Compliance In Schizophrenia Research Articles

Observance thérapeutique, définition et données récentes dans la schizophrénie

Therapeutic compliance is a crucial issue in dealing with chronic illnesses. Many studies have considered the problem since the 1970s. In the first part of this article, the author reviews a number of definitions, notably the one given by the French National Academy of Medicine in its dictionary. The world “compliance” is used in the English language but is an Anglicism in French with a totally different meaning and its use as a synonym of “observance” should be avoided in French. Some authors use the term “adherence” in a sense similar to “observance” but this stresses more explicitly that the doctor/patient relationship is a partnership rather than a paternalistic one. In the second part of the article, factors involved in poor adherence to treatment are reviewed: factors linked to the patient, the disease, the treatment, socio-economic factors and those inherent in the healthcare system. The author then discusses various aspects specific to the issue of treatment compliance in schizophrenia and the various stages of observance (Paillot et al., 2008), risk factors because of poor observance and measures that can be implemented to improve it (Aarab et al., 2015), and the correlation of the quality of the therapeutic relationship and observance (McCabe et al., 2012). All of which underlines the need for a multifactorial approach to this question. The author then explores various new technologies and applications that can measure observance and/or improve it with an emphasis on the need to approach these tools with an ethical eye. Finally, numerous studies and meta-analyses have demonstrated that psychoeducation improves adherence and have also shown its efficacy in reducing the risk of relapse in individuals with schizophrenia.

Dterminants of medication adherence in Moroccan schzophrenic patients

Abstract Introduction Schizophrenia is a psychiatric condition in which patient adherence is a key issue in its management. Objectives To estimate the prevalence and determine the factors associated with medication adherence in patients with schizophrenia. Methods This was a cross-sectional study conducted at the psychiatry department of the CHU IBN Rochd of Casablanca among schizophrenic patients followed from May 2019 to January 2020. The sample size was calculated apriori and the measurement of therapeutic compliance and Insight (patients' perception of the disorders related to their pathology) was made thanks to the Medication Adherence Rating Scale (MARS) and the Birchwood insight scale (BIS) respectively. Socio-demographic data and data on the management of schizophrenia were also collected. Statistical analyses were performed with RStudio software and the multivariate analysis method of logistic regression was used. The threshold of significance was set at 5%. Results A total of 370 were collected, the median age was 31 years and the most represented class was the over 28 years (26.25%). The female gender represented 28% and the majority was single (72%). Substance abuse was 68.8%, 46% were on dual therapy and 43.2% of patients were on regular follow-up. The prevalence of therapeutic compliance was 25.6% and 30.3% were aware of their pathology. The determinants of medication adherence in the schizophrenic patients included in the final model were: regularity of follow-up (p < 0.001), insight (p < 0.001), number of medications (p = 0.011), history of substance use (p = 0.008), place of residence (p = 0.082). Conclusions Therapeutic compliance was low, the knowledge of the factors associated with therapeutic compliance in schizophrenia allows us to put forward hypotheses in order to improve the management of patients. Key messages Patient adherence to treatment is important in the management of Schizophrenia. Therapeutic compliance is poor.

The Effects of Bi-Anodal tDCS Over the Prefrontal Cortex Regions With Extracephalic Reference Placement on Insight Levels and Cardio-Respiratory and Autonomic Functions in Schizophrenia Patients and Exploratory Biomarker Analyses for Treatment Response.

