Treatment Adherence In Schizophrenia Research Articles

411. Investigating the Effects of Adjunctive Transcranial Direct Current Stimulation on Treatment Adherence in Schizophrenia: Study Progress

411. Investigating the Effects of Adjunctive Transcranial Direct Current Stimulation on Treatment Adherence in Schizophrenia: Study Progress

The Relationship Between Internal Stigmatisation, Recovery and Treatment Adherence in Individuals with Schizophrenia

IntroductionSchizophrenia has a clinical course that has a great negative impact on the daily life of the person due to the cognitive and social problems it causes. Internalised stigmatisation is a very common negative phenomenon in individuals diagnosed with schizophrenia. It is known that treatment adherence is low in schizophrenia patients with high levels of internalised stigma. Lack of adequate treatment adherence in these patients is a negative factor in terms of recovery. Reducing the level of internal stigmatisation and reinforcing treatment adherence in schizophrenia has a positive effect on recovery. Considering this situation, it is important to determine the relationship between internal stigmatisation, treatment adherence and recovery in schizophrenia patients. In the literature review, there were no studies in which the relationship between internal stigmatisation, recovery and treatment adherence in individuals diagnosed with schizophrenia was carried out together.ObjectivesIn this study, it was aimed to fill the existing gap in the relevant field and to be a resource for further intervention programmes.MethodsThe study was planned as descriptive. The sample of the study consisted of individuals diagnosed with schizophrenia aged 18 years and over who met the inclusion criteria and accepted to participate in the study by purposive sampling method. In the power analysis, the sample number was calculated as (N=80) with a margin of error of 0.5. Personal information form, Internalised Stigma Scale in Mental Illness (ISMI), Recovery Assessment Scale (RAS) and Medication Adherence Rating Scale (MARS) were used for data collection. IBM SPSS 27.0 package programme was used for statistical analysis.ResultsThe data are still being analysed in detail by the researchers. The findings and relational results of the study will be presented.Conclusions It is thought that the results of the study will contribute to the reporting of the relationship between intrinsic stigma, recovery and treatment adherence in individuals diagnosed with schizophrenia, and by revealing the relationship between the variables, it is thought that it will be a source for planning interventions that will increase the treatment adherence and recovery perceptions of schizophrenia patients and reduce their intrinsic stigma.Disclosure of InterestNone Declared

Impact of insight quality on treatment adherence in schizophrenia

IntroductionSchizophrenia is a chronic, frequent, and disabling psychiatric condition. The prognosis is more severe in the absence of treatment.ObjectivesThe aims of our study were to evaluate the quality of treatment adherence and the quality of insight of patients with schizophrenia and to assess the implication of these factors as predictors of poor adherence.MethodsWe conducted a cross-sectional and analytical study. We recruited 150 patients with schizophrenia treated at Razi Hospital of Manouba, divided into 113 patients with good adherence compared to 37 patients with poor adherence. We used the Medical Adherence Report Scale (MARS) to assess the quality of therapeutic adherence and the Birchwood Insight Scale for Insight Assessment.ResultsPoor treatment adherence in patients with schizophrenia was significantly associated with poor insight (p=0.001). Good adherence was associated with positive perception of treatment effectiveness (p<0.001). The predictive factor for poor adherence to therapy in multivariate analysis, after adjusting for the confounding variables was the negative perception of side effects (p=0.02). The predictive factor for good adherence was the presence of insight into the need for treatment (p=0.002).ConclusionsTo prevent poor treatment adherence, a systematic screening for predictive factors and adequate management of schizophrenia would be imperative.Disclosure of InterestA. Rami Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no, E. Sana Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no, C. Mejda Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no, D. Rahma Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no

Adverse Events and Treatment Adherence in Schizophrenia.

Adverse Events and Treatment Adherence in Schizophrenia.

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.

Strategies for Promoting Treatment Adherence in Schizophrenia

Promoting treatment adherence in schizophrenia remains a primary challenge, with nonadherence resulting in a range of challenges across the biological, social, and psychological spectrum. While unknown nonadherence is a central cause of failed psychopharmacological treatment resulting in the initiation of more complex treatment regimens and higher antipsychotic doses, leading to a cycle of further unknown nonadherence and illness exacerbation. This article reviews the importance of treatment adherence including a discussion that can be utilized for promoting treatment adherence in schizophrenia. The following strategies are discussed; the importance of the therapeutic alliance, the use of motivational interviewing, nonpharmacological interventions, pharmacological interventions, and long-acting injectable (LAI) antipsychotics. The article concludes by restating the importance of treatment adherence in schizophrenia and making the patient aware of the consequences of nonadherence. Further, the role of LAI antipsychotics in adherence is highlighted.

