Strategies for Improving Treatment Adherence in Schizophrenia and Schizoaffective Disorder

Harvard University, Cambridge, Massachusetts, United States
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 12/2010; 71 Suppl 2(Suppl 2):20-6. DOI: 10.4088/JCP.9096su1cc.04
Source: PubMed


Nonadherence with medication treatment is common but difficult to detect in patients with schizoaffective disorder and schizophrenia, almost half of whom take less than 70% of prescribed doses. Like patients in all areas of medicine, patients with schizoaffective disorder weigh the perceived benefits of medications against perceived disadvantages, but this process is complicated by their impaired insight, the stigma of the diagnosis, and the often troubling side effects of antipsychotic medication. Interventions to improve adherence include encouraging acceptance of the illness, drawing analogies with treatment for chronic medical disease, and involving the patient in decision making. Clinicians must remain nonjudgmental, encouraging patients to disclose problems with adherence and anticipating that improvement in adherence may require a prolonged effort. Selection of antipsychotic medication is critical to avoid adverse side effects, and some medications may provide a sense of well-being, such as improvement in insomnia, anxiety, or depression. Depot (rather than oral) antipsychotics can improve adherence and provide the clinician with reliable information about the dosage of medication received, which can be used for purposes of dose adjustments or to guide response to relapse.

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    • "Fear of stigma connected to the diagnosis and being prescribed antipsychotics and fear of rejection due to revealing psychotic symptoms have been suggested to further increase non-adherence to both psychiatric and physical treatment (Freudenreich et al., 2004; Goff et al., 2010; Thornicroft, 2008). In a qualitative study patients reported that the stigma of taking antipsychotics caused them to hide their medication from others and to take it only in privacy (Jenkins and Carpenter-Song, 2009). "
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    ABSTRACT: The aims of this naturalistic non-interventional study were to quantify the level of stigma and discrimination in persons with schizophrenia and to test for potential associations between different types of stigma and adherence to antipsychotics. Antipsychotic medication use was electronically monitored with a Medication Event Monitoring System (MEMS(®)) for 12 months in 111 outpatients with schizophrenia and schizophrenia-like psychosis (DSM-IV). Stigma was assessed at endpoint using the Discrimination and Stigma Scale (DISC). Single DISC items that were most frequently reported included social relationships in making/keeping friends (71%) and in the neighborhood (69%). About half of the patients experienced discrimination by their families, in intimate relationships, regarding employment and by mental health staff. Most patients (88%) wanted to conceal their mental health problems from others; 70% stated that anticipated discrimination resulted in avoidance of close personal relationships. Non-adherence (MEMS(®) adherence≤0.80) was observed in 30 (27.3%). When DISC subscale scores (SD) were entered in separate regression models, neither experienced nor anticipated stigma was associated with adherence. Our data do not support an association between stigma and non-adherence. Further studies in other settings are needed as experiences of stigma and levels of adherence and their potential associations might vary by a healthcare system or cultural and sociodemographic contexts. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research 10/2014; 220(3):811-817. DOI:10.1016/j.psychres.2014.10.016 · 2.47 Impact Factor
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    • "). Psychiatrists have recognized this problem and there is an urgent need in clinical practice for an effective communication tool for patients to describe their subjective beliefs about the side effects of medications and their likelihood to alter or discontinue treatment (Cabeza et al., 2000; Dott et al., 2001; Dassori et al., 2003; Goff et al., 2010). "
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    ABSTRACT: Side effects of psychotropic medications are important determinants of adherence to treatment. Discussion between the patient and clinician facilitated through the use of a side effect self-report questionnaire (SRQ) could lead to improved communications and treatment adherence. The aim of this review was to 1) identify all currently available side effect SRQs used in the assessment of mental health patients׳ subjective experiences, 2) evaluate the characteristics of the studies and 3) assess the psychometric properties of each of the questionnaires. Eight electronic databases were searched for peer-reviewed published articles. Six side effect SRQs were identified. Two independent reviewers assessed the quality of the study designs and psychometric properties of the identified SRQs. All questionnaires consisted of closed questions relating to antipsychotic side effects and completion times ranged from 5 to 20min. Five questionnaires had undergone some form of psychometric testing, ranging from basic to comprehensive. There is a need in everyday clinical practice for a side effect communication tool applicable to all psychotropic medications, which allows the patient to express their subjective beliefs about their medications. This could provide an important contribution to the working relationship between patients and clinicians leading to informed decision-making and improved adherence.
    Psychiatry Research 06/2014; 219(3). DOI:10.1016/j.psychres.2014.05.060 · 2.47 Impact Factor
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    • "However, as treatment switch was accompanied by increased compliance in the majority of the study population, it can be postulated that patients switched to another antipsychotic due to efficacy reasons did not experience major side effects - i.e., extrapyramidal symptoms, weight gain, or metabolic disorders - or withdrawal symptoms, at least not to the extent that the possible side effects might have interfered with the patients' adherence to treatment. At the same time, patients that were switched due to tolerability reasons showed increased efficacy, a fact that may underline what has been previously suggested, i.e., reducing side effects improves tolerability and therefore may improve compliance, which in turn may be translated into enhanced efficacy [12,16]. "
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    ABSTRACT: Patients under antipsychotic treatment for schizophrenia commonly exhibit poor adherence to treatment, high rates of treatment discontinuation, and frequent treatment changes. The ETOS study aimed to identify the reasons leading physicians to decide to switch antipsychotic treatment in outpatients with schizophrenia and to evaluate the outcome of this switch. ETOS was an observational 18-week (four visits) study in outpatients 18 to 65 years old, diagnosed with schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders - 4th edition criteria at least 6 months prior to enrolment, who were initiated on a new antipsychotic monotherapy treatment within the 2 weeks prior to enrollment. A total of 574 patients were recruited by 87 hospital- and office-based physicians. Ethical approval was obtained prior to study initiation (NCT00999895). The final analysis included 568 patients, 39.0 +/- 11.2 years old with mean disease duration of 11.7 years. The male-to-female ratio was 53:47. The main reason for switching antipsychotic treatment was lack of tolerability (n = 369, 65.0%), followed by lack of efficacy (n = 249, 43.8%). Following treatment switch, 87.9% of patients (n = 499) showed meaningful clinical benefit by achieving a Clinical Global Impression-Clinical Benefit score of <=4 at the final visit. By the end of the study, total Positive and Negative Syndrome Scale, Clinical Global Impression-Improvement, Clinical Global Impression-Severity, and Simpson-Angus Scale scores demonstrated significant mean decreases of 31.69, 0.70, 1.14, and 11.30, respectively (all p < 0.0001). Treatment adherence remarkably improved. In the ETOS study, switch of antipsychotic monotherapy for reasons relating to lack of efficacy and/or tolerability was associated with significantly improved clinical benefit and significant increase of patients' adherence to treatment.
    Annals of General Psychiatry 12/2013; 12(1):42. DOI:10.1186/1744-859X-12-42 · 1.40 Impact Factor
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