BackgroundWe previously showed the efficacy of bi-anodal transcranial direct current stimulation (tDCS) over the prefrontal cortex (PFC) regions with extracephalic reference placement in improving negative symptoms in schizophrenia. In this ancillary investigation, the effects of this intervention on insight levels, other clinical outcomes, and cardio-respiratory and autonomic functions were examined and the potential of biomarkers for treatment response was explored.MethodsSchizophrenia patients were randomly allocated to receive 10 sessions of bi-anodal tDCS over the PFC regions with extracephalic reference placement (2 mA, 20 minutes, twice daily for 5 weeks) or sham stimulation. We examined, in 60 patients at baseline, immediately after stimulation and at follow-up visits, the insight levels, other clinical outcomes, blood pressure, respiratory rate, heart rate, and heart rate variability.ResultsInsight levels as assessed by the abbreviated version of the Scale to Assess Unawareness in Mental Disorder in schizophrenia awareness of the disease, positive and negative symptoms dimensions, and beliefs about medication compliance as assessed by Medication Adherence Rating Scale were significantly enhanced by active stimulation relative to sham. No effects were observed on cognitive insight, other clinical outcomes, or cardio-respiratory and autonomic functions. Heart rate variability indices as biomarkers were not associated with the clinical response to the intervention.ConclusionsOur results provide evidence for bi-anodal tDCS over the PFC regions with extracephalic reference placement in heightening the levels of insight into the disease and symptoms, as well as beliefs about medication compliance in schizophrenia, without impacting other clinical outcomes and cardio-respiratory/autonomic functions.

Study of various factors affecting compliance in schizophrenia: A single center experience in India

Aim of the studySchizophrenia is a major psychiatric disorder, imparting a major burden in health care sector. Many treatments are available now a days to treat schizophrenia, although, its burden is not decreasing. The main reason behind this is noncompliance to treatment.This study aims to find out the non compliance prevalence and to study influence of sociodemographic factors, treatment related variables, illness related variables and various subjective reasonings in patients with schizophrenia.Subject or material and methodsOver the period of 1 year, 80 patients with schizophrenia who gave written informed consent were enrolled in the study and their sociodemographic, treatment related and illness related variables were noted. PANSS(positive and negative syndrome scale for Schizophrenia) was used to indicate the severity of illness. ROMI(Rating of Medication Influences Scale in Schizophrenia) was used to assess subjective reasons. Chi square test was used to find out statistical significance.Results37.5% patients were non compliant in our study. Education, the illness severity, the type of regimen and dosages of medication have a significant influence on treatment compliance. The subjective reason “no perceived benefit” is significantly associated with treatment noncompliance.DiscussionA wide literature is available across the globe on compliance in schizophrenia. This study aids in the available resources and throws a light on the regional factor.ConclusionsSchizophrenia, being a major disease imparting burden in psychiatry health care system, needs an attention in the area of compliance to treatment. This type of research should be done on regional basis to find out and address the factors that influence treatment compliance.

Religious Beliefs and Their Relevance for Treatment Adherence in Mental Illness: A Review

Approximately 50% of patients do not adhere to medical therapy. Religious and spiritual factors may play an important role in determining medication compliance in mental illness. The aim of this paper is to review published evidence documenting a relationship between religion/spirituality (R/S) and treatment adherence in mental illness, in particular in schizophrenia, depression and substance abuse. This review summarizes, categorizes and defines the role of religious beliefs as a factor improving medication compliance in mental illness. Randomized controlled trials and observational studies were eligible for the review if they were published in December 2015 or earlier, analyzed the effects of religious beliefs or spirituality on medication compliance, or adherence to other therapeutic interventions in mental illness. The vast majority of published studies analyzed the effects of religion on medication compliance in schizophrenia and addiction. In schizophrenia patients, religious beliefs turned out to be a predictor of worse treatment adherence. However, spiritual orientation was shown to play an important role in the recovery from addiction, and to improve adherence in patients with this condition. Furthermore, better treatment adherence was observed in more religious patients diagnosed with depression. While religious beliefs and spirituality may represent an important source of hope and meaning, they often interfere with treatment adherence. Therefore, psychiatrists should consider religious and spiritual beliefs of their patients, and verify if and to what extent they improve their medication compliance.