P.546 Is self-compassion linked to treatment adherence in schizophrenia?

The aim of the present study was to assess the influence of scaling and root planing (SRP) with adjunct antimicrobial photodynamic therapy (aPDT) on periodontal parameters and gingival crevicular fluid (GCF) cortisol levels in type-2 diabetic and non-diabetic patients with periodontitis.One hundred and twenty-eight patients with periodontitis (64 with and 64 without type-2 diabetes mellitus, respectively) were included. In the test- and control-groups, patients underwent SRP with and without aPDT, respectivey. In both groups, plaque and gingival indices (PI and GI), probing depth (PD), clinical attachment loss (CAL), marginal bone loss (MBL) and GCF volume and cortisol levels were assessed at baseline and three and six-months after SRP with or without aPDT. The aPDT was performed at baseline using methylene blue and photobiomodulation. The Kruskall-Wallis test was used to assess data normality; and group-comparisons were done. P-values, which were below 0.01 indicated statistical significance.Sixty-four type-2 diabetic patients with and 64 non-diabetic patients with periodontitis were included. All individuals had Stage-III/Grade-C periodontitis. Among patients with type-2 diabetes mellitus (DM), there was no statistically significant difference in hemoblobin A1c, PI, GI, PD, CAL and MBL at baseline and at 3- and 6-months intervals. Amongst diabetic patietns, there was no difference in the GCF volume and cortisol levels in the test- and control-groups at all time intervals. In non-diabetic patients, there was a significqnt reductionin GCF volume and cortisol levels when SRP was done with aPDT than when SRP was carried out as the sole treatment strategyAmong non-diabetic patients, SRP with aPDT helps reduce periodontal inflammation and GCF cortisol levels for up to 6-months; however poorly-controlled DM compromises the beneficial effects of this treatment strategy.

Supervised treatment in outpatients for schizophrenia plus (STOPS+): protocol for a cluster randomised trial of a community-based intervention to improve treatment adherence and reduce the treatment gap for schizophrenia in Pakistan

IntroductionThere is a significant treatment gap, with only a few community-based services for people with schizophrenia in low-income and middle-income countries. Poor treatment adherence in schizophrenia is associated with poorer...

The Predicted Long-Term Benefits of Ensuring Timely Treatment and Medication Adherence in Early Schizophrenia

The impact of initiatives aimed at reducing time in untreated psychosis during early-stage schizophrenia will be unknown for many years. Thus, we simulate the effect of earlier treatment entry and better antipsychotic drug adherence on schizophrenia-related hospitalizations, receipt of disability benefits, competitive employment, and independent/family living over a ten-year horizon. We predict that earlier treatment entry reduces hospitalizations by 12.6–14.4% and benefit receipt by 7.0–8.5%, while increasing independent/family living by 41.5–46% and employment by 42–58%. We predict larger gains if a pro-adherence intervention is also used. Our findings suggest substantial benefits of timely and consistent early schizophrenia care.

The Effects of Non-invasive Brain Stimulation on Treatment Adherence in Schizophrenia

The Effects of Non-invasive Brain Stimulation on Treatment Adherence in Schizophrenia

Understanding and Managing Treatment Adherence in Schizophrenia

Schizophrenia is a chronic, debilitating and costly illness. The course of illness is often exacerbated by relapses which are associated with negative outcomes including rehospitalisation. The most important risk factor associated with relapse is medication nonadherence. Medication nonadherence is not specific to schizophrenia and is an issue across all of medicine. The objective of this paper is to present a narrative review which synthesizes the rates and predictors of medication nonadherence, as well as associated interventions, across schizophrenia, first episode psychosis and general medicine. Given the breadth of these topics, this paper does not aim to present a complete review of the data but rather a concise synthesis of several lines of research in order to provide a general framework for approaching this important topic. Overall, this paper identifies that rates and risk factors of nonadherence in schizophrenia are similar to those reported in general medicine. Rates of adherence are estimated at 50% for both. Predictors of nonadherence were also quite similar between various illnesses, with lack of insight, poor family support and substance abuse often being highlighted. Well studied approaches of improving adherence include simplifying medication regimens, psychoeducation, engaging family support and use of long-acting injectable antipsychotics. Emerging interventions included text-message reminders, financial incentives and MyCite technology. Additionally, several evidence based interventions were identified in general medicine that may have applicability in schizophrenia and first episode psychosis. Lastly, avenues of future research were identified including the need to further characterize the dichotomy between adherence, partial adherence and nonadherence.

