Treatment adherence among patients with schizophrenia treated with atypical and typical antipsychotics
Case Western Reserve University, Cleveland, Ohio, United States Psychiatry Research
(Impact Factor: 2.47).
12/2006; 144(2-3):177-89. DOI: 10.1016/j.psychres.2006.02.006
This study evaluated treatment adherence among patients with schizophrenia receiving atypical and typical antipsychotics. Claims data for 7017 treatment episodes of commercially insured patients with schizophrenia (ICD-9-CM) receiving antipsychotics, covering the period from January 1999 through August 2003, were assessed. Overall adherence was evaluated by adherence intensity (medication possession ratio) and treatment duration (length of treatment episode). Pair-wise comparisons of the individual atypicals and a combined group of leading typical antipsychotics were undertaken using multiple regression, adjusting for differing patient characteristics. Each atypical antipsychotic demonstrated a significantly higher adherence intensity than the combined typicals, while quetiapine demonstrated a significantly greater adherence intensity than risperidone and olanzapine. None of the atypicals showed treatment durations significantly different from the typicals. While the small improvements in adherence intensity among atypical agents do not appear to be clinically important, they may reflect an underlying, stronger tendency to use filled prescriptions.
- "In a retrospective claims database analysis (N=5,683), the use of any of four atypical antipsychotics included in the study was associated with significantly higher patient-adjusted medication-possession ratios compared with the use of typical antipsychotics (P≤0.049).19 However, there was no significant difference between typical and atypical antipsychotics with respect to treatment duration.19 In a study of 150 parolees on antipsychotic medication, patients prescribed an atypical antipsychotic were four times more likely to be adherent than those prescribed a typical antipsychotic.5 "
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In patients with schizophrenia, nonadherence to prescribed medications increases the risk of patient relapse and hospitalization, key contributors to the costs associated with treatment. The objectives of this review were to evaluate the impact of nonadherence to pharmacotherapy in patients with schizophrenia as it relates to health care professionals, particularly social workers, and to identify effective team approaches to supporting patients based on studies assessing implementation of assertive community treatment teams.
Materials and methods
A systematic review of the medical literature was conducted by searching the Scopus database to identify articles associated with treatment adherence in patients with schizophrenia. Articles included were published from January 1, 2003, through July 15, 2013, were written in English, and reported findings concerning any and all aspects of nonadherence to prescribed treatment in patients with schizophrenia.
Of 92 unique articles identified and formally screened, 47 met the inclusion criteria for the systematic review. The burden of nonadherence in schizophrenia is significant. Factors with the potential to affect adherence include antipsychotic drug class and formulation, patient-specific factors, and family/social support system. There is inconclusive evidence suggesting superior adherence with an atypical versus typical antipsychotic or with a long-acting injectable versus an oral formulation. Patient-specific factors that contribute to adherence include awareness/denial of illness, cognitive issues, stigma associated with taking medication, substance abuse, access to health care, employment/poverty, and insurance status. Lack of social or family support may adversely affect adherence, necessitating the assistance of health care professionals, such as social workers. Evidence supports the concept that an enhanced team-oriented approach to managing patients with schizophrenia improves adherence and supports corresponding reductions in relapse rates, inpatient admissions, and associated costs.
Optimization of medication and involvement of caregivers are important to promoting adherence. A multidisciplinary team approach may be invaluable in identifying barriers to adherence and helping schizophrenia patients overcome them.
Available from: Michele Fornaro
- "Also, since patients are more likely to stick with the treatment of MDE if they perceive their response to the treatment early (Papakostas et al., 2008), SGA response may be perceived as more rapid (whenever occurring), especially by most impulsive (TA À ) cases of acute BD-II depression . Yet it must be highlighted that the inclusion of high rates of sub-threshold mixed cases of BD-II in our sample may have itself concurred to a higher response rate to SGA (Gianfrancesco et al., 2006Gianfrancesco et al., , 2008 Sajatovic et al., 2006). "
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ABSTRACT: Treatment adherence (TA) is crucial during almost any phase of bipolar disorder (BD), including type-II (BD-II) acute depression. While a number of issues have been traditionally accounted on the matter, additional factors should be likewise involved, including affective temperaments and some clinically suggestive psychopathological traits whose systematic assessment represents the aim of this study.
Two hundred and twenty BD-II acute depressed outpatients were consecutively evaluated using the Structured Clinical Interviews for Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition Axis-I and II Disorders, Hamilton scales for Depression and Anxiety, Temperament Evaluation of the Memphis Pisa Paris San Diego-Auto-questionnaire-110-item, Visual Analogue Scale (VAS), Zuckerman's Sensation-Seeking Scale-Form-V (SSS-V), Barratt's Impulsivity Scale-11-item, State-Trait Anxiety Inventory modules, Severity module of the Clinical Global Impression Scale for BD, Morisky 8-Item Medication Adherence Scale (MMAS-8) and the Clinician Rating Scale (CRS). Patients were divided into non-adherent vs. treatment-adherent cases depending on MMAS-8+CRS scores.
In the TA(-) group, higher VAS and cyclothymic temperament scores were highly correlated (r=.699; p≤.001). Those latter scores, along with SSS-V scores and the occurrence of lifetime addiction to painkiller and/or homeopathic medications available over the counter defined a "therapeutic sensation seeking" pattern allowing to correctly classify as much as 93.9% [Exp(B)=3.490; p≤.001] of TA(-) cases (49/220).
Lack of objective TA measures and systematic pharmacological record; recall bias on some diagnoses; and relatively small sample size.
Stating the burden of TA in BD, additional studies on this regard are aimed, ideally contributing to enhance the management of BD itself.
Available from: Daniel Bressington
- "Some previous studies have reported modestly-increased rates of adherence with atypical antipsychotic medication (i.e. Dolder et al. 2002; Gianfrancesco et al. 2006; Lang et al. 2010; Perkins 2002; Voruganti et al. 2000), while other studies have opposing findings (Valenstein et al. 2004). It is surprising to note that only 28% of participants in this study were prescribed atypical antipsychotics, which is very low in comparison to the 2006–2007 rates of 67% reported by NICE (2008) in the UK. "
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ABSTRACT: The purpose of the present study was to examine the factors affecting adherence to antipsychotic medication in patients with schizophrenia registered with a community psychiatric nursing service in Hong Kong. The study was a cross-sectional observational survey; symptoms, drug attitudes, insight, side-effects, and sociodemographic characteristics were measured and explored in terms of their relationship with medication adherence. A total of 584 patients who were visited by community psychiatric nurses (CPN) participated, and 30% of these patients were non-adherent with their antipsychotic medication. Positive treatment attitudes, awareness of the need for treatment, being prescribed clozapine, receiving state benefits, lower levels of symptoms, and fewer side-effects were associated with adherence. The findings from this study suggest that the clinical efforts of CPN to improve adherence should aim to help patients amplify the personal relevance of treatment and modify patients' attitudes towards medication.
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