Treatment Compliance in the Long-Term Paranoid Schizophrenia Telemedicine Study

Schizophrenia is a chronic disease with a relatively high relapse rate. Different methods are introduced to improve compliance of the patients treated by psychiatrists; among them, a new and promising attitude is telepsychiatry. The 12-month clinical study of the compliance in paranoid schizophrenia was performed on the group of 199 patients. Every patient in the study was given a smartphone with the preinstalled original telemedicine platform (Telemedicine MoneoPlatform). The telemedicine system recorded every confirmation of the drug intake, and according to that, the compliance was counted as the percent of the doses of medication confirmed in relation to the planned ones. In the first month of the study, patients confirmed only 47.6% of the doses as taken. When analyzed in the total group, the compliance significantly decreased over the 12-month period (p < 0.001). The compliance observed in our study is lower in comparison with short-term studies, but to our knowledge, this project is the biggest long-term study of the treatment compliance in schizophrenia, performed on a large number of patients, and a possible conclusion is that the adherence in longer lasting project depends highly on the engagement of both patients and psychiatrists.

Study of factors affecting drug compliance in schizophrenia- cross sectional survey

Introduction: Schizophrenia is a condition characterized by delusions, hallucinations, disorganized behavior, disorganized thought, and negative symptoms. There is overwhelming evidence that antipsychotics can be effective in treating the symptoms of schizophrenia. Approximately 75% of individuals relapse without drugs compared to 25% with drug. Patients who receive long-acting depot have lower relapse rates than patients who receive oral medications. The factors affecting drug compliance include side effects, psychopathology, social support, and insight. Indian studies are comparatively few in this area; knowledge of these factors can help in formulating strategies for enhancing drug compliance and outcome. Methods: This study was conducted at the Department of Psychiatry T D Medical College, Alleppey, a tertiary care teaching hospital. Patients who attended the Outpatient department were assessed with following instruments, Positive and negative symptom scale, Udvalg Klinske Undersogelser Side Effect Rating Scale, Multidimensional scale of perceived social support, Scale to assess Unawareness of Mental Disorder (SUMD), Compliance was assessed by using the criteria of fully compliant defined as those miss less than 20% of medication, partially compliant those who misses 20% to 80% of medication and noncompliant those who miss more than 80% of medicines. Data was analysed using Chi square test and regression analysis. Result: Sex, Education status, marital status, Occupation, and drugs administered had significant relationships with Compliance. Conclusion:, it is advisable to use minimum number of drugs for ensuring compliance.

Association of symptom severity, insight and increased pharmacologic side effects in acutely hospitalized patients with schizophrenia

BackgroundMany studies have shown that more severe symptoms and poorer insight are associated with poor treatment compliance in schizophrenia while severe symptoms may result in higher medication dosages. Since pharmacologic side effects may accompany greater medication compliance and higher medication dosage, the relationship between symptoms, insight and side effects deserves study. MethodsIn this study, 174 inpatients diagnosed with schizophrenia were assessed during the week before hospital discharge from a large psychiatric hospital in Guangzhou, China. Symptoms were measured by the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). Insight was assessed by the Insight and Treatment Attitudes Questionnaire (ITAQ). Pharmacologic side effects were assessed by the Treatment Emergent Symptoms Scale (TESS). Bivariate and multivariate regression models were used to examine the relationship of symptoms, insight and the interaction between the two, to the severity of side effects. ResultsAs expected, the PANSS total score was significantly associated with poorer ITAQ scores and with more severe side effects, and on multivariate analysis both higher PANSS and lower ITAQ scores were associated with more severe side effects. Stepwise multiple linear regression analysis showed that the model with the PANSS total score alone explained 3.4% of the variance in side-effect scores, while adding the ITAQ increased the explained variance to 11.8%. Analysis of the interaction of symptoms and insight showed that patients with both more severe symptoms and high insight had the most severe side effects (B=.006, p=.008, R2=15.4%). ConclusionMore severe symptoms and greater insight among schizophrenic inpatients were both significantly if modestly associated with more severe pharmacologic side effects, the former presumably because of the need for higher doses of medication and the latter because of greater medication compliance. In addition, patients with both more severe symptoms and greater insight were even more prone to pharmacologic side effects than others presumably reflecting higher doses and higher compliance. Clinicians treating highly symptomatic but insightful patients, i.e. those most likely to need and to adhere to prescribed medications, may need to be especially vigilant about side effects.

Analysis of variables affecting drug compliance in schizophrenia.

