Strategies for Improving Treatment Adherence in Schizophrenia and Schizoaffective Disorder

Article · Literature Review · December 2010with419 Reads
DOI: 10.4088/JCP.9096su1cc.04 · Source: PubMed
Abstract
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.
    • Perhaps, a shift in GP attitudes from a perception that patients lack insight into their mental illness to recognition that there may be more suitable treatment options that meet an individual's needs could be more useful for suicide prevention as power relations associated with medical discourses are apparent in these accounts with the use of labels such as ''lacking insight''. Our findings were consistent with previous studies with respect to the prevalence of alcohol and drug dependency, distressing side effects, chaotic lifestyles, comorbid disorders, and dual diagnosis in patients who were non-adherent to treatment (Goff et al., 2010;Gold 2009;Hawton et al., 2005;Higashi et al., 2013;Hunt et al., 2016;Novick et al., 2010;Tacchi & Scott, 2005). Patients with dual diagnosis can be more difficult to engage within services and this can be due to not wanting to take medication alongside drug or alcohol use (Higashi et al., 2013).
    [Show abstract] [Hide abstract] ABSTRACT: Background: Individuals who do not adhere to their treatment regimens may be at greater risk of suicide but these issues are relatively unexplored in primary care services. Aim: To explore GPs' views and perspectives on the reasons why patients who were in contact with mental health services in the year prior to suicide was non-adherent to treatment prior to their death. Method: In total, 198 semi-structured face-to-face interviews with GPs of people who had died by suicide. Interviews were transcribed verbatim and analyzed using a thematic approach. Results: The following themes were conceptualized from GP interviews: (i) "Lack of insight or denial?" relates to what GPs perceived as their patients lack of insight into their psychiatric illness; (ii) "Lack of treatment choices" discusses GPs' understanding of patient treatment choices; (iii) "Services for comorbidity and dual diagnosis" refers to treatment availability for suicidal patients with two or more mental health diagnoses. Conclusions: For suicide prevention, it is crucial for health professionals to assess patients and manage the possible causes of non-adherence. Policies for increasing treatment adherence, improving services for dual diagnosis, or providing alternative treatments to meet individual patient needs may help to achieve the best health outcomes and could potentially prevent suicide.
    Article · Apr 2017
    • Positive attitude towards medications is related to better treatment outcomes (Baloush-Kleinman et al., 2011; Lincoln et al., 2007; Perkins et al., 2006 ). Negative attitude is commonly associated with non-adherence to treatment (Buckley et al., 2007), increasing the risk of relapse and hospitalization, violence and suicide (Goff et al., 2010; Law et al., 2008). Gender differences exist in schizophrenia in terms of clinical presentations, course and outcome, treatment response and adherence rate (Cotton et al., 2009; Koster et al., 2008; Leung and Chue, 2000; Nasser et al., 2002; Ran et al., 2015).
    [Show abstract] [Hide abstract] ABSTRACT: Non-adherence was more frequent in male than in female psychiatric patients. This multi-center study in China examined the gender difference with regard to attitude towards antipsychotic medications and its associations with socio-demographic variables, insight, and psychopathology. Patients’ basic socio-demographic and clinical data were collected. Psychopathology and insight were measured with the Symptom Checklist-90 (SCL-90) and the Insight and Treatment Attitudes Questionnaire (ITAQ), respectively. Their attitudes towards antipsychotic medications were assessed by two standardized questions. Nearly 40% (109/275) males and 31.1% (70/225) females reported negative attitudes towards antipsychotic medications. Binary logistic regression revealed that in males single marital status (OR=2.9, 95% CI=1.3-6.4), rural residence (OR=0.4, 95% CI=0.2-0.7), longer duration of schizophrenia (OR=1.0, 95% CI=1.01-1.1), knowledge of medication (OR=1.5, 95% CI=1.3-1.6) and the SCL-90 hostility subscale (OR=0.9, 95% CI=0.9-1.0) were contributors to negative attitudes. In female patients, knowledge about medications (OR=1.4, 95% CI=1.3-1.6), the SCL-90 somatization (OR=0.8, 95% CI=0.8-0.9) and anxiety (OR=1.1, 95% CI=1.0-1.2) subscales were contributors to negative attitudes. The study suggested that different psychosocial and clinical factors accounted for the negative attitude towards antipsychotic treatment in male and female patients.
    Article · Aug 2016
    • Finally, practitioners may need specialised education to correctly identify some side effects such as akathisia and dyskinesia (Chouinard & Margolese, 2005; Wolters, Knegtering, van den Bosch, & Wiersma, 2009). The difficulties involved in the identification of antipsychotic medication side effects highlight the need for assessment tools that either provide health professionals with the means to correctly discern the nature, frequency, and impact of side effects, or enable mental health consumers to report the occurrence of side effects (Dott et al., 2001; Goff, Hill, & Freudenreich, 2010; Hellewell, 1999; Stomski, Morrison, & Meyer, 2015). The use of these tools results in material that facilitates a clearer understanding of the issues mental health consumers experience when taking antipsychotic medication.
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Mental health nurses play a central role in delivering health care to people with severe mental health problems. Since antipsychotic medication remains the principal treatment for severe mental health conditions, an integral element of this role involves monitoring the effectiveness of medication and resultant side effects. The objective of this study was to examine nurses’ perceptions of the assessment of antipsychotic medication side effects. Methods: A questionnaire was developed and then disseminated to members of the Australian College of Mental Health Nurses. Quantitative data were analysed using Smallest Space Analysis (SSA). Qualitative data were grouped into themes and used to further delineate the regions identified through the SSA. Results: Questionnaires were returned by 152 respondents, of which 140 were included in the analysis. The SSA identified the following four regions: personal confidence in assessing side effects; system responsibilities and practices for assessing ...
