Medication Adherence In Schizophrenia Research Articles

Medication Adherence in Schizophrenia: Role of Opinion Makers

Background: Nonadherence to treatment is a recognized problem and the most challenging aspect of treatment, particularly in first-episode schizophrenia (FES). We aimed to identify a set of individuals in the social milieu of patients as opinion makers who play significant role in influencing treatment-seeking behavior in patients with FES. Materials and Methods: Patients with a diagnosis of schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), first episode, were administered with a 20 items semi-structured questionnaire to identify the individuals and their role in treatment-seeking behavior of patients with FES. Results: A total of 72 patients were enrolled in the study. The mean age of the sample was 29 years (standard deviation [SD] ±7.35), and the mean duration of illness was 9.2 (SD ± 0.58) months. Our study shows that apart from treating psychiatrists, patient's family members and relatives play a crucial role in influencing treatment-seeking behavior such as treatment commencement, drug dose, formulation, place of treatment, etc., A large number of patients went to faith healers on the advice of family members (34.7%) and also followed the advice of family members regarding the duration of treatment (63.3%) as well as discontinuing treatment (63.3%). Conclusion: The index study concludes the role of family members/relatives as opinion makers in the social milieu of patients with FES in influencing treatment-related decisions and affecting adherence to treatment.

Self-reported Medication Adherence in Schizophrenia and Bipolar Disorder Patients during COVID-19 Pandemic in a COVID Care Hospital: A Cross-sectional Study

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has made it difficult for patients with Schizophrenia and Bipolar Affective Disorder (BPAD) to receive ongoing care, which has led to non adherence to medication and undesirable health outcomes. Lower treatment adherence in severe mental illness might lead to symptom exacerbation and relapses and might cause a strain on the health system during COVID-19 pandemic. Aim: To assess the treatment adherence in Schizophrenia and BPAD patients during prevailing COVID-19 situation in India. Materials and Methods: This cross-sectional study was conducted among 92 patients with Schizophrenia and BPAD through a questionnaire between January to September 2021 in a COVID-19 care hospital Government Medical College Palakkad/District hospital Palakkad, Kerala, India. Demographic and clinical data, adherence to treatment, along with Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Depression (HAM-D). Clinical Global impression (CGI S&I), Work and Social Adjustment Scale (WSAS), Modified COVID Threat Scale (CTS) and Medication Adherence Rating Scale (MARS) were collected. The outcomes included adherence to medication, deterioration of the psychopathology, improvement in severity, social functioning. Descriptive statistics was used to define the sample characteristics and presented as mean and standard deviation and frequency and percentages. Spearman’s Correlation coefficient was used to find the correlation between MARS and other variables: CTS, BPRS, YMRS, HAM-D, CGI and WSAS. Results: A total of 92 patients were interviewed which comprised of 43 patients with Schizophrenia and 49 patients with Bipolar disorder. As assessed by MARS rating scale 19 patients (20.65%) had a MARS score less than six suggesting poor adherence and 73 (79.35%) had MARS score 6 and greater suggesting better adherence to the treatment. This was supported by negative correlation with BPRS, YMRS, HAM-D and CGI-S and CGI-I scales which implies that the COVID-19 pandemic did not hinder the patients to take the medication. The mean MARS score was 7.31±2.11. A total of 37 (40.2%) patients had acute exacerbation of the illness during the COVID-19 related lockdown and 37 (40.2%) had exacerbation during the six months prior to COVID-19 lockdown. There was negative correlation between MARS scores and the CTS but was not statistically significant. Conclusion: Despite the COVID-19 pandemic related restriction, patients with Schizophrenia and BPAD were adherent to the medication and the number of relapses during COVID19 pandemic was similar to the period before the pandemic. COVID-19 related anxiety didn’t have an impact on medication adherence and relapse in this study.

Association between functional recovery and medication adherence in schizophrenia.