Context:As compliance of the patient during management of schizophrenia is crucial, the current study was conducted to find out the factors that affected compliance.Aims:The aim of the study was to analyze the prevalence of noncompliance and to find out different factors affecting compliance in schizophrenic patients.Materials and Methods:Observational cross-sectional study was conducted on 100 adult schizophrenic patients. Noncompliance was assessed using the rating of medication influence (ROMI) scale. Severity of illness was measured using positive and negative syndrome scale (PANSS).Results:Prevalence of noncompliance was 37%. Using ROMI scale; positive relationship with psychiatrist, family pressure for taking medications, stigma, and substance abuse were found to be significant factors. Severity of illness was also found as determining factor.Conclusion:To improve the compliance in schizophrenia patients, roles of both psychiatrists and family members are crucial.

EPA-1601 - Long-acting injectable antipsychotics in patients with schizophrenia: a 18 months study

The expectative in regards achieving better therapeutic adherence related to medication compliance in schizophrenia has been shown to be greater in patients treated with long-acting injectable antipsychotics. The purpose of the present study was to investigate whether or not the schizophrenia treatment under evidence-based clinical practice conditions with Palmitate Paliperidone in comparison with conventional depots antipsychotics, will improve the patient evolution and prognosis in schizophrenia. This 18 months study, the patient population consisted of 30 outpatients, all diagnosed with schizophrenia, who received treatment with Paliperidone Palmitate (n=15). A comparison was conducted with the same number of patients who received treatment with depot conventional antipsychotic. All patients were evaluated every three months and the following scales were used for assessment and measurement: Positive and Negative Syndrome Scale (PANSS) Global illness Severity (Global Clinical Impression CGI), Treatment Satisfaction Scale, Remission Criteria (Andreassen criteria,) Personal and Social Performance (PSP) and the Subjective Well-being under Neuroleptic Scale (SWN-K) At endpoint, we found statistical differences among both study groups: The Paliperidone Palmitate group showed significantly higher remission rates (p < 0.05) and treatment satisfaction scores (p < 0.05). Also an improvement in global clinical impression (p < 0.05), PSP (p < 0.05) and SWN-K (p < 0.05) Paliperidone Palmitate group showed lower sexual dysfunction (p < 0.05) compared to conventional depot. The presented data demonstrated that Paliperidone Palmitate was an efficacy and safety treatment and could improve the outcomes prognosis and the clinical course of the illness in schizophrenic patients when compared with conventional depot

Patients’ Positive Regard for Psychotic Symptoms May Contribute to Nonadherence

Evaluation and treatment of patients with schizophrenia should include a focus on the patient’s subjective experience of symptoms and illness.

1290 – Relashionship between therapeutic modalities and treatment compliance in schizophrenia

Although effective treatment for schizophrenia is available, patient's compliance with treatment prescriptions is notoriously poor. Factors influencing compliance were identified: factors linked to patients, factors depending on the therapeutic relation the clinician and factors due to medications. To study the relationship between treatment techniques and medication compliance in schizophrenia. A cross-sectional study of patients with schizophrenia and their parents followed as outpatients in the department of psychiatry D in Razi hospital. 95 patients was recruited punctually. 84 patients (88.5%) were receiving long-acting neuroleptic. Just under half patients (48%) were compliant with their treatment. Almost all observing patients (91%) were receiving long-acting neuroleptic. The average dose of NLP prescribed in patients observing is slightly lower than that of not observed. The number of daily doses of treatment also appeared to influence the adherence behavior. The correlation between adverse events and compliance was statistically significant (p = 0.032). The management of schizophrenia could be greatly improved by considering the medication related factors leading to non compliance. Medication prescription complexity is important to take under consideration. However, strategies for the improvement of compliance must also take into consideration other factors such us patient-related and interactional factors.

