Comparing cognitive functions in medication adherent and non-adherent patients with schizophrenia

El-Missiry, Ahmed; Elbatrawy, Amira; Missiry, Marwa El; Moneim, Dalia Abdel; Ali, Ramy; Essawy, H.

doi:10.1016/j.jpsychires.2015.09.006

Cited by 35 publications

(33 citation statements)

References 57 publications

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“…The results of this study are also consistent with several previous studies in that cognition level and medication adherence were factors associated with the rehospitalization in patients with schizophrenia; thus, these are considered important factors in this regard. Other studies have reported that cognitive functioning in schizophrenia greatly affects functional outcomes, and it also affects insight and treatment adherence . Our previous study regarding the effects of OT interventions showed that adding IOT to standard care had benefits to improve cognitive functioning, intrinsic motivation, and treatment satisfaction during the inpatient treatment phase; therefore, the present study's findings may also provide support for the contributions of the cognitive functioning improvements achieved during GOT + IOT to prolonged time to rehospitalization and reduced risk of rehospitalization.…”

Section: Discussionsupporting

confidence: 72%

“…Other studies have reported that cognitive functioning in schizophrenia greatly affects functional outcomes, [3][4][5][6][7][8] and it also affects insight 40,41 and treatment adherence. 42,43 Our previous study regarding the effects of OT interventions showed that adding IOT to standard care had benefits to improve cognitive functioning, intrinsic motivation, and treatment satisfaction during the inpatient treatment phase 2 ; therefore, the present study's findings may also provide support for the contributions of the cognitive functioning improvements achieved during GOT + IOT to prolonged time to rehospitalization and reduced risk of rehospitalization. In addition, several studies have found that medication adherence has a strong influence on reducing rehospitalization risk, [35][36][37][38][39] and several interventions for improving adherence rates have been developed in recent decades.…”

Section: Pcn Psychiatry Andsupporting

confidence: 64%

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Effect of adding individualized occupational therapy to standard care on rehospitalization of patients with schizophrenia: A 2‐year prospective cohort study

Shimada

Ohori

Inagaki³

et al. 2019

Psychiatry Clin Neurosci

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Aim We examined the effect of individualized occupational therapy (IOT) compared to the usual group occupational therapy (GOT) on the rehospitalization of patients with schizophrenia. Methods A prospective cohort study included patients with schizophrenia who were discharged within 1 year from a psychiatric hospital. Time to rehospitalization by treatment group (GOT + IOT or GOT‐alone) was evaluated with Kaplan–Meier survival analysis. The impact of demographics and clinical factors associated with rehospitalization was investigated using Cox proportional hazards models. Results Of the 111 patients who met the criteria, 54 were in the GOT + IOT group and 57 in the GOT‐alone group. Over the 2 years from discharge, the overall rehospitalization rate was 51.376% (56 patients); the GOT + IOT group demonstrated a significantly lower rehospitalization rate with 16 patients rehospitalized compared to 40 patients from the GOT‐alone group. Time to rehospitalization was significantly longer for the GOT + IOT group compared to those in the GOT‐alone group (P < 0.001). The multivariate Cox proportional hazards models showed that type of occupational therapy (hazard ratio [HR] = 0.543), medication adherence (HR = 0.343), access to resident support persons (HR = 0.450), and executive function at discharge (HR = 0.740) were all significantly associated with rehospitalization. Conclusion Our results provide support for the prolonging effects of IOT in relation to rehospitalization and the reduction of rehospitalization risk compared to patients with schizophrenia who receive GOT alone, in addition to supporting good cognition at discharge and favorable medication adherence.

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Section: Discussionsupporting

confidence: 72%

Section: Pcn Psychiatry Andsupporting

confidence: 64%

Effect of adding individualized occupational therapy to standard care on rehospitalization of patients with schizophrenia: A 2‐year prospective cohort study

Shimada

Ohori

Inagaki³

et al. 2019

Psychiatry Clin Neurosci

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“…Additionally, antipsychotic treatment non-adherence has been identified as one of the main causes for antipsychotic treatment failure (Goff et al, 2010 ). Although medication non-adherence is a common problem throughout medicine, several factors make it especially challenging in treating patients with psychotic disorders: direct impact of symptoms on cognitive functions (El-Missiry et al, 2015 ; MacKenzie et al, 2018 ), lack of illness insight, stigma, comorbid substance abuse, and social isolation (Haddad et al, 2014 ). Astoundingly, while the number of patients taking antipsychotics has increased over the years, little progress has been made with regard to improving medication adherence in these patients, possibly because the choice of measurement of adherence is a long-standing methodological problem.…”

