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Coping Behavior Choice Behavior. Citations Publications citing this paper. Non-adherence to psychotropic medication assessed by plasma level in newly admitted psychiatric patients: Prevalence before acute admission. Effective strategies for nurses empowering the life quality and antipsychotic adherence of patients with schizophrenia Saida I. El-Azzab , Entisar M. GPs' views and perspectives on patient non-adherence to treatment in primary care prior to suicide.

Treatment Nonadherence in Schizophrenia: The Patient’s Perspective

Ebrahem , Faten Hasan Alam. Antipsychotics for schizophrenia: the paradigm of psychiatric drugs Emilio Pol Yanguas. Recovery from psychosis: physical health, antipsychotic medication and the daily dilemmas for mental health nurses. Daniel Bressington , Jacqueline White. References Publications referenced by this paper. Treatment discontinuation was significantly lower in the depot typical cohort hazard ratio: 0. Younger age and more severe positive symptoms were also associated with higher discontinuation.

Discontinuation of treatment for any cause and rehospitalizations were studied in adult patients in community care after the first hospitalization for schizophrenia or schizoaffective disorder in Finland Patients were followed up for an average of 3.

Number of patients who discontinued their initial treatment treatment that was started within 30 days after first discharge can be seen as a measure of persistence for that treatment. Relative risk RR for discontinuation was calculated for each treatment with oral haloperidol as the comparator treatment. Analogous calculations of RR were performed for rehospitalizations.

Depot perphenazine showed the lowest RR of all treatments examined. It was significantly superior to oral perphenazine. Similar to the previous study by the Tiihonen group described above 27 , the risk of rehospitalization and drug discontinuation in a nationwide cohort of patients hospitalized for the first time with a diagnosis of schizophrenia.

In analogous pairwise comparison. Compared with oral risperidone, clozapine and olanzapine were each associated with a significantly lower rehospitalization risk. Thus, these observational studies demonstrated superiority of a depot over oral formulation for persistence with treatment and for prevention of rehospitalizations.

In a study focusing on the continuity of care, schizophrenia patients who had been receiving LAI before hospitalization were more likely to show up for their first outpatient appointment within thirty days than those receiving oral preparations or no antipsychotics This finding remains unexplained.

We speculate that over a period of time, these contacts facilitate the development of a therapeutic alliance between the patient and his care givers. It is possible that the effects of such alliance carry over even after an interruption of regular contact by hospitalization or other factors, and that it is conducive to persistence on treatment. One of the traditionally cited hurdles preventing from wider use of LAI in clinical practice is their negative image among the consumers, patients and their families.

Measure Description

There is a popular assumption that LAI are associated with more severe and less-manageable side effects, plus, more importantly, arguably compromise individual decision autonomy and involve an element of coercion A systematic review of patient attitudes to depot antipsychotic scrutinized all published reports Nevertheless, the review conclusions suggested that patients may hold a favorable opinion on depot injections.

As for the attitudinal or preferential data, ten out of twelve reports included positive views on LAI, one negative and one neutral attitude. Direct comparison of preference of oral vs. A single report of patients switched from depot antipsychotics to oral risperidone found that patients preferred oral administration A follow-up review identified additional studies assessing patient preference Preference for LAI increased with familiarity or duration of exposure. It is likely that exposure to depot formula enhances its acceptance, as corroborated by a pre-discharge survey of patients from nine psychiatric hospitals in Germany One-hundred and forty-five patients were naive to depot treatment, 95 had experienced depot earlier and 60 were currently on depot medication.

Perception of LAI may vary across geographical regions. This is possibly confounded by different historical and cultural background, as evidenced by two European examples. A small study from a Swedish community mental health setting showed that patients on LAI appreciated positively a control over psychotic symptoms they had experienced during previous episodes Among three study groups patients, psychiatrists, and relatives , the most favorable view of depot formulation was held by the relatives A systematic review of studies evaluating attitudes of mental health professionals towards LAI identified eight relevant reports In summary, depot formulas were considered to be a old-fashioned, b stigmatizing, c causing more side effects, d costly, and e not prescribed because of a presumed adherence to oral medication.

An example of the reviewed studies is a cross-sectional survey among psychiatrists from the UK A series of surveys on the acceptance of LAI has been completed by a German group. Heres with collaborators 48 questioned psychiatrists attending international congress of biological psychiatry though nearly all respondents were German psychiatrists on their reasons not to prescribe LAI.

2018 MIPS Measure #383: Adherence to Antipsychotic Medications For Individuals with Schizophrenia

The most cited reason for all depot antipsychotics was presumed compliance with oral drug. A survey among psychiatrists concluded that the principal objections were seen on the part of drugs limited availability of the second-generation antipsychotics in depot form or patients first-episode patients frequently refuse LAI, patients underestimate risk of a relapse after first episode.