1286 – Therapeutic compliance in schizophrenia: the influence of psychotic symptoms and the insight

Medication adherence problems increase hospitalization, morbidity and mortality in the patients with the diagnosis of schizophrenia. Indicators of poor adherence to a medication regimen are a useful resource for physicians to help identify patients who are most in need for interventions to improve adherence. The objective of this analysis was to find out whether symptoms and insight would predict the therapeutic alliance in the treatment of schizophrenia. We proceeded to a transverse survey with 95 patients affected by schizophrenia followed in ambulatory in the psychiatric department D of the hospital Razi in Tunisia. A little more than half of our patients were not observing. The behavior of observance was positively correlated in the sex: the men were more observant that the women. The clinical shape of the disease, the level of insight, the cognitive state as well as the age of the disease are not connected to the degree of compliance. On the other hand, the positive or negative psychotic symptoms are strongly correlated in the therapist alliance. The results of this study suggest that simple measures as the psychoeducation for schizophrenics, and control of the psychotic symptoms advance us on the way of improvement of the therapist alliance and consequently the social reintegration of the patient and his quality of life.

P-1257 - Influence of socio-demographic factors on therapeutic compliance in schizophrenia

One of the reasons of therapeutic failure in schizophrenia is the poor compliance.Many factors can interfere with the therapeutic adherence. We propose to study the therapeutic compliance in schizophrenia and to determinate the socio-demographic factors that could be associated with the therapeutic adherence. We studied the relationship between socio-demographic factors and therapeutic compliance in schizophrenia. It was a cross-sectional study conducted among 95 outpatients with schizophrenia during the months of January and February 2009 in the department of psychiatry D. 54% of patients were observant. The average age of our sample was 41.2 years. We found a slight male predominance with 52.6% of men. Men were more frequently observant than women (58.0% vs 33.3%). The majority of our patients were not married: 82.1%. 96.8% of patients had electricity. 22.1% had heating. 6.3% had air conditioning and 35.8% had hot water. Almost half (42.1%) of patients had a level of primary education. The third had reached high school (32.6%) and 12.6% were illiterate. 5.3% had effectuated a professional training and only 7.4% had studied in a university. Three-quarters of surveyed patients were unemployed (75.8%). Some socio-demographic factors such as sex and employment status are correlated to the therapeutic compliance. While others are not: age, education, marital status and socioeconomic status. However, other factors should be considered and studied such as clinical features, treatment-related factors and those related to the environment of the patient to better identify and understand the treatment compliance.

P-1333 - Relashionship between therapeutic modalities and treatment compliance in schizophrenia

Introduction Although effective treatment for schizophrenia is available, patient's compliance with treatment prescriptions is notoriously poor. Factors influencing compliance were identified : factors linked to patients, factors depending on the therapeutic relation the clinician and factors due to medications. Objective To study the relationship between treatment techniques and medication compliance in schizophrenia. Method A cross-sectional study of patients with schizophrenia and their parents followed as outpatients in the department of psychiatry D in Razi hospital. Results 95 patients was recruited punctually. 84 patients (88.5%) were receiving long-acting neuroleptic. Just under half patients (48%) were compliant with their treatment. Almost all observing patients (91%) were receiving long-acting neuroleptic. The average dose of NLP prescribed in patients observing is slightly lower than that of not observed. The number of daily doses of treatment also appeared to influence the adherence behavior. The correlation between adverse events and compliance was statistically significant (p = 0.032). Conclusion The management of schizophrenia could be greatly improved by considering the medication related factors leading to non compliance. Medication prescription complexity is important to take under consideration. However, strategies for the improvement of compliance must also take into consideration other factors such us patient- related and interactional factors.

P-1205 - Therapeutic compliance in schizophrenia: the influence of psychotic symptoms and the insight

Introduction Medication adherence problems increase hospitalization, morbidity and mortality in the patients with the diagnosis of schizophrenia. Indicators of poor adherence to a medication regimen are a useful resource for physicians to help identify patients who are most in need of interventions to improve adherence. Objective The objective of this analysis was to find out whether symptoms and insight would predict the therapeutic alliance in the treatment of schizophrenia. Method We proceeded to a transverse survey with 95 patients affected by schizophrenia followed in ambulatory in the psychiatric department D of the hospital Razi in Tunisia. Results A little more than half our patients were not observing. The behavior of observance was positively correlated in the sex: the men were more observant that the women. The clinical shape of the disease, the level of insight, the cognitive state as well as the age of the disease are not connected to the degree of compliance. On the other hand, the positive or negative psychotic symptoms are strongly correlated in the therapist alliance. Conclusion The results of this study suggest that simple measures as the psychoeducation for schizophrenics, and control of the psychotic symptoms advance us on the way of improvement of the therapist alliance and consequently the social reintegration of the patient and his quality of life.

