Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia

Gunnar Morken, Jan H Widen, Rolf W Grawe, Gunnar Morken, Jan H Widen, Rolf W Grawe

Abstract

Background: The aims of this study were to describe outcome with respect to persistent psychotic symptoms, relapse of positive symptoms, hospital admissions, and application of treatment by coercion among patients with recent onset schizophrenia being adherent and non-adherent to anti-psychotic medication.

Materials and methods: The study included 50 patients with recent onset schizophrenia, schizoaffective or schizophreniform disorders. The patients were clinically stable at study entry and had less than 2 years duration of psychotic symptoms. Good adherence to antipsychotic medication was defined as less than one month without medication. Outcomes for poor and good adherence were compared over a 24-month follow-up period.

Results: The Odds Ratio (OR) of having a psychotic relapse was 10.27 and the OR of being admitted to hospital was 4.00 among non-adherent patients. Use of depot-antipsychotics were associated with relapses (OR = 6.44).

Conclusion: Non-adherence was associated with relapse, hospital admission and having persistent psychotic symptoms. Interventions to increase adherence are needed.

Trial registration: Current Controlled Trials NCT00184509. Key words: Adherence, schizophrenia, antipsychotic medication, admittances, relapse.

References

    1. WYATT RJ. Neuroleptics and the natural course of schizophrenia. Schizophr Bull. 1991;17:325–351.
    1. Haywood TW, Kravitz HM, Grossman LS, Cavanaugh JL, Jr, Davis JM, Lewis DA. Predicting the "revolving door" phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. Am J Psychiatry. 1995;152:856–861.
    1. Sullivan G, Wells KB, Morgenstern H, Leake B. Identifying modifiable risk factors for rehospitalization: a case-control study of seriously mentally ill persons in Mississippi. Am J Psychiatry. 1995;152:1749–1756.
    1. Ayuso-Gutierrez JL, del Rio V. Factors influencing relapse in the long-term course of schizophrenia. Schizophr Res. 1997;28:199–206. doi: 10.1016/S0920-9964(97)00131-X.
    1. Gilmer TP, Dolder CR, Lacro JP, Folsom DP, Lindamer L, Garcia P, et al. Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. Am J Psychiatry. 2004;161:692–699. doi: 10.1176/appi.ajp.161.4.692.
    1. Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353:1209–1223. doi: 10.1056/NEJMoa051688.
    1. Robinson D, Woerner MG, Alvir JM, Bilder R, Goldman R, Geisler S, et al. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry. 1999;56:241–247. doi: 10.1001/archpsyc.56.3.241.
    1. Grawe RW, Falloon IR, Widen JH, Skogvoll E. Two-years of early treatment for recent-onset schizophrenia. A randomised controlled study. Acta Psychiatrica Scandinavia. 2006;114:328–336. doi: 10.1111/j.1600-0447.2006.00799.x.
    1. Morken G, Grawe RW, Widen JH. Effects of Integrated Treatment on Antipsychotic Medication Adherence in a Randomized Trial in Recent-Onset Schizophrenia. J Clin Psychiatry. 2007;68:566–571.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders DSM-IV. 4. Washington, DC: American Psychiatric Association; 1994. text revision edn.
    1. First MB, Spitzer RL, Gibbon M, Williams JB. Structured Interview for the Diagnostic ans Statistical Manual of Mental Disorders, Patient Version. 4. Washington, DC: American Psychiatric Association; 1997.
    1. Falloon IR. Optimal treatment for psychosis in an international multisite demonstration project. Optimal Treatment Project Collaborators. Psychiatr Serv. 1999;50:615–618.
    1. Falloon IRH, Fadden G. Integrated Mental Health Care. Cambridge: Cambridge University Press; 1993.
    1. Tarrier N, Barrowclough C, Vaughn C, Bamrah JS, Porceddu K, Watts S, et al. The community management of schizophrenia. A controlled trial of a behavioural intervention with families to reduce relapse. Br J Psychiatry. 1988;153:532–542.
    1. Falloon IR, Boyd JL, McGill CW, Razani J, Moss HB, Gilderman AM. Family management in the prevention of exacerbations of schizophrenia: a controlled study. N Engl J Med. 1982;306:1437–1440.
    1. Ventura J, Green MF, Shaner A, Liberman RP. Training and Quality Assurance with the Brief Psychiatric Rating-Scale – the Drift Busters. International Journal of Methods in Psychiatric Research. 1993;3:221–244.
    1. Ventura J, Nuechterlein KH, Subotnik KL, Gutkind D, Gilbert EA. Symptom dimensions in recent-onset schizophrenia and mania: a principal components analysis of the 24-item Brief Psychiatric Rating Scale. Psychiatry Res. 2000;97:129–135. doi: 10.1016/S0165-1781(00)00228-6.
    1. Nuechterlein KH, Dawson ME, Gitlin M, Ventura J, Goldstein MJ, Snyder KS, et al. Developmental Processes in Schizophrenic Disorders: longitudinal studies of vulnerability and stress. Schizophr Bull. 1992;18:387–425.
    1. Valenstein M, Copeland LA, Blow FC, McCarthy JF, Zeber JE, Gillon L, et al. Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission. Med Care. 2002;40:630–639. doi: 10.1097/00005650-200208000-00002.
    1. Kissling W. The current unsatisfactory state of relapse prevention in schizophrenic psychoses – suggestions for improvement. Clin Neuropharmacol. 1991;14:S33–S44.
    1. Weiden P, Rapkin B, Mott T, Zygmunt A, Goldman D, Horvitz-Lennon M, et al. Rating of medication influences (ROMI) scale in schizophrenia. Schizophr Bull. 1994;20:297–310.
    1. Fenton WS, Blyler CR, Heinssen RK. Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophr Bull. 1997;23:637–651.
    1. Kamali M, Kelly L, Gervin M, Browne S, Larkin C, O'Callaghan E. Psychopharmacology: insight and comorbid substance misuse and medication compliance among patients with schizophrenia. Psychiatr Serv. 2001;52:161–3. doi: 10.1176/appi.ps.52.2.161. 166.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe