Antipsychotic Treatment Failure: A Systematic Review on Risk Factors and Interventions for Treatment Adherence in Psychosis

Abdellati, Kawtar El; Picker, Livia De; Morrens, Manuel

doi:10.3389/fnins.2020.531763

Cited by 58 publications

(47 citation statements)

References 89 publications

(242 reference statements)

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“… 1 , 5 , 18 Additionally, non-pharmacological strategies, such as verbal and non-verbal de-escalation of aggressiveness, along with relevant education, should be provided. 27 , 39 …”

Section: Discussionmentioning

confidence: 99%

Prescription patterns in psychiatric compulsory care: polypharmacy and high-dose antipsychotics

et al. 2021

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Background Antipsychotic polypharmacy and prescription of high-dose antipsychotics are often used for the treatment of psychotic symptoms, especially in compulsory psychiatric care although there is lack of evidence to support this practice and related risks for patients. Aims We aimed to investigate prescription patterns in patients with psychosis under compulsory psychiatric treatment in Cyprus and to identify predictors for pharmaceutic treatment patterns. Method This was a nationwide, descriptive correlational study with cross-sectional comparisons, including 482 patients with compulsory admission to hospital. Sociodemographic and clinical data were collected. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Prescribed medication patterns, including use of medication pro re nata (PRN, when required), were recorded. Results Antipsychotic polypharmacy with a PRN schema was reported in 33.2% (n = 160) of the participants. Polypharmacy without a PRN schema was reported in 5.6% (n = 27) of the participants. We found that 27.2% (n = 131) of the participants were prescribed high-dose antipsychotics without PRN included; and 39.2% (n = 189) prescribed high-dose antipsychotics with PRN included. In the logistic regression analyses, predictors for prescription of high-dose antipsychotics were male gender, positive psychiatric history, receiving state benefits and a negative history of substance use. Male gender was the only predictor for polypharmacy without a PRN schema whereas male gender, negative family psychiatric history, receiving state benefits and the total score on the positive symptoms PANSS subscale were predictors for polypharmacy with a PRN schema included. Conclusions A high frequency of polypharmacy and use of medication PRN beyond clinical guidelines has been reported for the first time in psychiatric compulsory care in Cyprus; revision in antipsychotic prescription is needed.

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“… 1 , 5 , 18 Additionally, non-pharmacological strategies, such as verbal and non-verbal de-escalation of aggressiveness, along with relevant education, should be provided. 27 , 39 …”

Section: Discussionmentioning

confidence: 99%

Prescription patterns in psychiatric compulsory care: polypharmacy and high-dose antipsychotics

et al. 2021

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“…Previous studies have reported that insight represents one of the most important factors influencing attitude toward treatment, with higher levels of insight associated to a more positive attitude ( 54 , 55 ). Poor illness insight has also been related to low adherence to treatment in psychotic patients, according to a recent systematic review ( 13 ). Another potential explanation is related to the combined use of LAIs and oral medication in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Severe mental illnesses are at higher risk of relapses associated with increased re-hospitalization rates, suicide attempts, behavioral abnormalities, persistent positive and residual symptoms, higher cognitive impairment, partial response with longer time to achieve remission, worsen quality of life and social functioning, and greater mortality and morbidity ( 1 – 5 ). A partial/absence adherence to pharmacological treatment is considered one of the most relevant risk factors for relapses ( 6 ), and it is influenced by several patient-, illness-, medication-, clinician-, and environmental-related factors ( 7 – 13 ).…”

Section: Introductionmentioning

confidence: 99%

The Role of Attitudes Toward Medication and Treatment Adherence in the Clinical Response to LAIs: Findings From the STAR Network Depot Study

