Risperidone Nonadherence and Return of Positive Symptoms in the Early Course of Schizophrenia

Abstract

Objective-This study examined the effect of medication nonadherence on the return of positive symptoms among recent-onset schizophrenia patients.Method-Three sets of operational criteria for medication nonadherence with differing levels of severity were compared for their ability to predict relapse. Explicit operational criteria are provided with the hope that they will be adopted by others. Psychotic symptoms were prospectively rated on a frequent basis, and systematic criteria were applied using a computer scoring program to identify periods of psychotic symptom return. In addition, a specialized statistical survival analysis method, optimal for examining risk periods and outcomes that can recur during the follow-up assessment, was used.Results-As hypothesized, medication nonadherence robustly predicted a return of psychotic symptoms during the early phase of schizophrenia (hazard ratios=3.7-28.5, depending on the severity of nonadherence). Conclusions-Even brief periods of partial nonadherence lead to greater risk of relapse thanwhat is commonly assumed. Patients in the early phase of schizophrenia should be cautioned about the possible consequences of partial or relatively brief periods of antipsychotic medication nonadherence.Nonadherence to antipsychotic medication is quite common among schizophrenia patients and is the greatest obstacle to recovery and relapse prevention. This issue is heightened among individuals with a recent onset of schizophrenia who are just beginning to come to terms with having a psychiatric disorder and have not been in treatment long enough to recognize the necessity of adhering to their medication regimen (1). Approximately 50% of patients discontinue antipsychotic medication or have significant nonadherence to their Address correspondence and reprint requests to Dr. Subotnik, University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, 300 UCLA Medical Plaza, Rm. 2240, Los Angeles, CA 90095-6968; ksubotnik@mednet.ucla.edu. HHS Public AccessAuthor manuscript Am J Psychiatry. Author manuscript; available in PMC 2016 October 19. Published in final edited form as: Am J Psychiatry. 2011 March ; 168(3): 286-292. doi:10.1176/appi.ajp.2010.09010087. Author Manuscript Author Manuscript Author ManuscriptAuthor Manuscript medication regimen within 1 year of beginning treatment, with rates rising to 75% within 2 years (2). Some evidence indicates that nonadherence is greater in the early course of the disorder (3). The clinical implications of nonadherence among first-episode patients are dramatic. Morken et al. (4) demonstrated an odds ratio of 10.3 for psychotic relapse among nonadherent first-episode patients. In another study of first-episode schizophrenia patients, those who discontinued their medication had an almost fivefold increase in the risk for a first and second relapse (5). Üçok et al. (6) demonstrated that first-episode schizophrenia patients who experienced a psychotic relapse h...

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