Early Predictors of Nonadherence to Antipsychotic Therapy in First-Episode Psychosis

Abstract

Objective: To examine the hypothesis that poorer social and family support, identifiable at the onset of treatment, is associated with nonadherence in the first 6 months of treatment of patients with first-episode psychosis (FEP), independent of other patient-related factors.Method: Consecutive patients (n = 100) admitted to a specialized early intervention service for FEP who met the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for either a schizophrenia spectrum disorder or an affective psychosis were evaluated monthly for 6 months regarding their adherence to medications. Using sociodemographic and illness-related factors, including social and family support, as independent variables and adherence as the dependent variable, univariate analyses were followed by logistic regression.Results: Fifty-six patients (54.9%) were adherent (76% to 100% of doses taken) and 46 (45.1%) nonadherent (less than 76% of doses taken). Nonadherent patients were less likely to have received a good level of social support (c 2 = 5.89, df = 1, P = 0.02), as rated by their respective case manager, and more likely to be single (Fisher exact test, P = 0.019) and to have refused medication at the first offer of treatment (c 2 = 19.70, df = 1, P = 0.001). Using logistic regression, both the level of social support (OR = 3.552, P = 0.03) and early medication acceptance (OR = 11.092, P < 0.001) were significant as predictors of adherence. Conclusion Clinical Implications· Social and family support may be an important determinant of adherence to medication very early in the course of treatment of FEP. · Refusal to be treated at the first offer of treatment remains the most likely reason for nonadherence to medication, at least in the first 6 months of treatment of FEP. · Interventions may need to be designed to influence adherence to medication very early in the course of treatment. Limitations· The measure of social and family support used may have been too brief and not able to tap into different aspects of support from family and others in the social environment. · The absence of influence of insight on adherence to medication might have resulted from using the one item from the Positive and Negative Symptom Scale for assessing insight and not using a more detailed measure of insight. · The relatively high level of nonadherence may be a reflection of a very conservative measure of adherence to medication (taking greater than 75% of doses of medication prescribed).

The Influence of Perceived Social Support on Medication Adherence in First-Episode Psychosis

“…Regarding psychotic disorders, there is evidence that social and family support have an impact on medication adherence early in treatment, 20,21 although such evidence has not been demonstrated consistently. 5 In a recent study 20 conducted on an earlier cohort of patients, we reported that social support, as evaluated by case managers, was associated with subsequent adherence to medication in FEP. However, social support was assessed with only 2 questions, and evaluation of social support by patients themselves failed to show such association with adherence.…”

Drug attitude as predictor for effectiveness in first-episode schizophrenia: Results of an open randomized trial (EUFEST)

“…The indicators included and extracted are as manifold as in multiple episode patients: lower occupational status, substance abuse, psychopathology (more pronounced delusional symptoms and suspiciousness; Verdoux et al 2000), negative attitudes toward drug treatment and lack of insight (Kampmann et al 2002, Mutsatsa et al 2003, poor premorbid (cognitive) and post-acute (executive) functioning, more pronounced (extrapyramidal) side effects (Robinson et al 2002, Perkins et al 2008, lower expectations regarding the need for or effectiveness of general or drug-specific treatment, treatment with first (vs. second) generation antipsychotics (FGAs / SGAs; Perkins et al 2006), hostility and uncooperativeness, involuntary admission (De Haan et al 2007), poor treatment response, low adherence to preceding treatment, poor cognitive functioning, persisting negative or depressive symptoms, ethnicity (Perkins et al 2008), less social support, living alone, refusing drugs at treatment initiation (Rabinovitch et al 2009), and substance abuse (Perkins et al 2008, Miller et al 2009). …”

Prevalence and Risk Factors of Non-Adherence in Psychiatric Patients in Taif, Saudi Arabia

“…This is in accordance with results of other studies in patients with schizophrenia [12] and patients with a first psychotic episode. [41,42] Moreover, Living alone was identified as a risk factor in schizophrenic patients. [43] Additionally, distressing personal relationships maybe a risk factor.…”