Medication adherence is important for achieving functional recovery from schizophrenia and is commonly assessed using the Drug Attitude Inventory-30 (DAI-30). Subscales of the DAI-30, including "awareness of the need for medication," "awareness of the effects of psychiatric drugs," and "impression of medication," have been used to assess medication adherence. To determine which of these subscales are associated with the prognosis of schizophrenia, this study followed patients with schizophrenia to identify the prognosis and examine the subscales related to "recovery." In total, 89 patients were recruited, 78 of whom were registered in the study. After assessing adherence using the DAI-30, Positive and Negative Syndrome Scale and Global Assessment of Functioning scores were assessed at 0 and 24week to define the functional prognosis. At the end of the 24-week follow-up period, 36% of patients showed recovery from schizophrenia. A comparison of subscales revealed that the score for "impression of medication" was significantly higher in the recovery than in the non-recovery group. Logistic regression analysis identified only the "impression of medication" score as being predictive of recovery. The results indicated that among the three DAI-30 subscales, "impression of medication" was the most closely associated with recovery in patients with schizophrenia.

Psychotropic medicine beliefs, side effects and adherence in schizophrenia: a patient-caregiver dyad perspective.

Background Medication adherence is essential in the management of schizophrenia. Yet poor treatment uptake has negative consequences on patients and their primary caregivers. Objective To examine the association among beliefs about psychotropic medications, side effects and adherence from a patient-caregiver dyad perspective. Setting This study was conducted in a public psychiatric hospital setting in Accra, Ghana. Methods A cross-sectional study was conducted among 121 patient-caregiver dyads using an interviewer-administered data collection approach.Main outcome measure Beliefs about medicines, side-effects and medication adherence. Results The patient and caregiver-reported level of medication adherence was 28.1 %. Using the Kappa index, the level of agreement between the responses of patients and their caregivers ranged from slight to moderate. Both patients and caregivers rated necessity higher than concern (patients: 1.67 ± 0.84, caregiver: 1.79 ± 0.96). Significant positive relations between specific-necessity, necessity-concerns differential and medication adherence were recorded while specific-concern, general harm and side-effects correlated negatively with medication adherence from the dyad. The odds of adhering to medications increased by 58 and 64 % for each unit increase in specific-necessity and general overuse scores respectively. However, a unit increase in specific-concern score and high side-effects scores were associated with lower odds of adherence. Conclusions This study highlights the need for patient-caregiver collaborations in decision-making relating to medication adherence in schizophrenia. Thus, in clinical practice, there is the need to recognize that caregivers are essential partners, and patient-caregiver views about psychotropic medications are critical in enhancing adherence for positive mental health outcomes.

Insight and medication adherence in schizophrenia: An analysis of the CATIE trial

Adherence to antipsychotic medication is critical for the treatment of patients with schizophrenia. Impaired insight into illness is one of the principal drivers of medication nonadherence, which contributes to negative clinical outcomes. The aims of this study were to examine the relationships between impaired insight and (1) rates of antipsychotic medication nonadherence, and (2) time to medication nonadherence using data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. Insight was assessed using the Positive and Negative Syndrome Scale (PANSS) item G12 (lack of judgment and insight). Patients were divided into 3 groups based on their degree of insight impairment, i.e. no impairment (PANSS G12 = 1), minimal impairment (PANSS G12 = 2–3), and moderate-to-severe insight impairment (PANSS G12 ≥ 4). Medication nonadherence was defined as taking less than 80% of monthly pill counts. Kaplan-Meier survival and Cox regression analyses were performed to examine differences in time to medication nonadherence between insight groups. There were significant differences between insight groups in the percentage of nonadherent patients at 6 months (χ2(2) = 8.80, p = 0.012) and 18 months (χ2(2) = 10.04, p = 0.007) after study initiation. Moderate-to-severe insight impairment was associated with earlier nonadherence compared to minimal (χ2 = 4.70, p = 0.030) or no impairment (χ2 = 11.92, p = 0.001). The association remained significant after adjustment for illness severity, substance use, attitudes toward medication, cognition, level of hostility, and depression. The results of this study indicate a strong link between impaired insight and antipsychotic medication nonadherence. Interventions to enhance insight early during treatment may help improve medication adherence, and in turn, long-term clinical and functional outcomes in patients with schizophrenia.This article is part of the issue entitled ‘Special Issue on Antipsychotics’.

Association between Therapeutic Alliance and Adherence in Outpatient Schizophrenia Patients.