Erratum to: Improving Treatment Adherence in Schizophrenia

Erratum to: Improving Treatment Adherence in Schizophrenia

Improving Treatment Adherence in Schizophrenia

Poor treatment adherence among people with schizophrenia is associated with several negative outcomes, including increased risk of symptom relapse, persistent psychotic symptoms, frequent hospitalizations, increased emergency room use, and suicide attempts. In addition, the benefits of treatment adherence in this population include improved quality of life and reduced treatment costs. Clearly, feasible and effective strategies to maximize treatment adherence are essential. Interventions to promote adherence to medications include environmental cues and supports, technology-based interventions, medication management coordinators, adherence therapy, and the use of long-acting injectable medications. Interventions to promote continuity of care between inpatient and outpatient treatment include Assertive Community Treatment, transitional care models, and the use of peer support personnel as care navigators. Transitional care models have also demonstrated effectiveness in promoting adherence to primary care follow-up among people with schizophrenia and comorbid medical illnesses. In the context of complex treatment regimens for psychiatric and medical illnesses, thorough education and skill development on illness management and health promotion, tailored to the unique learning needs of PWS, are essential. In addition, more research is needed to address understanding of medical illnesses, the accuracy in which people with schizophrenia implement activities for medical illness self-management, and development of strategies to promote engagement in health promotion activities among people with schizophrenia.

Treatment adherence in schizophrenia: A patient-level meta-analysis of combined CATIE and EUFEST studies

The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) obtained a sample of 1493 chronic schizophrenia patients. The European First Episode Schizophrenia Trial (EUFEST) studied a sample of 498 patients. We have combined these two samples to study the predictors and correlates of adherence to treatment. Here we report on adherence to pharmacological treatment at the six and twelve month assessments of these trials with a combined subsample of 1154 schizophrenia patients. Individual patients׳ data were used for analyses. We used logistic regression to examine the effects of substance use, akathisia, parkinsonism, dyskinesia, hostility, and insight on pharmacological adherence. The results showed that reduced adherence to pharmacological treatment was associated with substance use (p=0.0003), higher levels of hostility (p=0.0002), and impaired insight (p<0.0001). Furthermore, poor adherence to study medication was associated with earlier discontinuation in the combined data. The clinical implications of the results point to the importance of routine assessments and interventions to address patients׳ insight and comorbid substance use and the establishment of therapeutic alliance.

Shared understanding in psychiatrist–patient communication: Association with treatment adherence in schizophrenia

ObjectiveEffective doctor–patient communication, including a shared understanding, is associated with treatment adherence across medicine. However, communication is affected by a diagnosis of schizophrenia and reaching a shared understanding can be challenging. During conversation, people detect and deal with possible misunderstanding using a conversational process called repair. This study tested the hypothesis that more frequent repair in psychiatrist–patient communication is associated with better treatment adherence in schizophrenia. MethodsRoutine psychiatric consultations involving patients with (DSM-IV) schizophrenia or schizoaffective disorder were audio-visually recorded. Consultations were coded for repair and patients’ symptoms and insight assessed. Adherence was assessed six months later. A principal components analysis reduced the repair data for further analysis. Random effects models examined the association between repair and adherence, adjusting for symptoms, consultation length and the amount patients spoke. Results138 consultations were recorded, 118 were followed up. Patients requesting clarification of the psychiatrist's talk and the clarification provided by the psychiatrist was associated with adherence six months later (OR 5.82, 95% CI 1.31–25.82, p=0.02). ConclusionThe quality of doctor–patient communication also appears to influence adherence in schizophrenia. Practice implicationsFuture research should investigate how patient clarification can be encouraged among patients and facilitated by psychiatrists’ communication.

2965 – How to assess and study treatment adherence in schizophrenia? The influence of clinical trial design on adherence outcome measures

