Adherence therapy for people with schizophrenia

Gray, Richard; Leese, Morven; Bindman, Jonathan; Becker, Thomas; Burti, Lorenzo; David, Anthony S.; Gournay, Kevin; Kikkert, Martijn; Koeter, Maarten W. J.; Puschner, Bernd; Schene, Aart H.; Thornicroft, Graham; Tansella, M

doi:10.1192/bjp.bp.105.019489

Cited by 157 publications

(122 citation statements)

References 24 publications

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“…The sample size calculation was based on the average effects size on symptom severity (Positive and Negative Syndrome Scale; 0.48 to 0.54) and level of medication adherence (Positive and Negative Syndrome Scale; 0.46 to 0.52) at immediately post-intervention in four clinical trials of AT [8,16] or psycho-education programs with medication management as core components in schizophrenia [1,19]. With the level of statistical significance set at P = 0.05 (two-sided) and a study power of 80 %, the sample size was 47 per group to detect an average effect size (Cohen’s d) of 0.50 on the above two outcomes, using G*Power 3.1 for Windows [20], taking into account an attrition rate of 20 % [10,19].…”

Section: Methodsmentioning

confidence: 99%

“…These nurse therapists had received two full-days training by the research team based on both the AT instructor program developed by Gray et al [11] and a psycho-education program for Chinese patients with schizophrenia [1,21]. The trained nurses were provided with supervised practices on AT for at least three outpatients with schizophrenia until the supervisors (the first and second authors) agreed and confirmed the consistency and competency of their implementation of the treatment protocol (over 90 % of items rated as ‘Fully competent’), using a validated competency scale of AT [16]. During the therapy, three sessions were randomly selected for each nurse therapist, audio-taped (with the nurses’ and participants’ prior consents) and assessed by two raters (researchers) to monitor the treatment fidelity using the same competency scale.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, this randomized controlled trial was designed to test the effects of a modified AT program for Chinese outpatients with schizophrenia spectrum disorders (together with principles of cognitive behavioral therapy), as recommended by Gray et al [16]. We hypothesized that that the participants who received AT would demonstrate significantly greater improvements in symptom severity at immediately and six months after completion of the intervention, compared with treatment as usual (TAU).…”

Section: Introductionmentioning

confidence: 99%

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

Chien

Mui

Cheung

et al. 2015

Trials

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127

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Chien

Mui

Cheung

et al. 2015

Trials

Self Cite

127

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“…In particular, a well-conducted, adequately powered RCT found adherence therapy to be ineffective in improving adherence, psychotic symptoms or quality of life in people with schizophrenia (Gray et al, 2006).…”

Section: Interventions To Improve Adherencementioning

confidence: 99%

Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology

2011

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These guidelines from the British Association for Psychopharmacology address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting, involving experts in schizophrenia and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from the participants and interested parties, and cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. The practice recommendations presented are based on the available evidence to date, and seek to clarify which interventions are of proven benefit. It is hoped that the recommendations will help to inform clinical decision making for practitioners, and perhaps also serve as a source of information for patients and carers. They are accompanied by a more detailed qualitative review of the available evidence. The strength of supporting evidence for each recommendation is rated.

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“…Many other randomized controlled trials of patient education for people with schizophrenia have also reported no QoL differences between different education methods [46][47][48]. Nevertheless, both computer-based education and education with standard leaflets can offer more systematic alternatives to standard patient education.…”

Section: Discussionmentioning

confidence: 97%

Patient education methods to support quality of life and functional ability among patients with schizophrenia: a randomised clinical trial

et al. 2011

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In light of the findings there is no evidence to support a particular education method as the best way to improve patients' quality of life or improve functional ability. On the other hand, no intervention was found to be harmful. Thus computer-based patient education may be a suitable alternative for some patients. While information technology will be more widely used in societies, computer-based intervention may be beneficial for some patients with serious mental disorders.

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Adherence therapy for people with schizophrenia

Abstract: This effectiveness trial provides evidence for the lack of effect of adherence therapy in people with schizophrenia with recent clinical instability, treated in ordinary clinical settings.

Cited by 157 publications

References 24 publications

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

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

Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology

Patient education methods to support quality of life and functional ability among patients with schizophrenia: a randomised clinical trial

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