Predictive Factors of Treatment Resistance in First Episode of Psychosis: A Systematic Review

Bozzatello, Paola; Bellino, Silvio; Rocca, Paola

doi:10.3389/fpsyt.2019.00067

Cited by 80 publications

(57 citation statements)

References 106 publications

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“…Other reports have documented the close association between poor adherence and poor outcomes, including relapse, leading to hospital admission and treatment-resistant illness. 32,33 The findings from this sample suggest that most poorly adherent patients experience barriers to adherence in multiple domains, and it seems likely that care approaches will need to target patient attitudes/beliefs about medication, communication with providers to address treatment expectations and discussions regarding side-effects, and managing medication in the context of lifestyle and routines.…”

Section: Discussionmentioning

confidence: 99%

Correlates of poor medication adherence in chronic psychotic disorders

et al. 2020

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Background Chronic psychotic disorders (CPDs) occur worldwide and cause significant burden. Poor medication adherence is pervasive, but has not been well studied in sub-Saharan Africa. Aims This cross-sectional survey of 100 poorly adherent Tanzanian patients with CPD characterised clinical features associated with poor adherence. Method Descriptive statistics characterised demographic and clinical variables, including barriers to adherence, adherence behaviours and attitudes, and psychiatric symptoms. Measures included the Tablets Routine Questionnaire, Drug Attitudes Inventory, the Brief Psychiatric Rating Scale, the Clinical Global Impressions scale, the Alcohol Use Disorders Identification Test and Alcohol, Smoking and Substance Involvement Screening Test. The relationship between adherence and other clinical variables was evaluated. Results Mean age was 35.7 years (s.d. 8.8), 61% were male and 80% had schizophrenia, with a mean age at onset of 22.4 (s.d. 7.6) years. Mean proportion of missed CPD medication was 64%. One in ten had alcohol dependence. Most individuals had multiple adherence barriers. Most clinical variables were not significantly associated with the Tablets Routine Questionnaire; however, in-patients with CPD were more likely to have worse adherence (P ≤ 0.01), as were individuals with worse medication attitudes (Drug Attitudes Inventory, P < 0.01), higher CPD symptom severity levels (Brief Psychiatric Rating Scale, P < 0.001) and higher-risk use of alcohol (Alcohol Use Disorders Identification Test, P < 0.001). Conclusions Poorly adherent patients had multiple barriers to adherence, including poor attitudes toward medication and treatment, high illness acuity and substance use comorbidity. Treatments need to address adherence barriers, and consider family supports and challenges from an intergenerational perspective.

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Section: Discussionmentioning

confidence: 99%

Correlates of poor medication adherence in chronic psychotic disorders

et al. 2020

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“…They may have treatment-resistant psychosis or have experienced adverse events with prior treatments, or for other reasons, were resistant to discussing compliance. 26 , 34 , 35 With a relatively short study period, understanding the course of disease for each patient is limited. However, most patients had baseline BH-related claims for ambulatory care, and nearly half for ED or inpatient care.…”

Section: Discussionmentioning

confidence: 99%

Treatment Compliance Communications Between Patients with Severe Mental Illness and Treating Healthcare Providers: A Retrospective Study of Documentation Using Healthcare Reimbursement Claims and Medical Chart Abstraction

Martin¹,

Koep²,

White³

et al. 2021

POR

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Introduction Successful treatment for serious mental illnesses (SMIs) requires a good therapeutic alliance with healthcare providers and compliance with prescribed therapies such as antipsychotic medications. This retrospective study, which utilized administrative claims linked with abstracted medical chart data, addressed a data gap regarding compliance-related discussions between providers and patients. Methods Commercially insured patients in ambulatory care post-acute (emergency or inpatient) event were eligible. Criteria included age 18–65 years; schizophrenia, bipolar disorder, or major depressive disorder diagnoses; continuous enrollment 6 months before to 12 months after the first acute event claim dated 01/01/2014 to 12/31/2015; and antipsychotic medication prescription. Demographic and clinical data, and patient–provider discussions about treatment compliance were characterized from claims and abstracted medical charts. Results Ninety patients (62% female, mean age 41 years) were included and 680 visits were abstracted; only 58% had first-visit antipsychotic compliance discussions. Notably, 18% of patients had discussions using the specific terms “compliance,” “persistence,” or “adherence,” whereas half were identified by more general terms. Compliance discussions were observed least often among the patients with schizophrenia, as compared with bipolar or major depressive disorders—a counterintuitive finding. Discussion Compliance discussions may represent intervention opportunities to optimize treatment, yet their study is a complex endeavor. The results of this study show an opportunity to improve this valuable treatment step.

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“…The social, clinical, and neurocognitive characteristics have also been examined in detail [10, 11], especially to explore the factors predictive of treatment resistance during FEPs, including negative symptoms, comorbid substance use, and “lower premorbid functioning” [12].…”

Section: Introductionmentioning

confidence: 99%

The Lived Experience of First-Episode Psychosis: A Systematic Review and Metasynthesis of Qualitative Studies

et al. 2020

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Both research and care have focused on first episodes of psychosis (FEPs) as a way to address the issue of early stages of schizophrenia and to reduce the duration of untreated psychosis. The objective of this study was to explore specifically the lived experience of FEP from the point of view of patients and their families by applying a metasynthetic approach, including a systematic review of the literature and analyses of qualitative studies on the subject. This metasynthesis follows thematic synthesis procedures. Four databases were systematically searched for qualitative studies reporting FEP from the patient or family’s perspective. Article quality was assessed with the Critical Appraisal Skills Program. Thematic analysis was used to identify key themes and synthesize them. Thirty-eight articles were included, covering data from 554 participants (378 patients and 176 relatives). Three themes emerged from the analyses: (1) When and how does a FEP start? (2) What are its negative and positive aspects? (3) How do patients and families recount FEPs? Our results found important discrepancies between the experiences of patients and those of their families, especially regarding positive aspects. In light of the confusion reported by patients and notable in our results, we also discuss the gap between the name, FEP, and the lived experience of patients and family members in order to explore its practical implications.

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Predictive Factors of Treatment Resistance in First Episode of Psychosis: A Systematic Review

Cited by 80 publications

References 106 publications

Correlates of poor medication adherence in chronic psychotic disorders

Correlates of poor medication adherence in chronic psychotic disorders

Treatment Compliance Communications Between Patients with Severe Mental Illness and Treating Healthcare Providers: A Retrospective Study of Documentation Using Healthcare Reimbursement Claims and Medical Chart Abstraction

The Lived Experience of First-Episode Psychosis: A Systematic Review and Metasynthesis of Qualitative Studies

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