Medication Compliance in Psychotic Disorders

Medication Compliance in Psychotic Disorders

Janssen, Birgit., Gaebel, Wolfgang., Haerter, Martin, Komaharadi, F., Lindel, Birgit., & Weinmann, Stefan. (2006 April). "Evaluation of factors influencing medication compliance in inpatient treatment of psychotic disorders. Psychopharmacology 187:229-236.

The authors and researchers examine short- and long-term compliance to prescribed antipsychotic drugs. Their objective is to evaluate patient-related and treatment-related factors associated with medication compliance in inpatients with the following diagnoses: schizophrenia, schizoaffective disorder, and other psychotic disorders. The study is a "naturalistic study," based in seven hospitals with patients assessed weekly. The following characteristics were studied: social function, side-effects of medication, mental status, and compliance to medication requests. The researchers in this study attempted to determine whether medication is the basis for compliance or whether multiple factors including innate factors such as social influence and individual characteristics, environmental characteristics, genetic and personality characteristics were more likely to influence medication compliance in psychotic patients because medication compliance is so low among psychotic patients. Previous research suggests that medication compliance has less to do with medication alone and more to do with a combination of factors including traits associated with the psychosis of the patient.

The researchers in this study used logistic regression analysis to measure medication compliance. The results of the study showed a clear association between patient's compliance with orders and substance abuse and involuntary admission and compliance. Also relevant were factors including aggression, lack of education or high-school graduation and personality traits including negative symptoms. The medication regime the patient took had little effect on medication compliance, showing a link between external traits to medication compliance. Atypical antipsychotic treatment seemed to be more effective than tradition medication treatment with regard to medication compliance. Patient-related factors may therefore according to the results of this research, be more significant than medication related regimes with regard to medication compliance.

Kemp, Roisin; Hayward, Peter; Applewhaite, Grantley; Everitt, Brian; David, Anthony. (1996

Feb). Compliance therapy in psychotic patients: Randomized controlled trial. BMJ, Vol 312.

The researchers and authors of this study attempt to determine whether compliance therapy which is a cognitive-behavioral intervention might improve medication compliance with treatment in psychotic patients. The researchers emphasize the importance of not relying on medication alone, or personality characteristics or naturalistic studies alone to solve the issue of medication compliance in patients with psychotic disorders. The researchers hypothesize that cognitive-behavioral interventions along with medication may improve social adjustment which will improve medication compliance as patients begin to realize benefits associated with fitting into society. Much of the lack of medication compliance may be associated more with the lack of viable results associated with the sense of psychosis. The researchers also explore whether if this improves social adjustment, whether this effect persisted six months following treatment. The design for the study is a randomized controlled trial of compliance therapy with non-specific counseling with each patient undergoing four to six sessions no less than 10 minutes and no more than 60 minutes each. Each patient participated in sessions in an acute care psychiatric ward in a London facility. Forty-seven patients were monitored with a diagnosis of psychosis. Patients were observed and also were asked to provide self-rated attitudes to drug treatment and intervention one month later and report symptoms six months after treatment. A control group was also followed. The results of the study suggest that compliance therapy is a plausible and practical method for improving medication compliance therapy in psychotic patients. It also confirms that drug treatment in psychotic patients will persist for a minimum of six months, and social functioning in these patients can persist for six months following initial treatment. Modifications may be necessary for some patients depending on their particular diagnosis. Some patients may require an increasing number of sessions and more cognitive approaching to psychotic symptoms "especially when they impinged on compliance" according to the researchers. The approach is brief and practical according to the study, especially when applied to acute patients or those demonstrating acute psychosis that are presented with a need for treatment in a standard "inpatient environment."

Dolder, Christian R., Pharm.D., Jonathan P. Lacro, Pharm.D., Laura B. Dunn, M.D., and Dilip

V. Jeste., M.D (2002 Jan). Antipsychotic medication adherence: Is there a difference between typical and atypical agents? Am J. Psychiatry, 159:103-108.