Medication adherence and cognitive performance in schizophrenia-spectrum and bipolar disorder: results from the PsyCourse Study

Abstract

Existing guidelines recommend psychopharmacological treatment for the management of schizophrenia and bipolar disorder as part of holistic treatment concepts. About half of the patients do not take their medication regularly, although treatment adherence can prevent exacerbations and re-hospitalizations. To date, the relationship between medication adherence and cognitive performance is understudied. Therefore, this study investigated the relationship between medication adherence and cognitive performance by analyzing the data of 862 participants with schizophrenia-spectrum and bipolar disorders (mean [SD] age, 41.9 [12.48] years; 44.8% female) from a multicenter study (PsyCourse Study). Z-scores for three cognitive domains were calculated, global functioning was measured with the Global Assessment of Functioning Scale, and adherence was assessed by a self-rating questionnaire. We evaluated four multiple linear regression models and built three clusters with hierarchical cluster analyses. Higher adherence behavior (p < 0.001) was associated with better global functioning but showed no impact on the cognitive domains learning and memory, executive function, and psychomotor speed. The hierarchical cluster analysis resulted in three clusters with different cognitive performances, but patients in all clusters showed similar adherence behavior. The study identified cognitive subgroups independent of diagnoses, but no differences were found in the adherence behavior of the patients in these new clusters. In summary, medication adherence was associated with global but not cognitive functioning in patients with schizophrenia-spectrum and bipolar disorders. In both diagnostic groups, cognitive function might be influenced by various factors but not medication adherence.

Physical activity influences adherence to pharmacological treatments in patients with severe mental disorders: results from the multicentric, randomized controlled LIFESTYLE trial

“…However, both our and WHO findings highlight the need to improve medication adherence among patients with chronic physical and mental illnesses ( Fernandez-Lazaro et al, 2019 ; Laranjeira et al, 2023 ). The lower adherence rates found in people with severe mental disorders compared to those reported by people suffering from other chronic conditions can be due to the presence of specific symptoms, such as cognitive impairment in schizophrenia ( El-Missiry et al, 2015 ; Mendes et al, 2019 ; Senner et al, 2023 ); inflated mood in bipolar disorder or hopelessness in major depressive disorder ( Chauhan et al, 2021 ). Indeed, in our sample having a psychiatric diagnosis of schizophrenia and/or bipolar disorder did not influence patients’ adherence to treatments, which is partially in line with findings from Ghosh et al (2022) .…”

Comparison of cognitive performance in first-episode drug-naïve schizophrenia, bipolar II disorder, and major depressive disorder patients after treatment

“…There is a number of studies available that compares cognitive performance after treatment [ 29 , 30 ], it is a crucial aspect of understanding the effectiveness of the treatment. Comparing pre- and post-treatment cognitive performance allows us to assess the impact of the treatment on cognitive function and gain insights into its potential benefits.…”

Coping strategies and adherence in people with mood disorder: a cross-sectional study

“…Other consequences include: rehospitalization, worse QoL, recurrence of symptoms, and increased suicide rates (14)(15)(16). Since nonadherence is recognized to elevate the risk of unfavorable clinical outcomes, patient-specific non-adherence risk should be evaluated, and individuals at high risk for non-adherence should be closely monitored (17). However, it should be mentioned that some researchers have not found a direct positive effect of medication adherence on the functioning of patients with mood disorders (18).…”