Section: Introductionmentioning

confidence: 99%

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

2020

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Objective: Antipsychotic medication non-adherence has detrimental effects on patients' clinical outcome. It is unclear which risk factors affect adherence most and which interventions are effective at improving adherence to antipsychotic medication. The aim of this systematic review is to summarize evidence exploring risk factors of non-adherence to antipsychotic treatment and effectiveness of intervention to improve adherence in patients with psychotic spectrum disorders. Methods: We conducted a systematic search in PubMed from 1994 to 2019 using a structured search strategy. Studies were quality assessed, and studies reporting on possible risk factors and intervention strategies were synthesized. Results: We reviewed 26 studies on factors related to antipsychotic medication adherence and 17 studies on interventions to improve adherence in patients with psychosis spectrum disorders. Risk factors of non-adherence included younger age, poor illness insight, cannabis abuse, and the presence of severe positive symptoms. Antipsychotic medication adherence was associated with positive attitude toward medication of both patients and their family, family involvement, and illness insight. Somewhat consistent evidence was found for interventions involving family and technology-based interventions and strategies combining depot medication with psychoeducation. However, given the wide range of heterogeneous interventions and methodological limitations, findings must be interpreted with caution. Conclusion: Despite much effort invested in the research area of antipsychotic medication adherence, the heterogeneity in study design and outcome, adding to confounding effects and possible biases, and methodological restraints complicate comparability of the results. Future research in this field should therefore be conducted on patient-tailored interventions, considering risk factors affecting the patient and implementing well-validated, standardized assessment methods. Accordingly, this systematic review seeks to facilitate endeavors improving adherence to antipsychotic treatment by identifying modifiable and non-modifiable risk factors, outlining effective intervention strategies, and proposing recommendations to enhance adherence strategies.

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“…There are several confounders that likely have a bearing on this relationship including general symptom improvement, the stage, and duration of the illness, dose of the AP, adherence to treatment, medication-related sedation, and anticholinergic side effects. Many of these aspects have been investigated and reviewed in detail elsewhere (33–37), and are summarized briefly here.…”

Section: Introductionmentioning

confidence: 99%

“…Medication adherence also contributes to the relationship between AP and cognitive functioning. In studies where medication adherence was considered, those who were adherent, not surprisingly, have been reported to show greater improvements in cognition compared to those who did not take their medications regularly (37). However, whether poor adherence leads to a lack of improvement in cognition or inherent cognitive deficits related to the diagnosis of schizophrenia lead to poor medication adherence remains an unanswered question.…”

Section: Introductionmentioning

confidence: 99%

Antipsychotics, Metabolic Adverse Effects, and Cognitive Function in Schizophrenia

et al. 2018

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Cognitive impairment is a core symptom domain of schizophrenia. The effect of antipsychotics, the cornerstone of treatment in schizophrenia, on this domain is not fully clear. There is some evidence suggesting that antipsychotics may partially improve cognitive function, and that this improvement may vary depending on the specific cognitive domain. However, this research is confounded by various factors, such as age, duration/stage of illness, medication adherence, and extrapyramidal side effects that complicate the relationship between antipsychotics and cognitive improvement. Furthermore, antipsychotics—particularly the second generation, or “atypical” antipsychotics—can induce serious metabolic side effects, such as obesity, dyslipidemia and type 2 diabetes, illnesses which themselves have been linked to impairments in cognition. Thus, the inter-relationships between cognition and metabolic side effects are complex, and this review aims to examine them in the context of schizophrenia and antipsychotic treatment. The review also speculates on potential mechanisms underlying cognitive functioning and metabolic risk in schizophrenia. We conclude that the available literature examining the inter-section of antipsychotics, cognition, and metabolic effects in schizophrenia is sparse, but suggests a relationship between metabolic comorbidity and worse cognitive function in patients with schizophrenia. Further research is required to determine if there is a causal connection between the well-recognized metabolic adverse effects of antipsychotics and cognitive deficits over the course of the illness of schizophrenia, as well as, to determine underlying mechanisms. In addition, findings from this review highlight the importance of monitoring metabolic disturbances in parallel with cognition, as well as, the importance of interventions to minimize metabolic abnormalities for both physical and cognitive health.

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Comparing cognitive functions in medication adherent and non-adherent patients with schizophrenia

Cited by 35 publications

References 57 publications

Effect of adding individualized occupational therapy to standard care on rehospitalization of patients with schizophrenia: A 2‐year prospective cohort study

Effect of adding individualized occupational therapy to standard care on rehospitalization of patients with schizophrenia: A 2‐year prospective cohort study

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

Antipsychotics, Metabolic Adverse Effects, and Cognitive Function in Schizophrenia

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