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Kamali et al. assessed all patients from a Dublin catchment area who were admitted to the services and met the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) criteria for schizophrenia or schizophreniform disorder, over a 4-year period.
This study population used first-episode patients, defined as the first presentation of a patient with acute psychotic symptoms to a psychiatric service.
Data relating to alcohol and drug misuse were derived from the Structured Clinical Interview for DSM Disorders interview.
Lack of judgment and insight was assessed using the Positive and Negative Syndrome Scale.
After 6 months, adherence was assessed using the Compliance Interview—a validated, 6-item interview examining patients concordance with, and knowledge of, prescribed medications.
Nonadherence was defined as 0% to 74% adherence over the preceding 3 months.
20 of 60 patients were nonadherent with medication.
Logistic regression analysis showed that total positive symptom score (P<0.01), alcohol misuse (P=0.01), lack of insight (P=0.04), and drug misuse (P=0.04) predicted nonadherence at 6 months.
- Grandiosity (P=0.04) is the individual positive symptom with the highest predictive power.
- Reduced insight is a more significant predictor of nonadherence (P=0.03) in the subgroup of patients without drug misuse.
Reference:
Kamali M, Kelly BD, Clarke M, et al. A prospective evaluation of adherence to medication in first episode schizophrenia. Eur Psychiatry. 2006; 21(1): 29-33.