Adherence therapy versus routine psychiatric care for people with schizophrenia spectrum disorders: a randomised controlled trial

Wai Tong Chien, Jolene Mui, Richard Gray, Eric Cheung, Wai Tong Chien, Jolene Mui, Richard Gray, Eric Cheung

Abstract

Background: Current practice guidelines for schizophrenia care recommend that antipsychotic medication is essential for patients' long-term maintenance treatment but their non-adherence to this medication is still a main obstacle to relapse prevention. This study evaluated the effects of a motivational-interviewing-based adherence therapy for people with schizophrenia spectrum disorders.

Methods: This randomised controlled trial was conducted with 134 outpatients with schizophrenia spectrum disorders; 67 of them received a six-session adherence therapy (in addition to usual care) and 67 received usual psychiatric care alone. Participants' outcome measures included symptom severity, medication adherence, hospitalisation rates, insight into illness/treatment, and functioning.

Results: The adherence therapy group reported significantly greater improvements in symptom severity (p < 0.003), insight into illness/treatment (p < 0.001), functioning (p < 0.005), duration of re-hospitalisations (p < 0.005), and medication adherence (p < 0.005) over 18 months follow-up, when compared with usual care alone.

Conclusions: Motivational-interviewing-based adherence therapy can be an effective approach to treatment for people with early stage of schizophrenia who poorly adhere to medication regimen.

Trial registration: ClinicalTrials.gov NCT01780116, registration date January 29, 2013.

Figures

Fig. 1
Fig. 1
This figure indicates a flow diagram of the controlled trial procedure. One hundred and thirty-four out of 650 approached patients with schizophrenia spectrum disorders were recruited from two community psychiatric nursing service units (i.e., 67 participants in each setting). After informed consent and baseline measurement, they were randomly assigned into either adherence therapy (plus usual care, n = 67) or treatment as usual alone (n = 67) group. Following 3-month intervention, the participants completed the post-test outcome measurements at 2 weeks, 6 months and 18 months follow-up. With an attrition of totally 6 participants, outcome data of 65 in adherence therapy and 63 in treatment as usual group were finally analysed and compared
Fig. 2
Fig. 2
Five figures show the mean scores of each of the five study outcomes, including symptom severity (PANSS score), level of functioning (SLOF score), insight into illness/treatment (ITAQ score), duration of re-hospitalisations, for two study groups at baseline (T0) and 2 weeks, 6 months and 18 months follow-ups (T1-T3). These five study outcomes were found significantly greater improvements among the participants in adherence therapy, when compared to those in treatment as usual
Fig. 3
Fig. 3
Two figures shows the mean scores of the positive and negative symptoms in PANSS for two study groups at baseline (T0) and 2 weeks, 6 months and 18 months follow-ups (T1-T3). The mean scores of these two subscales of the PANSS were found significantly greater improvements among the participants in adherence therapy, when compared to those in treatment as usual

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