Antipsychotic Medication Adherence: Is There a Difference Between Typical and Atypical Agents?

Dolder, Christian R.; Lacro, Jonathan P.; Dunn, Laura B.; Jeste, Dilip V.

doi:10.1176/appi.ajp.159.1.103

Cited by 348 publications

(215 citation statements)

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“…25 Dolder et al also did not find significant differences in antipsychotic adherence among patients prescribed typical versus atypical agents. 26 So far the evidence regarding atypical antipsychotics and better compliance in schizophrenia has been inconclusive. 27,28 No significant difference was seen between oral and depot injectables on adherence, however from previous studies there is some evidence that managing patients with depot antipsychotics leads to higher rates of medication adherence.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting adherence in patients with schizophrenia

2016

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INTRODUCTIONSchizophrenic illnesses are typically long term illnesses. Nonadherence to medication can lead to relapse, which can mean more visits to the emergency room, rehospitalizations and increased need for clinician intervention -all of which lead to increased costs to healthcare systems. 1Rates of non-compliance in psychotic disorders have been reported to vary from 11 to 80% and in most of the cases it would result in relapse.2,3 Nonadherent patients have an average risk of relapse that is 3.7 times greater than that of adherent patients. 4 As per World Health Organization (WHO) estimates the median treatment gap for schizophrenia, including other non-affective psychosis, was 32.2 % and so the poor adherence results in wastage and under utilization of already limited treatment resources and compounds the challenges of improving health in poor populations. 5 Weiden and Olfson found that nonadherence in schizophrenia accounted for about 40% of the annual costs of rehospitalization.6 Johnson et al, reported that patients with schizophrenia who experienced a relapse did not return to their pre relapse level of social adjustment 1 year after recovery, implying that the cost of relapse is much greater than just the cost of rehospitalization.7 The cost of relapse may be particularly severe for patients with jobs and family responsibilities since they have the most to lose. Knowledge of how to improve adherence ABSTRACT Background: Nonadherence with medication regimens is among the most common causes of psychotic relapse and the need for rehospitalisation. This study was designed to look into the factors affecting attitude towards medication adherence in Schizophrenia and its relationship with severity of illness, side effects of medication. Methods: Adult males and females in the age range of 18-55 years fulfilling criteria for schizophrenia according to ICD -10, DCR, and reporting at outpatient department were taken up for this study. Severity of illness was assessed by Brief Psychiatric Rating Scale (BPRS), Side effects to medication were assessed by Udvalg for Kliniske Undersogelser (UKU) side effect scale, and Adherence was assessed by Medication adherence rating scale (MARS). Results: Adherence negatively correlated with severity of illness, and side effects in the form of increased sleep duration, asthenia, increased fatigability, lassitude and diminished sexual desire. Regression analysis with MARS as dependent variable showed side effects of medication in the form of increased sleep duration in followed by asthenia, lassitude, and increased fatigability to be predictors of poor adherence in the sample. Conclusions: Poor adherence is associated with severity of schizophrenia, sedation and asthenia like side effects due to medication. Sedation and asthenia like side effects caused a decline in adherence.

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Section: Discussionmentioning

confidence: 99%

Factors affecting adherence in patients with schizophrenia

2016

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“…Schizophrenia is an especially serious chronic illness that requires lifelong medication 1,2) . However, various side effects are caused by antipsychotic medication.…”

Section: Introductionmentioning

confidence: 99%

“…However, various side effects are caused by antipsychotic medication. For example, extrapyramidal symptoms (EPS) are often induced by typical antipsychotic medication that is effective for schizophrenic patients 1,2) . In addition, EPS can result from atypical antipsychotic medications 3) .…”

Section: Introductionmentioning

confidence: 99%

Reach Distance and Movement Strategy Patterns During the Functional Reach Test of Psychiatric Patients

et al. 2011

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Abstract.[Purpose] Ability in activities of daily living of psychiatric patients is decreased because of postural control and voluntary movement disorders, and the quality of life of inpatients is also decreased. As preliminary research for evaluating standing balance of psychiatric patients, the purpose of this study was to investigate reach distance and movement strategy while subjects performed the functional reach test.[Subjects] Thirty-eight psychiatric patients and 38 healthy elderly control volunteers participated in this study.[Methods] Reach distance and movement strategy patterns were measured while subjects performed the functional reach test.[Results] The reach distance of the psychiatric patients was significantly shorter than that of the controls. The hip strategy was most often used by both patients and controls. Patients were more likely to select the ankle movement strategy than controls.[Conclusion] Based on the above findings, we speculate that the hip strategy is the ideal movement strategy for safely extending the reach distance of both psychiatric patients and controls. However, psychiatric patients were more likely to select the ankle movement strategy than controls.

