Medication adherence in first-episode psychosis and its association with psychopathology

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Abstract

Background:

The purpose of the study was to follow-up the individuals with first-episode psychosis (FEP) for a period of 1 year to assess their medication adherence rates and to identify the association between medication adherence and psychopathology.

Materials and Methods:

In a 1 year longitudinal study, 59 individuals with FEP were assessed for their sociodemographic profile and medication adherence at 1 month and 12-month follow-up period using a semi-structured per forma. Positive and negative symptoms were assessed by positive and negative syndrome scale (PANSS) while the functioning by global assessment of functioning (GAF) scale.

Results:

Nearly 85% of the individuals were adherent with medications during the 1-month follow-up period, 32.2% were poorly adherent at the end of 12 months. Among various factors examined for association with medication adherence, positive and negative symptoms, and global functioning of the individuals at the end of 12 months were found to significant associated with poor medication adherence.

Conclusion:

There is a high rate of medication nonadherence in individuals with FEP at 12-month follow-up, and factors affecting nonadherence should be addressed specifically to improve medication adherence in these individuals.

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Most cited references 21

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The positive and negative syndrome scale (PANSS) for schizophrenia.

L Opler, Jennifer Kay, Paul Opler … (1986)

The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.

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A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF).

S Jones, G. Thornicroft, M. Coffey … (1995)

The Global Assessment of Functioning (GAF) is a quick and simple measure of overall psychological disturbance. However, there is little research on the reliability and validity of this measure in severely mentally ill populations. Multidisciplinary keyworkers assessed 103 patients at monthly intervals over a 6-month period. Overall GAF scores were obtained, with additional separate ratings for symptoms and disability. These were compared with changes in antipsychotic medication and support needs over the same period. Satisfactory reliability was obtained for total GAF score and for symptom and disability measures, in spite of raters having only one brief training session. All GAF scores were associated with current support needs of patients. Symptom and disability scores were associated with changes in antipsychotic medication in the previous month. Only symptom score was associated with increases in antipsychotic medication at time of rating. GAF proved to be a reliable and, within the limits of the indicators used, a valid measure of psychiatric disturbance in our sample of the severely mentally ill. Differences in relationships between the three GAF scores and medication/support needs indicate the usefulness of obtaining all three scores for monitoring levels and type of psychiatric disturbance in this population.

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Non-adherence to medication in patients with psychotic disorders: epidemiology, contributing factors and management strategies.

John M Kane, Taishiro Kishimoto, Christoph U. Correll (2013)

Although non-adherence is common across all branches of medicine, psychotic disorders pose additional challenges that increase its risk. Despite the importance of non-adherence, clinicians generally spend too little time on assessing and addressing adherence attitudes and behaviors. Importantly, how adherence is measured significantly impacts the findings, and the most frequently employed methods of asking patients or judging adherence indirectly based on efficacy or tolerability information have poor validity. Novel technologies are being developed that directly assess adherence and that can also be used to both provide real-time feedback to clinicians and serve as an intervention with patients. Several treatments are available that can positively impact adherence. Among psychosocial interventions, those combining multiple approaches and involving multiple domains seem to be most effective. Although long-acting injectable antipsychotics are theoretically a very powerful tool to assure adherence and signal non-adherence, recent results from randomized controlled trials failed to show superiority compared to oral antipsychotics. These data are in contrast to nationwide cohort studies and mirror-image studies, which arguably include more representative patients receiving long-acting antipsychotics in clinical practice. This disconnect suggests that traditional randomized controlled trials are not necessarily the best way to study interventions that are thought to work via reducing non-adherence. Clearly, non-adherence is likely to remain a major public health problem despite treatment advances. However, increasing knowledge about factors affecting adherence and leveraging novel technologies can enhance its early assessment and adequate management, particularly in patients with psychotic disorders.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Psychiatry

Journal ID (iso-abbrev): Indian J Psychiatry

Journal ID (publisher-id): IJPsy

Title: Indian Journal of Psychiatry

Publisher: Wolters Kluwer - Medknow (India )

ISSN (Print): 0019-5545

ISSN (Electronic): 1998-3794

Publication date (Print): 2019

Volume: 61

Issue: 4

Pages: 342-346

Affiliations

[1]Consultant Psychiatrist, Schizophrenia Research Foundation, Chennai, Tamil Nadu, India

[1 ]Psychologist, Schizophrenia Research Foundation, Chennai, Tamil Nadu, India

Author notes

Address for correspondence: Dr. Vijaya Raghavan, Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai - 600 101, Tamil Nadu, India. E-mail: vijayaraghavan@ 123456scarfindia.org

Article

Publisher ID: IJPsy-61-342

DOI: 10.4103/psychiatry.IndianJPsychiatry_148_17

PMC ID: 6657546

PubMed ID: 31391636

SO-VID: f619d2d6-0754-4604-858d-6ada821325ca

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This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Medication adherence in first-episode psychosis and its association with psychopathology

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Abstract

Background:

Materials and Methods:

Results:

Conclusion:

Related collections

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Most cited references 21

The positive and negative syndrome scale (PANSS) for schizophrenia.

A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF).

Non-adherence to medication in patients with psychotic disorders: epidemiology, contributing factors and management strategies.

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