ObjectiveAlthough various clinical factors that affect medication adherence in schizophrenia have been studied, the role of the therapeutic alliance has not been studied in detail. Accordingly, we investigated the association between medication adherence and therapeutic alliance in patients with schizophrenia treated in a community outpatient clinic in Korea.MethodsIn this cross-sectional study, 81 outpatients who met the DSM-IV-TR criteria for schizophrenia were analyzed. Therapeutic alliance was measured via patient-self-report questionnaires consisting of 12 questions, which evaluate both “affective bond” and “collaborative bond” of alliance. We investigated the relationship between medication adherence and therapeutic alliance through correlation and regression analyses.ResultsOverall therapeutic alliance was weakly associated with medication adherence (r=0.268, p<0.05). Among two factors of therapeutic alliance, “affective bond” was associated with adherence (r=0.302, p<0.05), but collaborative was not. Regression analysis showed that therapeutic alliance significantly predicted medication adherence even after adjustment for duration of treatment, insight, and symptom severity.ConclusionMaintaining a favorable therapeutic alliance is associated with medication adherence in schizophrenia. Further, treating patients in a frank and genuine manner might be important to improve adherence.

Randomized controlled trial of the effects of nursing care based on a telephone intervention for medication adherence in schizophrenia.

Our aim was to determine the effects of "Telephone Intervention Problem Solving" (TIPS) on medication adherence among individuals diagnosed with schizophrenia. This randomized controlled trial was conducted with 45 patients. TIPS was applied to the intervention group for 2 months, whereas the control group received routine care. We found that the rate of voluntary continuation of medicine (P < 0.001), belief in the necessity of medication (P = 0.008) and medication adherence scores were higher in the intervention group (P < 0.001). This study may serve as a guide for applying telephone communication to clinical interventions in psychiatric nursing.

Medication adherence in schizophrenia: Understanding patient's views

Background: Schizophrenia is a chronic mental disorder that requires long-term treatment. Non-adherence to antipsychotics is common and associated with poor outcomes. Numerous studies have reported factors that influence non-adherence but without exploring the patient’s views. Aims and Objectives: The present study was undertaken to analyze patient views on non-adherence to antipsychotic medication in schizophrenia. Materials and Methods: This cross-sectional study was conducted among patients diagnosed as schizophrenia by the psychiatrist, on antipsychotic medication and providing informed consent. Each patient’s demographic, clinical, and treatment data along with the adherence levels using Medication Adherence Rating Scale (MARS) were recorded along with reasons for medication adherence behavior. The statements were reviewed and grouped into six categories: Insight, medication attitude and expectation, family support, efficacy of medication, side effects, and information. Results: A total of 72 patients were included in the study. The mean age was 38±12 years and non-adherence to antipsychotic medications was 46%. Reasons stated for non-adherence were lack of illness insight (37%) followed by negative medication attitude (29%) and lack of family support (9%). In adherent group, the presence of insight about illness (40%), followed by positive medication attitude (23%) and having family support (17%) was recorded. Conclusion: Non-adherence to antipsychotic medication was noted to be 46%. Illness insight, followed by medication attitude of the patients, plays an important role in the medication adherence behavior of the patients.

Pharmacokinetics and Safety of Risperidone Subcutaneous Implants in Stable Patients With Schizophrenia

A subcutaneous risperidone implant (RI) formulation was developed to improve medication adherence in schizophrenia. Two phase 1 studies were conducted to evaluate the pharmacokinetics of RI in adult patients with schizophrenia. In study 1, all subjects were stable on 4 mg oral risperidone; subsequently, the first subject received 375mg RI for 1 month, and the remaining subjects received 375mg RI for 3 months. In study 2, all subjects were stable on oral risperidone 4mg, 6mg, or 8mg and subsequently received RI 480mg, 720mg, or 960mg, respectively, for 6 months. Blood samples were collected at prespecified time points. Various pharmacokinetic parameters were determined in both studies. In both studies risperidone total active moiety plasma concentrations following RI increased slowly, reached therapeutic levels within approximately 2 days, and remained relatively stable. In study 1, the average concentration for RI was 81.3% of the oral trough concentration and 27.5% of the oral peak concentration. In study 2, the steady-state concentration for RI was comparable to the oral trough concentration of the corresponding dose. Patient disease status remained stable with no major safety issues. RI may represent an alternative formulation for schizophrenia treatment with a lower peak-to-trough plasma drug ratio than oral risperidone.

Correction: Patients' Knowledge about Prescribed Antipsychotics and Medication Adherence in Schizophrenia: A Cross-Sectional Survey.

