Defining and Assessing Adherence to Oral Antipsychotics: a Review of the Literature

Overview

Journal Schizophr Bull

Publisher Oxford University Press

Specialty Psychiatry

Date 2006 May 19

PMID 16707778

Citations 87

Authors

Dawn I Velligan

Yui-Wing Francis Lam

David C Glahn

Jennifer A Barrett

Natalie J Maples

Larry Ereshefsky

Alexander L Miller

Affiliations

Soon will be listed here.

Abstract

The definition and assessment of adherence vary considerably across studies. Increasing consensus regarding these issues is necessary to improve our understanding of adherence and the development of more effective treatments. We review the adherence literature over the past 3 decades to explore the definitions and assessment of adherence to oral antipsychotics in schizophrenia patients. A total of 161 articles were identified through MEDLINE and PsycINFO searches. The most common method used to assess adherence was the report of the patient. Subjective and indirect methods including self-report, provider report, significant other report, and chart review were the only methods used to assess adherence in over 77% (124/161) of studies reviewed. Direct or objective measures including pill count, blood or urine analysis, electronic monitoring, and electronic refill records were used in less than 23% (37/161) of studies. Even in studies utilizing the same methodology to assess adherence, definitions of an adherent subject varied broadly from agreeing to take any medication to taking at least 90% of medication as prescribed. We make suggestions for consensus development, including the use of recommended terminology for different subject samples, the increased use of objective or direct measures, and the inclusion in all studies of an estimate of the percentage of medication taken as prescribed in an effort to increase comparability among studies. The suggestions are designed to advance the field with respect to both understanding predictors of adherence and developing interventions to improve adherence to oral antipsychotic medications.

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References

Adams Jr S, HOWE J . Predicting medication compliance in a psychotic population. J Nerv Ment Dis. 1993; 181(9):558-60. DOI: 10.1097/00005053-199309000-00005. View

Casper E, REGAN J . Reasons for admission among six profile subgroups of recidivists of inpatient services. Can J Psychiatry. 1993; 38(10):657-61. DOI: 10.1177/070674379303801006. View

Hoffmann H . Age and other factors relevant to the rehospitalization of schizophrenic outpatients. Acta Psychiatr Scand. 1994; 89(3):205-10. DOI: 10.1111/j.1600-0447.1994.tb08093.x. View

Weiden P, Rapkin B, Mott T, Zygmunt A, Goldman D, Horvitz-Lennon M . Rating of medication influences (ROMI) scale in schizophrenia. Schizophr Bull. 1994; 20(2):297-310. DOI: 10.1093/schbul/20.2.297. View

Sellwood W, Tarrier N . Demographic factors associated with extreme non-compliance in schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 1994; 29(4):172-7. DOI: 10.1007/BF00802014. View

Xiong W, Phillips M, Hu X, Wang R, Dai Q, Kleinman J . Family-based intervention for schizophrenic patients in China. A randomised controlled trial. Br J Psychiatry. 1994; 165(2):239-47. DOI: 10.1192/bjp.165.2.239. View

Barker S, Barron N, McFarland B, Bigelow D . A community ability scale for chronically mentally ill consumers: Part I. Reliability and validity. Community Ment Health J. 1994; 30(4):363-83. DOI: 10.1007/BF02207489. View

Parker G, Hadzi-Pavlovic D . The capacity of a measure of disability (the LSP) to predict hospital readmission in those with schizophrenia. Psychol Med. 1995; 25(1):157-63. DOI: 10.1017/s0033291700028178. View

McFarlane W, Lukens E, Link B, Dushay R, Deakins S, Newmark M . Multiple-family groups and psychoeducation in the treatment of schizophrenia. Arch Gen Psychiatry. 1995; 52(8):679-87. DOI: 10.1001/archpsyc.1995.03950200069016. View

10.

Norman R, Malla A . Examining adherence to medication and substance use as possible confounds of duration of untreated psychosis. J Nerv Ment Dis. 2002; 190(5):331-4. DOI: 10.1097/00005053-200205000-00010. View

11.

Rzewuska M . Drug maintenance treatment compliance and its correlation with the clinical picture and course of schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 2002; 26(4):811-4. DOI: 10.1016/s0278-5846(01)00294-9. View

12.

Robinson D, Woerner M, Alvir J, Bilder R, Hinrichsen G, Lieberman J . Predictors of medication discontinuation by patients with first-episode schizophrenia and schizoaffective disorder. Schizophr Res. 2002; 57(2-3):209-19. DOI: 10.1016/s0920-9964(01)00312-7. View

13.

Coldham E, Addington J, Addington D . Medication adherence of individuals with a first episode of psychosis. Acta Psychiatr Scand. 2002; 106(4):286-90. DOI: 10.1034/j.1600-0447.2002.02437.x. View

14.

Holzinger A, Loffler W, Muller P, Priebe S, Angermeyer M . Subjective illness theory and antipsychotic medication compliance by patients with schizophrenia. J Nerv Ment Dis. 2002; 190(9):597-603. DOI: 10.1097/01.NMD.0000030524.45210.FD. View

15.

Zygmunt A, Olfson M, Boyer C, Mechanic D . Interventions to improve medication adherence in schizophrenia. Am J Psychiatry. 2002; 159(10):1653-64. DOI: 10.1176/appi.ajp.159.10.1653. View

16.

Sellwood W, Tarrier N, Quinn J, Barrowclough C . The family and compliance in schizophrenia: the influence of clinical variables, relatives' knowledge and expressed emotion. Psychol Med. 2003; 33(1):91-6. DOI: 10.1017/s0033291702006888. View

17.

Hertling I, Philipp M, Dvorak A, Glaser T, Mast O, Beneke M . Flupenthixol versus risperidone: subjective quality of life as an important factor for compliance in chronic schizophrenic patients. Neuropsychobiology. 2003; 47(1):37-46. DOI: 10.1159/000068874. View

18.

Godleski L, Goldsmith L, Vieweg W, Zettwoch N, Stikovac D, Lewis S . Switching from depot antipsychotic drugs to olanzapine in patients with chronic schizophrenia. J Clin Psychiatry. 2003; 64(2):119-22. DOI: 10.4088/jcp.v64n0203. View

19.

Weiss K, Smith T, Hull J, Piper A, Huppert J . Predictors of risk of nonadherence in outpatients with schizophrenia and other psychotic disorders. Schizophr Bull. 2003; 28(2):341-9. DOI: 10.1093/oxfordjournals.schbul.a006943. View

20.

Velligan D, Lam F, Ereshefsky L, Miller A . Psychopharmacology: Perspectives on medication adherence and atypical antipsychotic medications. Psychiatr Serv. 2003; 54(5):665-7. DOI: 10.1176/appi.ps.54.5.665. View