Table 1.
Reasons for nonadherence to antipsychotic medication in patients with SMI: summary of methods used in prospective studies
| References | Reason(s) | Design/patients | Measurement
|
|
|---|---|---|---|---|
| Adherence | Reasons | |||
| Novick et al19 | • Insight • Therapeutic alliance |
• Post hoc analysis, 1-year observational study, France, Germany, Greece • SZ (n=612) and BPD (n=291), consecutive outpatients |
MARS | Functioning: GAF; insight: SUMD (first 3 items); symptom severity: CGI-SCH or CGI-BP; therapeutic alliance: physician-reported scale, WAI |
| Brain et al20 | • Attitude toward medication • Insight |
• 1 year, Sweden • SZ or SZ-like psychosis as part of the COAST study (N=112) |
Electronic monitoring with a MEMS | Attitude toward medication: DAI-10; functioning: GAF and PSP; insight: 1 item from PANSS; side effects: UKU-SERS-Pat; symptom severity: PANSS, CGI-SCH |
| Lam et al21 | • Attitude toward medication • Insight • Prospective memory |
• 3 months, Hong Kong • SZ (N=82) clinically stable patients, ~50% inpatients |
Composite mean score of 4 methods: clinical impressions of the physician, structured clinical interview, pill counts by nurses, and MPR | Attitude toward medication: DAI; insight: SUMD-A; prospective memory: MMAA, computer paradigm, and self-report CAPM; side effects: AIMS, BAS, ESRS; symptom severity: PANSS |
| Baloush-Kleinman et al22 | • Attitude toward medication • Insight • Family support • Side effects • Therapeutic alliance |
• 6 months, post-hospital discharge, naturalistic, Israel • Early-episode SZ or SZD (N=112), convenience patient sample |
Patient-rated at admission, discharge, 3 and 6 months after discharge using VAS-ATA (0%–100%) | Attitude toward medication: DAI; family support: modified DAI; insight: SUMD; side effects: ESRS, LUNSERS, and a patient-based measure of subjective side effects; symptom severity: CGI, SAPS, SANS; therapeutic alliance: TPS |
| Novick et al12 | • Therapeutic alliance (hostility) • Independent housing • Social functioning • Substance abuse |
• Post hoc analysis, 3-year observational SOHO study of real-world patients, 10 European countries • SZ, outpatients initiating or changing antipsychotic medication (N=6,731) |
Adherence in past 4 weeks: interview with the physician | Hostility, living conditions, social functioning, alcohol/drug dependence/abuse: study-specific data collection form Symptom severity: CGI Quality of life: EQ-5D |
| Gonzalez-Pinto et al23 | • Insight • Substance abuse |
• 2-year observational study (EMBLEM), 14 European countries • BPD with a manic/mixed episode (N=1,831) |
Adherence in past 4 weeks: interview with the physician | Insight: 1 item in the YMRS; symptom severity: CGI-BP, YMRS |
| Lepage et al24 | • Neurocognition | • 6 months, following treatment initiation, Canada • First episode psychosis (N=160; 35 healthy controls) |
5-point scale based on patient interview, review by case managers at 6 months of prescriptions and amount consumed | Standardized cognitive battery testing 7 cognitive domains (verbal memory, visual memory, working memory, speed of processing, reasoning/problem solving, attention, and social cognition) at baseline and at patient stabilization; symptom severity: SAPS, SANS |
| Miller et al25 | • Substance abuse (cannabis) | • 1-year RCT, United States • First-episode SZ, SZP, or SZD (N=112) |
Patient, family, clinician weekly report and plasma levels 4 times/year | Cannabis use: SADS-C (monthly), SCID (every 6 months), urine toxicology, clinician report, family report |
| Rabinovitch et al26 | • Attitude toward medication • Insight • Social and family support |
• 6 months, Canada • First-episode psychosis, mostly SZ, SZP, or SZD, consecutive patients (N=100) |
Interview CORS with a rater 4 times after baseline (% of total doses taken over the last 4 weeks); case manager weekly evaluation; Information combined into a 5-point measure |
Attitude toward medication: initial adherence assessment at entry into the program served as a proxy; insight: 1 item on PANSS; social and family support: case manager and patient-rated using 1 item in the provider and patient versions of the WQOL scale; symptom severity: SAPS, SANS |
| Mohamed et al27 | • Attitude toward medication • Insight |
• Post hoc analysis, 18 months, CATIE trial, United States • SZ (N=1,432) |
Composite of monthly pill counts, patient questionnaire, clinician, and family feedback | Attitude toward medication: DAI; functioning: a panel of tests; insight: ITAQ; side effects: BAS, AIMS; symptom severity: PANSS, CDRS |
| Morken et al28 | • Family support | • 2-year RCT comparing effect of interventions on adherence, Norway • SZ, SZP, SZD, recent onset (past 2 years), consecutive patients (N=50) |