Introduction Data on the knowledge about antipsychotic medications prescribed in patients with schizophrenia are very limited. Moreover, it remains unclear how patients’ knowledge about prescribed antipsychotics affects medication adherence. Methods ighty-one Japanese outpatients with schizophrenia according to the International Classification of Diseases, 10th edition, were included. Patients’ knowledge of the primary antipsychotics prescribed to them in terms of therapeutic effects, type, and implicated neurotransmitters was assessed with a multiple-choice questionnaire developed for this study. Medication possession ratios (MPRs) were compared between patients who answered correctly and those who did not in each category. Results The percentages of subjects who answered correctly regarding antipsychotic effects, type, and implicated neurotransmitters were low at 30.9%, 30.9%, and 7.4%, respectively. No differences were found in MPRs between subjects who answered correctly and those who did not. Discussion Our preliminary results indicate that patients lack knowledge about their antipsychotic medications. More concerning, they suggest that knowledge about prescribed antipsychotics may not directly translate into actual medication adherence in patients with schizophrenia.

Medication adherence in schizophrenia: The role of insight, therapeutic alliance and perceived trauma associated with psychiatric care

Medication non adherence in schizophrenia is a major cause of relapse and hospitalization and remains for clinicians an important challenge. This study investigates the associations between insight, therapeutic alliance, perceived trauma related to psychiatric treatment and medication adherence in patients with schizophrenia. In this multicenter study, 72 patients were assessed regarding symptomatology, self-reported adherence with medication, insight, medication side-effects, therapeutic alliance and perceived trauma related to psychiatric treatment. Structural Equation Modeling (SEM) was used to test predicted paths among these variables. The data fit a model in which medication adherence was directly predicted by insight, therapeutic alliance and perceived trauma related to psychiatric treatment. Perceived trauma moderates the role of insight on medication adherence. The final model showed good fit, based on four reliable indices. Greater adherence was correlated with higher insight, higher therapeutic alliance and lower perceived trauma. These three variables appear to be important determinants of patient's medication adherence. Medication adherence could be enhanced by reducing perceived trauma and by increasing insight. The need for mental health providers to acknowledge patients' potentially traumatic experience with psychiatric treatment and the need to encourage greater involvement in care are discussed.

Medication Adherence in Schizophrenia: A Hospital Based Cross Sectional Study of Family Related Factors

Adherence to medication is essential in schizophrenia for improved outcome. Studies on family related factors associated with the adherence are sparse. To determine the adherence rate and to explore the family related factors in relation to antipsychotic medication adherence along with socio-demographic and clinical factors, among patients with schizophrenia. It was a cross sectional study. 20 patients with schizophrenia with their close family member were assessed on medication adherence rating scale, family interaction pattern scale (FIPS), family interview burden schedule (FIBS) and social support questionnaire along with brief psychiatry rating scale and insight scale for psychosis. Showed 35% of subjects were poorly adherent to medications. They had significantly lesser mean age (t = 2.23, p = 0.038), lesser cohesion (t = 2.327, p = 0.03) in FIPS and higher effect on family interaction (t = 2.64, p = 0.01) on FIBS scale. Dysfunctional family interaction is associated with poor adherence and could be a result of perceived burden of illness in schizophrenia. This could have direct implications in planning interventions for psychosis.

Patients' Knowledge about Prescribed Antipsychotics and Medication Adherence in Schizophrenia: A Cross-Sectional Survey.

Introduction Data on the knowledge about antipsychotic medications prescribed in patients with schizophrenia are very limited. Moreover, it remains unclear how patients' knowledge about prescribed antipsychotics affects medication adherence. Methods ighty-one Japanese outpatients with schizophrenia according to the International Classification of Diseases, 10th edition, were included. Patients' knowledge of the primary antipsychotics prescribed to them in terms of therapeutic effects, type, and implicated neurotransmitters was assessed with a multiple-choice questionnaire developed for this study. Medication possession ratios (MPRs) were compared between patients who answered correctly and those who did not in each category. Results The percentages of subjects who answered correctly regarding antipsychotic effects, type, and implicated neurotransmitters were low at 30.9%, 30.9%, and 7.4%, respectively. No differences were found in MPRs between subjects who answered correctly and those who did not. Discussion Our preliminary results indicate that patients lack knowledge about their antipsychotic medications. More concerning, they suggest that knowledge about prescribed antipsychotics may not directly translate into actual medication adherence in patients with schizophrenia.