The primary goals of maintenance treatment in schizophrenia are sustained symptomatic control, relapse prevention, and delaying functional and cognitive decline. 1 Successful pharmacotherapy is dependent on several factors including efficacy, therapeutic alliance, availability of optimal dosages and formulations, treatment adherence, and a low side-effect burden. New long-acting injectable (LAI) formulations of atypical antipsychotics have been developed to address suboptimal therapy outcomes by enhancing drug delivery, assuring efficacy of treatment, reducing side effects, and improving compliance. 2 Evidence differentiating the effectiveness of oral vs. long-acting antipsychotics is difficult to obtain in randomized controlled trials (RCTs) where adherence to both is optimized. RCTs are designed to establish clinical efficacy in an “ideal” setting in which medication adherence is controlled and highly regulated. 3 However, RCTs cannot by definition assess treatment effectiveness. Conversely, naturalistic studies that mimic clinical practice are more likely to uncover real-world effectiveness differences of different treatment options. Research has demonstrated major benefits of LAIs in naturalistic studies, including large, nationwide cohort studies and mirror-image studies where patients serve as their own controls. Results from these trials are likely to be underestimated in RCTs owing to stringent inclusion criteria, frequent clinic visits and direct provision of medications. 4 Therefore, data from meta-analyses can be misleading if the trial design is not considered in the interpretation of the results. 5 Furthermore, naturalistic studies can more accurately assess the consequences for patients with regards to relapse and rehospitalization rates. Therefore, clinicians have to be aware of the origin of data and its impact on the results before making treatment decisions. The current presentation will critically review data from 3 meta-analyses comparing LAIs with oral antipsychotics, exploring how to interpret the data from different trial designs in the context of unmet patient needs, and how the results from differential designs may impact treatment outcomes.

P.3.e.008 Treatment adherence in schizophrenia using risperidone long-acting injectable: as early as possible, as long as possible

To systematically review studies of communication and decision-making in mental health-based samples including BP patients.Qualitative systematic review of studies using PsychINFO, MEDLINE, SCOPUS, CINAHL, and EMBASE (January 2000–March 2015). One author assessed study eligibility, verified by two co-authors. Data were independently extracted by two authors, and cross-checked by another co-author. Two independent raters assessed eligible studies using a validated quality appraisal.Of 519 articles retrieved, 13 studies were included (i.e., 10 quantitative/1 qualitative/1 mixed-methods). All were cross-sectional; twelve were rated good/strong quality (>70%). Four inter-related themes emerged: patient characteristics and patient preferences, quality of patient-clinician interactions, and influence of SDM/patient-centred approach on patient outcomes. Overall BP patients, like others, have unmet decision-making needs, and desire greater involvement. Clinician consultation behaviour influenced patient involvement; interpersonal aspects (e.g., empathy, listening well) fostered therapeutic relationships and positive patient outcomes, including: improved treatment adherence, patient satisfaction with care, and reduced suicidal ideation.This review reveals a paucity of studies reporting bipolar-specific findings. To inform targeted BP interventions, greater elucidation of unmet decision-making needs is needed.Eliciting patient preferences and developing a collaborative therapeutic alliance may be particularly important in BP, promoting improved patient outcomes.

Treatment Adherence in Schizophrenia and Schizoaffective Disorder

Medication nonadherence is common and difficult to detect in patients with schizoaffective disorder and schizophrenia. Roughly 50% of patients take less than 70% of prescribed doses. Many factors contribute to nonadherence, including poor illness insight, a negative attitude toward medication, substance abuse, and disorganization. Interventions to improve adherence consist of advising acceptance of illness, drawing analogies with treatment for chronic medical disease, and involving the patient in decision making. Clinicians must remain nonjudgmental, encouraging patients to disclose problems with adherence and anticipating that improvement in adherence may require a prolonged effort. Selection of medication is critical to avoid side effects and to provide a sense of well-being, which can result from improvement in insomnia, anxiety, or depression. Depot antipsychotics can improve adherence and provide the clinician with reliable information about the dosage of medication received for purposes of dose adjustments or to guide response to relapse.

Neuropsychological correlates of cognitive insight in schizophrenia

Clinical practice has highlighted a possible discrepancy between patient's verbal assertions, called clinical insight, and the actual convictions about the illness, called emotional insight. The complementary construct of cognitive insight refers to the cognitive processes involved in self-reflection and the ability to modify erroneous beliefs and misinterpretations. The aim of this study was to determine the psychopathological and neuropsychological predictors of cognitive insight in schizophrenia. Sixty outpatients with Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) schizophrenia diagnosis were administered the Beck Cognitive Insight Scale, the Positive and Negative Symptom Scale (PANSS), and a comprehensive neuropsychological battery. Results indicate that poor global cognitive insight in schizophrenia is significantly related to lower visual working memory, while a higher self-overconfidence is significantly related to deficits in verbal and visual memory and to the failure in using external information to correct erroneous convictions. Thus, our study suggests that impaired cognitive insight depends mainly on reduced working memory and executive function performances. These findings highlight the fundamental importance of the development of specific therapeutic strategies to improve the metacognitive components of insight in order to enhance treatment adherence in schizophrenia.

An educational intervention designed to improve treatment adherence in schizophrenia

An educational intervention designed to improve treatment adherence in schizophrenia