stimulated tVNS in schizophrenia patients. Schizophrenia patients are characterized by significant noncompliance, which results in 40-60 % discontinuing their antipsychotic treatment [36,39]. The noncompliance rate in our study is in this range.…”

Modeling Determinants of Medication Attitudes and Poor Adherence in Early Nonaffective Psychosis: Implications for Intervention

“…84 and similar predictive validity. 11 Individuals' adherence fluctuates: one group 12 found 33%-44% were nonadherent sometime in any 6-month period and 53% sometime in the first 2 years, while another 13 found 63% nonadherent for at least a week over a year. Another study 14 estimated 45% took under 75% of antipsychotics in the first 6 months, while 42%-60% were rated as nonadherent at some point in first episode psychosis cohorts followed up for at least 1 year, 12,13,[15][16][17] particularly if the samples were juvenile or all had schizophrenia.…”

“…Poor adherence predicts total discontinuation. 13,18 Relapse is also variably defined. 19 Nonetheless, irregular adherence consistently predicts similarly increased risk of relapse, readmission, and other adversity.…”