The Nursing Assessment of Medication Acceptance: the reliability and validity of a schizophrenia medication adherence scale.

Many patients with schizophrenia have low medication adherence. There is, however, no objective assessment scale that can be used by nurses or caregiver specialists. The Nursing Assessment of Medication Acceptance (NAMA) was developed to assess patients' medication adherence. The aim of this study was to examine the validity and reliability of the NAMA in patients with schizophrenia. A total of 121 Japanese patients with schizophrenia were enrolled. All patients underwent evaluation using the NAMA and the Drug Attitude Inventory (DAI-10). Reliability was investigated using a test-retest method and a parallel-test method. To determine the test-retest reliability of the NAMA, we tested 101 schizophrenia patients twice, with the second assessment 2-4 weeks after the date of the first assessment. For validity verification, standard-related validity and the degree of concordance with the DAI-10 scores were measured. The Cronbach's alpha value of the NAMA in schizophrenia was 0.88. The test-retest correlation coefficients were all between 0.53-0.74. The total scores and all subscores for the NAMA were significantly correlated, and the NAMA total scores were significantly correlated with the DAI-10 total scores. The NAMA shows good reliability and validity in measuring medication adherence in schizophrenia.

PM518. Medication Adherence in schizophrenia: Focus on therapeutic relationship

PM518. Medication Adherence in schizophrenia: Focus on therapeutic relationship

Medication adherence in schizophrenia

IntroductionCompliance is a major issue in the treatment of schizophrenia. Many studies have attempted to identify factors that influence it.ObjectiveTo assess treatment adherence in patients with schizophrenia. To identify factors correlated with poor adherence.MethodsIt was a cross-sectional, descriptive and analytical study, involving 37 outpatients with DSM-IV diagnosis of schizophrenia, followed in the psychiatry department at the Hédi Chaker University Hospital of Sfax (Tunisia). The questionnaire included socio-demographic, clinical and therapeutic data. We also used the Medication Adherence Rating Scale “MARS”, the Insight Scale “IS” and the Stigma Scale (9 items).ResultsThe average age was 36.4 years. The majority of patients was male (68.8%), did not exceed the level of secondary education (89.2%) and had a low socioeconomic level (84.4%).Paranoid schizophrenia was the most frequent type of schizophrenia (54.1%). Atypical antipsychotic were prescribed in 40.5% of cases.Patients were non-adherent to treatment in 56.8% of cases. The factors correlated with poor adherence were: psychoactive substance use (P = 0.036), sexual dysfunction (P = 0.036), complexity of treatment (P = 0.036), poor insight according to the subscale “awareness of the need for treatment” of the IS (P = 0.047) and high score on the subscale “discrimination” of the Stigma Scale (P = 0.008).ConclusionTunisian schizophrenic patients have a poor adherence to treatment. Acting on risk factors (such as substance use, sexual side effects, poor insight and discrimination perception) would improve patient compliance and management of schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Factors affecting adherence in patients with schizophrenia

Background: Nonadherence with medication regimens is among the most common causes of psychotic relapse and the need for rehospitalisation. This study was designed to look into the factors affecting attitude towards medication adherence in Schizophrenia and its relationship with severity of illness, side effects of medication. Methods: Adult males and females in the age range of 18-55 years fulfilling criteria for schizophrenia according to ICD – 10, DCR, and reporting at outpatient department were taken up for this study. Severity of illness was assessed by Brief Psychiatric Rating Scale (BPRS), Side effects to medication were assessed by Udvalg for Kliniske Undersogelser (UKU) side effect scale, and Adherence was assessed by Medication adherence rating scale (MARS). Results: Adherence negatively correlated with severity of illness, and side effects in the form of increased sleep duration, asthenia, increased fatigability, lassitude and diminished sexual desire. Regression analysis with MARS as dependent variable showed side effects of medication in the form of increased sleep duration in followed by asthenia, lassitude, and increased fatigability to be predictors of poor adherence in the sample. Conclusions: Poor adherence is associated with severity of schizophrenia, sedation and asthenia like side effects due to medication. Sedation and asthenia like side effects caused a decline in adherence.

Nurses' perceptions of medication adherence in schizophrenia: results of the ADHES cross-sectional questionnaire survey.

