Abstract
BackgroundNon-adherence to antipsychotic medication is commonly found in schizophrenia and other psychotic disorders, thus forming a major obstacle to long-term maintenance treatment and contributing to high relapse rates. With limited evidence on the success of interventions in enhancing medication adherence, this controlled trial was designed to test and evaluate the effectiveness of an adherence therapy (AT) for outpatients with schizophrenia spectrum disorders, based on a motivational interviewing approach over a six-month follow-up period.MethodsA single-blind, randomized controlled trial with a repeated-measures, two parallel groups design was conducted in a random sample of 114 participants with schizophrenia spectrum disorders in one community psychiatric nursing service. After pre-test, the participants were randomly assigned to either an eight-session course of AT plus usual care or usual psychiatric care (n = 57 per group). The main outcomes, including medication adherence, symptom severity, insight into treatment, hospitalization rate, and functioning, were measured at baseline and immediately and six months post-intervention.ResultsA total of 110 participants completed this trial and thus the attrition rate was 3.5 %. Results of repeated-measures analysis of variance followed by Helmert’s contrasts test indicated that the AT participants reported significantly greater improvements in their insight into illness and/or treatment, psychosocial functioning, symptom severity, number of re-hospitalizations, and medication adherence (F = 5.01 to 7.45, P = 0.007 to 0.030) over six months follow-up, when compared with usual care.ConclusionsMotivational interviewing-based AT for people with schizophrenia can be effective to reduce symptom severity and re-hospitalizations, and improve medication adherence, functioning, and insight into illness and/or treatment over a medium term (six months) period of follow-up. Further study on the effects of AT in people with psychotic disorders in terms of diverse sociodemographic and illness characteristics, and a longer term (for example, over 12 months) follow-up period is recommended.Trial registrationThe trial was registered at Clinicaltrials.gov (identifier: NCT01780116) on 6 July 2014.
Highlights
Non-adherence to antipsychotic medication is commonly found in schizophrenia and other psychotic disorders, forming a major obstacle to long-term maintenance treatment and contributing to high relapse rates
Sample characteristics A total of 114 participants completed the questionnaires at baseline
Results of Helmert’s contrasts test indicated that the adherence therapy (AT) participants had significantly greater improvements than those in the treatment as usual (TAU) group on the following patient outcomes at post-tests: 1. Insight into illness and/or treatment significantly increased at both T1 and T2; 2
Summary
Non-adherence to antipsychotic medication is commonly found in schizophrenia and other psychotic disorders, forming a major obstacle to long-term maintenance treatment and contributing to high relapse rates. With limited evidence on the success of interventions in enhancing medication adherence, this controlled trial was designed to test and evaluate the effectiveness of an adherence therapy (AT) for outpatients with schizophrenia spectrum disorders, based on a motivational interviewing approach over a six-month follow-up period. The use of antipsychotic medication in acute, chronic, and maintenance stages of the illness for symptom reduction, improvements of psychosocial functioning, and relapse prevention in these psychotic patients is widely accepted. Continuous efforts are required for the design of innovative and effective interventions, which can be evaluated in improving medication adherence and other patient outcomes among patients with schizophrenia, reducing their rate of relapse occurrence [4]
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