et al. 2021

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Background: Long-acting injectable (LAI) antipsychotics are efficacious in managing psychotic symptoms in people affected by severe mental disorders, such as schizophrenia and bipolar disorder. The present study aimed to investigate whether attitude toward treatment and treatment adherence represent predictors of symptoms changes over time.Methods: The STAR Network “Depot Study” was a naturalistic, multicenter, observational, prospective study that enrolled people initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centers were assessed at three time points: baseline, 6-month, and 12-month follow-up. Psychopathological symptoms, attitude toward medication and treatment adherence were measured using the Brief Psychiatric Rating Scale (BPRS), the Drug Attitude Inventory (DAI-10) and the Kemp's 7-point scale, respectively. Linear mixed-effects models were used to evaluate whether attitude toward medication and treatment adherence independently predicted symptoms changes over time. Analyses were conducted on the overall sample and then stratified according to the baseline severity (BPRS < 41 or BPRS ≥ 41).Results: We included 461 participants of which 276 were males. The majority of participants had received a primary diagnosis of a schizophrenia spectrum disorder (71.80%) and initiated a treatment with a second-generation LAI (69.63%). BPRS, DAI-10, and Kemp's scale scores improved over time. Six linear regressions—conducted considering the outcome and predictors at baseline, 6-month, and 12-month follow-up independently—showed that both DAI-10 and Kemp's scale negatively associated with BPRS scores at the three considered time points. Linear mixed-effects models conducted on the overall sample did not show any significant association between attitude toward medication or treatment adherence and changes in psychiatric symptoms over time. However, after stratification according to baseline severity, we found that both DAI-10 and Kemp's scale negatively predicted changes in BPRS scores at 12-month follow-up regardless of baseline severity. The association at 6-month follow-up was confirmed only in the group with moderate or severe symptoms at baseline.Conclusion: Our findings corroborate the importance of improving the quality of relationship between clinicians and patients. Shared decision making and thorough discussions about benefits and side effects may improve the outcome in patients with severe mental disorders.

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“…Then, in order to increase adherence to treatment, depot therapy is prescribed algorithmically and without considering recommendations on the need to combine prolonged-release antipsychotics with psychoeducation programs to achieve the desired level of compliance. 10 There is solid evidence that different categories of patients demonstrate significantly different rates of treatment adherence, even with depot antipsychotics, depending on their motivation for treatment and attitude to the disease. 11 At the same time, in addition to the patient's own motivation for treatment, the perceived external pressure from the patient's environment is an independent factor in increasing involvement in the therapeutic process, acting along with the factors of distress and insight on the disease.…”

Section: Introductionmentioning

confidence: 99%

Revisiting Drug Compliance: The Need for a Holistic Approach in the Treatment of Severe Mental Disorders

Sorokin¹,

Незнанов

Лутова³

et al. 2021

Consortium Psychiatricum

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INTRODUCTION: The limited practice of depot antipsychotics and psychoeducation use, recommended for overcoming the noncompliance of patients with severe mental disorders, is linked to a high incidence of treatment violation. Therefore, the development of personalized mental healthcare approaches is a crucial healthcare task. AIM: To describe and differentiate the role of clinical, social and psychological factors that lead to different level of treatment engagement of psychiatric inpatients. METHODS: Secondary analysis of findings from 91 inpatients, based on the Treatment Motivation Assessment Questionnaire and Medication Compliance Scale, as well as the Scale of Internalized Stigma of Mental Illness and Perceived Discrimination and Devaluation Scale. Factorial analysis, cluster analysis and analysis of variance with p-level=0.05 and the calculation of the effect size (ES) according to Cohens d and Cramers V were used. RESULTS: The nature of therapy compliance in various categories of patients is mediated differentially, including: the severity of negative symptoms (ES=0.29), the global level of functioning and work maladjustment (ES=0.230.26), various motivational and behavioral styles (ES0.74) and the intensity of psychiatric stigmatization (ES0.88). CONCLUSIONS: Consideration of the clinical, social and psychological factors should empirically determine the strategies for the personalized use of prolonged antipsychotics and socio-psychotherapeutic interventions when developing an individual treatment plan for psychiatric in-patients.

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Antipsychotic Treatment Failure: A Systematic Review on Risk Factors and Interventions for Treatment Adherence in Psychosis

Cited by 58 publications

References 89 publications

Prescription patterns in psychiatric compulsory care: polypharmacy and high-dose antipsychotics

Prescription patterns in psychiatric compulsory care: polypharmacy and high-dose antipsychotics

The Role of Attitudes Toward Medication and Treatment Adherence in the Clinical Response to LAIs: Findings From the STAR Network Depot Study

Revisiting Drug Compliance: The Need for a Holistic Approach in the Treatment of Severe Mental Disorders

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