Poor adherence to antipsychotic treatment is a widespread problem within schizophrenia therapy with serious consequences including increased risks of relapse and rehospitalization. Mounting evidence supports the key roles that nurses play in monitoring patient progress and facilitating long-term treatment adherence. The Adherencia Terapéutica en la Esquizofrenia (ADHES) nurses' survey was designed to assess the opinions of nurses on the causes and management of partial/nonadherence to antipsychotic medication. A questionnaire-based cross-sectional survey of 4120 nurses from Europe, the Middle East and Africa. Interpretation of results was based on a descriptive comparison of responses. Nurses perceived 54% of patients seen in the preceding month to be partially/nonadherent to treatment. Most nurses (90%) reported some level of experience with administration of long-acting injectable (LAI) antipsychotics, with 24% of nurses administering >10 injections per month. The majority (85%) of nurses surveyed believed that improving adherence would improve patient outcomes. Nearly half (49%) reported that most of their patients depend on a family member or other nonprofessional carer to remind them to take their medication as prescribed. A similar proportion of nurses (43%) reported that most of their patients relied on a professional to remind them to take medication. Most nurses (92%) felt that ensuring continuous medication with LAI antipsychotics would yield long-term benefits for patients, but their opinion was that over a third of patients were unaware of LAI antipsychotic treatments. In a series of forced options, the strategy used most often by respondents (89%) to promote medication adherence was to build trusting relationships with patients while listening to and interpreting their needs and concerns. Respondents also rated this as the most effective strategy that they used (48%). Nurses are highly aware of adherence issues faced by their patients; further patient education on treatment options is needed.

Comparative Study of Insight and Medication Adherence in Schizophrenia and Bipolar Disorder.

Insight is defined as the recognition that one has a mental disorder, the ability to identify its symptoms, and cognizance of the need for treatment. Lack of insight into having a mental disorder is found to be associated with a poorer clinical outcome, treatment noncompliance, and a more severe cognitive impairment. Compare the insight and medication adherence in a population of schizophrenia and bipolar disorder patients. We assessed and compared the insight and compliance of 60 patients with schizophrenia (n=30) and bipolar disorder (n=30) recruited in Psychiatry department Sfax, Tunisia. Insight was assessed using the rating scale of consciousness disorder (Q8). Adherence was assessed using the Drug Attitude Inventory [ICD-10]. Patients were mainly young adults, male (70%) and did not live in a couple (61.7%). About half of them (43.3%) had no profession. Insight was low in 15% of patients, intermediate in 53.3%, and good in 31.7% of cases. Bipolar disorder patients displayed better insight into having a mental disorder compared to schizophrenia patients (p=0.04) Good adherence was observed in 64.4% of patients. Factor influencing adherence in both populations was the type of treatment: patients treated with atypical antipsychotics have better compliance (p = 0.005). A good insight was significantly correlated with good adherence (p = 0.000) Our results showed that bipolar disorder patients have better insight compared to schizophrenia patients. So it is necessary; in schizophrenia; to work on awareness of the disorder and the need for treatment to improve adherence.

Post-discharge medication adherence in schizophrenia

Aim of the studyTo assess the stability of medication adherence and risk factors for non-adherence in outpatients with schizophrenia after hospital discharge.Subject or material and methodsPatients with schizophrenia (n=40) were recruited one month after hospital discharge for acute hospitalization and followed up for 5 months. Medication adherence and relevant clinical variables and socio-demographic factors were assessed at baseline and at the end of follow-up.ResultsOne month after hospital discharge 32.5% of the patients showed high treatment adherence. Adherence rates decreased further up to 16.7% six months after hospital discharge. While antipsychotic side effects differentiated adherent from non-adherent patients at baseline, both groups were differentiated at follow-up by the level of insight. Non-adherence prior to hospitalization and in the first month after hospital discharge, and hospitalization in the previous year predicted further non-adherence.DiscussionMedication adherence in schizophrenia decreases substantially after hospital discharge with partial adherence being common in clinical practice. Risk factors for non-adherence have been identified. The post-discharge period seems important for establishing high treatment adherence in schizophrenia.ConclusionsVigorous interventions in community-based settings should be applied in the post-discharge period in order to improve medication adherence and outcome in outpatients with schizophrenia.