Medication Problems Confronted by the Schizophrenic Outpatient

Hoffmann, Richard P.; Moore, Willis E.; O'Dea, Loren F.

doi:10.1016/s0003-0465(16)32982-2

Cited by 7 publications

(10 citation statements)

References 9 publications

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“…Although the complexity of a medication regimen is associated with compliance across a broad range of medical disorders (Haynes 1976), only one (Razali and Yahya 1995) of four empirical studies that focused exclusively on schizophrenia identified a statistically significant association between complexity of regimen and compliance. Hoffman et al (1974), Hogan et al (1983), and Buchanan (1992) found no such association.…”

Section: Medication-related Factorsmentioning

confidence: 85%

“…An additional investigation reported greater noncompliance as measured with urine screens among inpatients with paranoid delusions (Wilson and Enoch 1967). In contrast, one investigation found no association between paranoid schizophrenia subtype and the expressed willingness to take medications (Soskis 1978), one study found no association between subtype and self-reported outpatient compliance (Hoffman et al 1974), and another study reported no association between paranoid ratings and missed depot appointments (Bartko et al 1988). In a study that may reconcile these discrepant findings, Van Putten et al (1976) found no association between compliance and paranoid schizophrenia subtype, but noted that 85 percent of paranoid schizophrenia patients with delusions of persecution or influence habitually complied with medications, whereas 92 percent of paranoid patients with grandiose delusions habitually refused medications.…”

Section: Illness Characteristicsmentioning

confidence: 98%

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Determinants of Medication Compliance in Schizophrenia: Empirical and Clinical Findings

Fenton

Blyler

Heinssen

1997

Schizophrenia Bulletin

848

520

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Advances in psychopharmacology have produced medications with substantial efficacy in the treatment of positive and negative symptoms of schizophrenia and the prevention of relapse or symptom exacerbation after an acute episode. In the clinical setting, the individual patient's acceptance or rejection of prescribed pharmacological regimens is often the single greatest determinant of these treatments' effectiveness. For this reason, an understanding of factors that impede and promote patient collaboration with prescribed acute and maintenance treatment should inform both pharmacological and psychosocial treatment planning. We review the substantive literature on medication adherence in schizophrenia and describe a modified health belief model within which empirical findings can be understood. In addition to factors intrinsic to schizophrenia psychopathology, medication-related factors, available social support, substance abuse comorbidity, and the quality of the therapeutic alliance each affect adherence and offer potential points of intervention to improve the likelihood of collaboration. Because noncompliance as a clinical problem is multidetermined, an individualized approach to assessment and treatment, which is often best developed in the context of an ongoing physician-patient relationship, is optimal. The differential diagnosis of noncompliance should lead to interventions that target specific causal factors thought to be operative in the individual patient.

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Section: Medication-related Factorsmentioning

confidence: 85%

Section: Illness Characteristicsmentioning

confidence: 98%

Determinants of Medication Compliance in Schizophrenia: Empirical and Clinical Findings

Fenton

Blyler

Heinssen

1997

Schizophrenia Bulletin

848

520

View full text Add to dashboard Cite

show abstract

“…There is a general notion that unwanted side effects have a negative influence on compliance (van Putten et al 1984; Marder and May 1986). There are reports that some patients discontinue prescribed neuroleptic medicines because of side effects such as sexual dysfunction, sedation, or extrapyramidal symptoms (Hoffmann et al 1974; del Campo et al 1983). In most studies with schizophrenia patients, however, no significant difference in frequency or intensity of side effects was found in general (Linden 1987) or specifically—for instance, akathisia (McEvoy et al 1984; Buchanan 1992; Fleischhacker et al 1994) or parkinsonism (McEvoy et al 1984; Buchanan 1992; Fleischhacker et al 1994).…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study of Factors Influencing Adherence to a Continuous Neuroleptic Treatment Program in Schizophrenia Patients During 2 Years

Lindén

Godemann

Gäebel

et al. 2001

Schizophrenia Bulletin

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Dropout from prophylactic neuroleptic treatment is one major reason for relapse in schizophrenia patients. There is a lack of prospective studies on factors that predict medication adherence. We investigated factors suspected to predict dropout from continuous neuroleptic treatment in a 2-year prospective study involving 122 outpatients with a DSM-III-R diagnosis of schizophrenia. Forty-two (34.4%) were classified as patient-related dropouts. No significant difference between compliant patients and dropouts was found with regard to sociodemographic variables, except that compliant patients were significantly older. Also, no differences in psychopathology were seen at the beginning of treatment, but compliant patients had a longer duration of illness. Compliant patients had higher doses of neuroleptics in the initial stabilization phase and correspondingly showed more extrapyramidal signs. Physicians rated compliant patients from the beginning as more cooperative. These patients also showed significantly higher scores in positive treatment expectations. In a stepwise regression analysis, positive illness concepts, the global assessment of functioning (GAF), and the physicians' view of patients' cooperation predicted 19 percent of the variance. We concluded that the prediction of dropouts is insufficient and remains largely an unsolved problem. Future research should focus more on context factors in the search for clinically meaningful explanations of patient dropout from treatment.

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“…Despite the overwhelming evidence that neuroleptic medication is effective in the acute treatment and prophylaxis of schizophrenia, many patients do not take their medication [6,12,13]. Several studies have shown that approximately one-third of patients are fully compliant, one-third partially compliant, and the final onethird entirely noncompliant [4,9,20].…”

Section: Introductionmentioning

confidence: 99%

Predictors of compliance with neuroleptic medication among inpatients with schizophrenia: a discriminant function analysis

Donohoe

Owens²,

O'Donnell³

et al. 2001

Eur. psychiatr.

100

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Medication Problems Confronted by the Schizophrenic Outpatient

Cited by 7 publications

References 9 publications

Determinants of Medication Compliance in Schizophrenia: Empirical and Clinical Findings

Determinants of Medication Compliance in Schizophrenia: Empirical and Clinical Findings

A Prospective Study of Factors Influencing Adherence to a Continuous Neuroleptic Treatment Program in Schizophrenia Patients During 2 Years

Predictors of compliance with neuroleptic medication among inpatients with schizophrenia: a discriminant function analysis

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