Recorded bimonthly from patient, therapist, caregiver interviews, also from plasma assays and patient records | Expressed emotion of a key relative about a mentally ill family member: assessed by a 5-min speech sample based on the CFI; symptom severity: BPRS |
| Liu-Seifert et al29 | • Attitude toward medication • Stigma |
• Post hoc analysis, RCT, 1 year, pooled groups, United States • SZ, SZP, SZD (N=664) |
Discontinuation before trial completion; switching medication was not counted as discontinuation | Negative aspects of medication; denial of illness, positive external influence, perceived medication benefit, stigma: modified ROMI; symptom severity: PANSS |
| de Haan et al30 | • Attitudinal, behavioral factors • Insight • Substance abuse • Therapeutic alliance (hostility) |
• 5 years, the Netherlands • First episode SZ, SZP, SZD, consecutive inpatients (N=119) |
By psychiatrists and specialized nurses every 6 months (3 levels), average was calculated for the 5-year period | Attitudinal and behavioral factors: ROMI; insight: 1 item on PANSS; subjective experience past 7 days: SWN; symptom severity: PANSS |
| McEvoy et al31 | • Insight | • Post hoc analysis, 2-year RCT comparing efficacy of antipsychotics, United States • First episode SZ, SZP, SZD (N=251) |
Pill counts at each study visit; patient interview | Insight: ITAQ; symptom severity: CGI-SCH, PANSS |
| Kamali et al32 | • Insight • Substance abuse |
• 6 months, Ireland • First-episode SZ, SZP, consecutive patients (N=100) |
Compliance interview 6 months after baseline | Alcohol and drug abuse within the past month: SCID; insight: 1 item on PANSS; symptom severity: PANSS |
| Yamada et al33 | • Insight | • 2-year adherence follow-up, Japan • SZ, outpatients with good adherence for >3 months at baseline (N=90) |
Method not described; Nonadherence defined as being nonadherent for ≥1 week during the 2-year follow-up | Functioning: GAF; insight: ROMI-J (37-item Japanese version of ROMI); side effects: UKU-SERS-Pat; symptom severity: BPRS |
| Ascher-Svanum et al34 | • Prior antidepressant use • Side effects • Substance abuse |
• Post hoc analysis, naturalistic, 3-year study (US-SCAP), United States • SZ (N=1,579) |
Self-report and the annual MPR based on prescription information in medical records | 39 previously reported risk factors for nonadherence (~20 were demographic and illness related); functioning: GAF; side effects: AIMS, SAS; substance abuse: SCAP-HQ; symptom severity: PANSS |
Abbreviations: AIMS, Abnormal Involuntary Movement Scale; BAS, Barnes Akathisia Scale; BPD, bipolar disorder; BPRS, Brief Psychiatric Rating Scale; CAPM, Comprehensive Assessment of Prospective Memory questionnaire; CDRS, Calgary Depression Rating Scale; CFI, Camberwell Family Interview; CGI, Clinical Global Impression; CGI-BP, CGI for Bipolar Disorder; CGI-SCH, CGI for Schizophrenia; COAST, Cognition, Adherence and Stigma in Schizophrenia; CORS, Circumstances of Onset and Relapse in Schizophrenia; DAI, Drug Attitude Inventory; DAI-10, Drug Attitude Inventory-10; EMBLEM, European Mania in Bipolar Longitudinal Evaluation of Medication; EQ-5D, EuroQol-5D quality of life instrument; ESRS, Extrapyramidal Symptom Rating Scale; GAF, Global Assessment of Functioning; ITAQ, Insight and Treatment Attitudes Questionnaire; LUNSERS, Liverpool University Neuroleptic Side Effect Rating Scale; MARS, Medication Adherence Rating Scale; MEMS, Medication Event Monitoring System; MMAA, Medication Management Ability Assessment; MPR, Medication Possession Ratio; PANSS, Positive and Negative Syndrome Scale; PSP, Personal and Social Performance scale; RCT, randomized controlled trial; ROMI, Rating of Medication Influences; ROMI-J, Rating of Medication Influences (Japanese version); SADS-C, Schedule for Affective Disorders and Schizophrenia-Change; SANS, Scale for the Assessment of Negative Symptoms; SAPS, Scale for the Assessment of Positive Symptoms; SAS, Simpson-Angus Scale; SCAP-HQ, Schizophrenia Care and Assessment Program-Health Questionnaire; SCID, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition for Axis I Disorders; SMI, serious mental illness; SOHO, Schizophrenia Outpatient Health Outcomes; SUMD, Scale to Assess Unawareness of Mental Disorder; SUMD-A, Scale to Assess Unawareness of Mental Disorder, abridged; SWN, Subjective Well-Being Under Neuroleptics; SZ, schizophrenia; SZD, schizoaffective disorder; SZP, schizophreniform disorder; TPS, Trust in Physician Scale; UKU-SERS-Pat, Udvalg for Kliniske Undersøgelser side effect self-rating scale; US-SCAP, US Schizophrenia Care and Assessment Program; VAS-ATA, Visual Analog Scale for Assessing Treatment Adherence; WAI, Working Alliance Inventory; WQOL, Wisconsin Quality of Life; YMRS, Young Mania Rating Scale.