A multidimensional and cluster analysis based on a questionnaire of psychiatrists helped to identify two patient subgroups that may most benefit from LAI However, the second group was vastly different, consisting of patients well-informed about their illness, with high education, open to antipsychotic treatment, with high level of insight, good therapeutic alliance, and high level of participation in decisions.

Thus, it is of no surprise that there have been first clinical trials with the administration of LAI in young patients during early phases of illness 52 , or even first-episode patients 32, In the study by Emsley and collaborators 53 , fifty newly diagnosed patients with schizophrenia or schizophreniform disorder were administered LAI risperidone.

Depot antipsychotic formulations were widely used in Czechoslovakia in the past; some of them were even original compounds developed here. Nevertheless, available data indicates their continuing underutilization. In , LAI made up mere Olanzapine LAI newly available from took just 0. The major limitations preventing wider use of depot formulas of atypical antipsychotics risperidone, paliperidone, and olanzapine in many countries, including the Czech Republic and Slovakia are still mainly economic barriers such as prescription and reimbursement limits.

There is a general agreement that nonadherence to antipsychotic medication poses a major problem in the long-term management of schizophrenia. Currently, there are no reliable methods to measure adherence. The most frequently used self-reports and provider reports may inflate the rates of adherence.

More objective assessments electronic pill count, plasma levels are too expensive in everyday clinical practice plus they are not completely infallible. Factors associated with poor adherence are history of nonadherence, recent substance use, limited insight, prior treatment with antidepressants, cognitive impairment sometimes induced by medication , current hostility, and history of violent behavior. It may thus be assumed that timely recognition and treatment of comorbid conditions substance abuse, depressive symptoms together with better tolerated antipsychotics might improve cooperation with treatment regimen.

Nonadherence results in partial or no response to antipsychotic treatment with all negative consequences, including higher mortality. The high rates of nonadherence among schizophrenia patients imply that without adequate control for adherence it is virtually impossible to tell in nonresponders whether the prescribed medication is not working due to lack of efficacy or simply because is not taken. The obvious solution to this problem would be the use of depot antipsychotics. Nevertheless, a recently published meta-analysis comparing adherence to oral and LAI failed to confirm superiority of depot formulations.

It should be noted that the analyzed studies reported unusually high rates of adherence, thus the results must be viewed with caution and considered as inconclusive at best. Indirect and replicated evidence comes from large observational studies.


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Two cohort studies in Finland showed that depot formulation as compared to oral formulation of the same antipsychotic was associated with a significantly lower risk of rehospitalization and drug discontinuation. Similar results were seen in a large observational study. LAI are underutilized. However, surveys repeatedly showed that patients with previous exposure to LAI appraised them more favorably than those with no experience or little information.

Actively participating, cooperative, well-informed and educated patients with insight may also benefit from depot antipsychotic treatment. Perkins DO. Predictors of noncompliance in patients with schizophrenia. J Clin Psychiatry ; The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness.

J Clin Psychiatry ;70 Suppl. Mohr P, Volavka J. Adherence and depot formulations of antipsychotics in schizophrenia. Psychiatrie ; Adherence to atypical antipsychotic treatment among newly treated patients: a population-based study in schizophrenia. Schizophr Res ; Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med ; Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial.

Lancet ; Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission. Med Care ; Defining and assessing adherence to oral antipsychotics: a review of the literature. Schizophr Bull ; Compliance therapy in psychotic patients: randomised controlled trial.

BMJ ; Medication adherence in outpatients with severe mental disorders: relation between self-reports and serum level. J Clin Psychopharmacol ; Relationships among subjective and objective measures of adherence to oral antipsychotic medications. Psychiatr Serv ; Medication nonadherence and treatment outcome in patients with schizophrenia or schizoaffective disorder with suboptimal prior response.

Alvarez-Jimenez, M. Risk factors for relapse following treatment for first episode psychosis: a systematic review and meta-analysis of longitudinal studies. Kane, J. Non-adherence to medication in patients with psychotic disorders: epidemiology, contributing factors and management strategies. World Psychiatr.

Adherence to Antipsychotic Medications for Individuals With Schizophrenia - NCQA

Lopez, L. Accuracy of clinician assessments of medication status in the emergency setting: a comparison of clinician assessment of antipsychotic usage and plasma level determination.


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Alphs, L. Factors associated with relapse in schizophrenia despite adherence to long-acting injectable antipsychotic therapy. Samaha, A.


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Correspondence to Jose M. Kane has received grant support from Otsuka and Janssen.

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