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“…Most factors influencing the clinicians' attitudes toward the use of LAI antipsychotics are shared in many countries. Conversely, some attitudes related to organizational aspects, particularly the relevance of health care costs, may vary from one country to another.Key Words: Antipsychotics, long-acting injectable, attitudes, schizophrenia (J Nerv Ment Dis 2013;201: 553Y559) A ccording to systematic reviews, between 40% and 60% of patients with schizophrenia are known to be partially or totally noncompliant to oral antipsychotic medication (Dolder et al, 2002;Valenstein et al, 2004). Poor adherence is associated with higher risk for relapse of schizophrenia and increased health care costs (Patel et al, 2008).…”

mentioning

confidence: 99%

“…A ccording to systematic reviews, between 40% and 60% of patients with schizophrenia are known to be partially or totally noncompliant to oral antipsychotic medication (Dolder et al, 2002;Valenstein et al, 2004). Poor adherence is associated with higher risk for relapse of schizophrenia and increased health care costs (Patel et al, 2008).…”

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1151 – Clinicians’ attitudes toward the use of long-acting injectable antipsychotics

Samalin

Charpeaud

Heres³

et al. 2013

European Psychiatry

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Depot formulations are not widely used in everyday practice. This study aimed to assess psychiatrists' attitudes toward the use of long-acting injectable (LAI) antipsychotics in schizophrenia. We interviewed 113 French psychiatrists about the factors that influenced their prescription of LAI antipsychotics. Multidimensional and cluster analyses were used to detect correlations. The most important factor against the use of LAI antipsychotics is a sufficient estimated compliance with the oral formulation. For first-generation LAI, the main factor is the risk for extrapyramidal symptoms; and for secondgeneration LAI, it is the unavailability of the equivalent oral formulation. Four factors incite the psychiatrists to prescribe LAI. Two different clusters of patients can also be identified. Most factors influencing the clinicians' attitudes toward the use of LAI antipsychotics are shared in many countries. Conversely, some attitudes related to organizational aspects, particularly the relevance of health care costs, may vary from one country to another.Key Words: Antipsychotics, long-acting injectable, attitudes, schizophrenia (J Nerv Ment Dis 2013;201: 553Y559) A ccording to systematic reviews, between 40% and 60% of patients with schizophrenia are known to be partially or totally noncompliant to oral antipsychotic medication (Dolder et al., 2002;Valenstein et al., 2004). Poor adherence is associated with higher risk for relapse of schizophrenia and increased health care costs (Patel et al., 2008).However, depot formulations are not widely used in routine practice, with a prescription rate of generally lower than 30% in different countries (Barnes et al., 2009; Patel and David, 2011). However, the use of long-acting injectable (LAI) formulations varies between countries. The prescription rates are higher in France (23.5%;Fourrier et al., 2000) and in the United Kingdom (29%; Barnes et al., 2009) compared with other European countries and with Canada (6.3%; Williams et al., 2006) or the United States (17.6%; West et al., 2008).This discrepancy between countries can be considered to derive from the health care system and from the different attitudes displayed by psychiatrists.Perceived coercion or presumed risks for lower tolerance of depot forms have been identified as factors responsible for this low use (Heres et al., 2006; Patel and David, 2011). More generally, negative attitudes from practitioners toward these forms have been shown to account for part of the low prescription rates of depot antipsychotics (Hamann et al., 2010;Heres et al., 2006Heres et al., , 2008Heres et al., , 2011.The main goal of our study was to assess the attitudes of psychiatrists toward LAI antipsychotics in patients with schizophrenia to understand the reasons for using or not assigning depot treatment.We studied these attitudes in a sample of psychiatrists working in France using the same questionnaire that was used in a population of German psychiatrists (Heres et al., 2006(Heres et al., , 2008. Our results will be discus...

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Antipsychotic Medication Adherence: Is There a Difference Between Typical and Atypical Agents?

Abstract: Interventions to improve adherence are warranted even for patients who receive atypical antipsychotic medications.

Cited by 348 publications

References 32 publications

Factors affecting adherence in patients with schizophrenia

Factors affecting adherence in patients with schizophrenia

Reach Distance and Movement Strategy Patterns During the Functional Reach Test of Psychiatric Patients

1151 – Clinicians’ attitudes toward the use of long-acting injectable antipsychotics

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