Predicting Medication Noncompliance After Hospital Discharge Among Patients With Schizophrenia

Olfson, Mark; Mechanic, David; Hansell, Stephen; Boyer, Carol A.; Walkup, James; Weiden, Peter J.

doi:10.1176/appi.ps.51.2.216

Cited by 361 publications

(268 citation statements)

References 34 publications

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“…The effect of social support on adherence has been demonstrated in studies involving both chronic schizophrenia 1,36 and FEP. 12 Although our study did not examine symptomatic and functional outcomes, it has been demonstrated that in FEP, family and social support in itself is a strong predictor of the level of positive symptoms and rehospitalization over several years following treatment of FEP, independent of age of onset, sex, and premorbid adjustment.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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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).

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Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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“…One study found that neuroticism and neurocognitive impairment both predicted the use of avoidant strategies, while extroversion predicted a higher likelihood of seeking social support (Lysaker et al, 2004). A body of research has also found support for a relationship between substance abuse and poor medication adherence (a form of coping) among persons with schizophrenia (Hunt, Bergen, & Bashir, 2002;Kamali et al, 2001;Olfson et al, 2000).…”

Section: The Personal System and Copingmentioning

confidence: 99%

Determinants of functioning and well-being among individuals with schizophrenia: An integrated model

Yanos

Moos

2007

Clinical Psychology Review

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Outcomes for health conditions are typically the result of multiple factors; however, studies tend to focus on a narrow class of variables. Functioning and well-being outcomes for schizophrenia are diverse and have resisted simple explanation; however, prior research has not offered an integrated understanding of the relative contributions of enduring and episodic environmental factors, personal resources and psychiatric factors, and cognitive appraisal and coping, on functioning and well-being outcomes in schizophrenia. The present article sets out an integrated model of the determinants of functioning and well-being among individuals with schizophrenia. To examine evidence that bears on the model, literature on hypothesized relationships is reviewed to identify areas for which there is strong evidence and areas where more research is needed. The article suggests areas for further research, and directs researchers and practitioners toward areas of intervention that can enhance functioning and well-being for persons diagnosed with schizophrenia.

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“…Persons who have both a mental illness and a substance use disorder appear to have the highest risk of poor adherence; studies have usually shown a strong association between substance use and nonadherence (2)(3)(4)(5)(6)(7)(8), although some studies have shown no relationship (9,10).…”

mentioning

confidence: 99%

Adherence to Medication Regimens and Participation in Dual-Focus Self-Help Groups

Magura¹,

Laudet²,

Mahmood³

et al. 2002

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Objective-The authors examined the associations between attendance at self-help meetings, adherence to psychiatric medication regimens, and mental health outcomes among members of a 12-step self-help organization specifically designed for persons with both chronic mental illness and a substance use disorder.Methods-A sample of members of Double Trouble in Recovery (DTR) was interviewed at baseline and one year later. Correlates of adherence to psychiatric medication regimens at the followup interview were identified for 240 attendees who had received a prescription for a psychiatric medication.Results-Consistent attendance at DTR meetings was associated with better adherence to medication regimens after baseline variables that were independently associated with adherence were controlled for. Three baseline variables were associated with adherence: living in supported housing, having fewer stressful life events, and having a lower severity of psychiatric symptoms. In addition, better adherence was associated with a lower severity of symptoms at one year and no psychiatric hospitalization during the follow-up period.Conclusions-Treatment programs and clinicians should encourage patients who have both mental illness and a substance use disorder to participate in dual-focus self-help groups that encourage the responsible use of effective psychiatric medication, particularly after discharge to community living. Clinicians also should be sensitive to stressful life events and discuss with patients how such events might affect their motivation or ability to continue taking medication.Poor adherence to psychiatric medication regimens is a major obstacle to the effective care of persons who have chronic mental illness. A recent review reported that patients who were receiving antipsychotics or antidepressants took an average of 58 percent and 65 percent,

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Predicting Medication Noncompliance After Hospital Discharge Among Patients With Schizophrenia

Cited by 361 publications

References 34 publications

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

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

Determinants of functioning and well-being among individuals with schizophrenia: An integrated model

Adherence to Medication Regimens and Participation in Dual-Focus Self-Help Groups

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