    Article · Mar 2016
    • The uptake of the open-ended questions demonstrates the significance of using a qualitative approach to gain a greater insight of the patient's individual experience (Gray et al., 2005; Perkins, 2002). It is reported that anywhere from 40-90% of patients taking psychotropic medications will discontinue their medications primarily due to the side effects (Goff et al., 2010; Llorca, 2008; Lambert et al., 2004; Sajatovic et al., 2010). In our study over half the patients (53%) reported that they had thought of stopping their medication, with the majority of them actually stopping at some point.
    [Show abstract] [Hide abstract] ABSTRACT: The primary aim was to assess usability of the My Medicines and Me Questionnaire (M3Q) as a self-reported questionnaire for mental health patients to subjectively express side effects experienced with their psychotropic medications. The secondary aim was to evaluate patients' attitudes towards treatment and psychotropic medications following dialogue with their clinicians about side effects. Questionnaires were administered at six adult mental health facilities. A total of 205 participants were divided into intervention (facilitated dialogue) and non-intervention groups (no facilitated dialogue). The mean completion time for the M3Q was 15min (SD=6.5) with only 11 (5%) patients requiring assistance. The most commonly reported side effect was sedation (77%) and weight gain was ranked as the most bothersome (23%). The previously validated M3Q provided patients with the opportunity to express the impact these effects had on their lives. Side effects were the most common reason given for non-adherence. There were no significant changes in patient attitudes towards treatment and medications in the intervention group, mainly due to the logistical challenges in the clinicians' ability to view the questionnaire for the subsequent meeting with the patient. The M3Q demonstrated its usability in allowing patients to easily express their subjective experiences with side effects.
    Article · Oct 2015
    • These issues with the identification of antipsychotic medication side effects and how these may be managed constructively could be addressed through methods that facilitate effective communication between mental health consumers and clinicians. This underlines the need for assessment tools that either enable clinicians to readily ascertain the nature, frequency and impact of side effects or allow mental health consumers to detail the side effects they experience (Cabeza et al., 2000; Dott et al., 2001; Goff et al., 2010; Hellewell, 1999). Information from such tools can provide clinicians with a better understanding of the real and potential issues mental health consumers encounter when taking antipsychotic medication, and thereby facilitate discussions with consumers about strategies to ameliorate side effects and improve medication adherence.
    [Show abstract] [Hide abstract] ABSTRACT: Objective: The aim of this systematic review was to critically appraise the psychometric properties of antipsychotic medication side effect assessment tools. Methods: Systematic searches were undertaken in PubMed, CINAHL and CENTRAL from inception to October 2014. Studies were included if they detailed the evaluation of psychometric properties of antipsychotic medication side effect assessment tools in mental health populations. Studies were excluded if they examined the use of antipsychotic medication side effect assessment tools in non-mental health populations, including people suffering from dementia, Parkinsonism and Alzheimer's. Narrative reviews and studies published in any language other than English were also excluded. Results: Content validity was appropriately established for only one of the tools, reliability was inappropriately evaluated for all but one tool, and the assessment of responsiveness was not acceptable for any tool. Conclusion: Further psychometric studies are warranted to consolidate the psychometric properties of the included antipsychotic medication side effect assessment tools before any of these tools can be confidently recommended for either research or clinical purposes.
    Full-text · Article · Oct 2015
    • Another study found that the drug attitude of the patient was a predictor of adherence (Brain et al., 2013 ), but the association between stigma and adherence has not previously been formally assessed using quantitative methods. 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).
    [Show abstract] [Hide abstract] ABSTRACT: The aim was to apply a structured questionnaire, the Inventory of Stigmatizing Experiences (ISE), to study experiences of stigma (associated stigma) among relatives of persons with schizophrenia who attended outpatient clinics, using an approach based on assertive community treatment in a Swedish major city. A second aim was to explore the relationship between associated stigma and overall burden among these relatives. Relatives (N=65) of persons taking oral antipsychotics who attended outpatient clinics completed a mailed questionnaire that included the ISE and the Burden Inventory for Relatives of Persons with Psychotic Disturbances. Associations were analyzed with ordinal logistic regression. More than half of the relatives (53%) stated that their ill relative had been stigmatized, but only 18% (N=11) reported that they themselves had been stigmatized (responses of sometimes, often, or always). One-fifth of the relatives (23%) acknowledged that they avoided situations that might elicit stigma. Neither experienced stigma nor anticipated stigma was associated with overall burden level in ordinal logistic regression models. The impact of stigma on both the relative's personal quality of life and the family's quality of life were both significantly associated with overall burden after adjustment for patient age and level of functioning. Stigma had an impact on quality of life at the personal and family levels, and this was associated with overall burden. Increased awareness among service providers may decrease the impact of stigma on relatives, but associations need to be examined in larger studies in diverse cultures and treatment settings.
    Full-text · Article · Jun 2015
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June 2014 · The Journal of Clinical Psychiatry · Impact Factor: 5.50
    Compliance is a critical issue across all chronic conditions, including schizophrenia. Compliance is not an all-or-nothing phenomenon, with a continuum from taking all medications as prescribed to partial compliance to complete noncompliance. Partial compliance is a serious problem that may result in abrupt dose changes leading to unanticipated adverse effects and can demoralize the patient.... [Show full abstract]
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      This review examines the use of antipsychotic medication during the early years of psychosis. A selective literature review was conducted. The early years of schizophrenia represent a critical period for intervention. Importantly, first-episode patients differ from those with chronic schizophrenia in several important respects. While treatment response to antipsychotic medication is better,... [Show full abstract]
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