Observance médicamenteuse et lieu de contrôle de la santé dans la schizophrénie

Schizophrenia is a frequent disorder since it affects about 1% of the general population. Drug compliance, that is to say patients' adherence to their treatment, remains rather poor concerning this disease with, on an average, one patient out of two not complying with his/her medication. Among the factors influencing drug compliance, we focused on patients' beliefs in terms of health control, a concept known as health locus of control. This is a concept that originated from social psychology and derived from the Rotters' original concept of locus of control: it corresponds to the type of connexion established by an individual between subsequent events in the history of his/her disease and internal (personal abilities) or external factors (chance, powerful others). Nowadays, the tridimensional structure of this concept is commonly admitted as being in three dimensions: internality, chance externality and powerful others externality, the latter group being divided between doctors and others. We have assumed that there is a correlation between the degree of drug compliance and the internal and/or doctors' external health locus of control. For this purpose, we have determined the quality of drug compliance by using the Medical Adherence Rating Scale (MARS) and the type of health locus of control by using the Multidimensional Health Locus of Control (MHLC) scale among 65 schizophrenic patients. We have also considered it was important to evaluate patients' insight by using the Amador's scale (Scale of Unawareness of Mental Disorder) because many researchers have established a strong correlation between insight and drug compliance in schizophrenia. Associations between the four dimensions of health locus of control ("internal", "chance external", "others external" and "doctors' external") and drug compliance were assessed by estimating Spearman's rank correlation coefficient (r) and its degree of significance (p). These associations were judged significant at an alpha threshold of 5%, which corresponded to a level of p inferior to 0.05. Our results tend to confirm a statistically significant positive correlation between internal (r=0.25; p=0.043) and/or doctors' external (r=0.27; p=0.027) health locus of control and drug compliance. Conversely, there is no correlation between chance external or others' external health locus of control and drug compliance (p>0.05). This means that the more patients believe that their schizophrenia can be controlled by themselves and/or by doctors, the more they follow their prescriptions. Furthermore, the link between health locus of control and drug compliance appears to be confused by two dimensions of insight, namely awareness of the response to the treatment and perceived need for treatment. An application of these results is that, in the case of patients whose health locus of control is chance or others' external, it can be beneficial to attempt to change their beliefs in order to improve drug compliance. These results hold particular interest in the field of psycho-education and can be directly applied to cognitive therapy for beliefs among stabilized schizophrenic patients.

Psychopathology, insight and compliance in schizophrenia.

The study was conducted using Insight and Treatment Attitude Questionnaire (ITAQ), Positive and Negative Syndrome Scale (PANSS) and Medication Adherence Rating Scale (MARS). The sample comprised 50 patients with schizophrenia diagnosed according to research criteria of the International Classification of Diseases (ICD-10), with a mean duration of illness of 5.32 years. Substantial psychopathology was observed at intake and it improved significantly at the end of four weeks. Similar changes were observed in the score of insight and of compliance over four weeks. The insight and the compliance were positively correlated to each other at the beginning and at the end of four weeks. Both of these were negatively correlated with psychopathology scores on both occasions. Insight and psychopathology remain important determinants of treatment compliance in schizophrenia over short term and long term follow up.

A study of relationship between psychopathology, insight and compliance in schizophrenia

A study of relationship between psychopathology, insight and compliance in schizophrenia

The Family Forum: Directions for the Implementation of Family Psychoeducation for Severe Mental Illness

The Family Forum: Directions for the Implementation of Family Psychoeducation for Severe Mental Illness