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Clinical Drug Investigation
Published in: Clinical Drug Investigation 2/2013

01-02-2013 | Review Article

Improving Treatment Adherence in Your Patients with Schizophrenia

The STAY Initiative

Authors: Fernando Cañas, Koksal Alptekin, Jean Michel Azorin, Vincent Dubois, Robin Emsley, Antonio G. García, Philip Gorwood, Peter M. Haddad, Dieter Naber, José M. Olivares, Georgios Papageorgiou, Miquel Roca

Published in: Clinical Drug Investigation | Issue 2/2013

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Abstract

Partial and non-adherence to medication is a common problem in schizophrenia, leading to an increased risk of relapse, increased likelihood of hospitalization and poorer long-term outcomes. In contrast, continuous medication in the treatment of schizophrenia is associated with positive outcomes, including improved clinical status, improved quality of life and functioning, and reduced risk of relapse and rehospitalization. Strategies aimed at improving medication adherence are therefore key for patients to achieve their treatment goals. In an attempt to address the issues of partial/non-adherence to antipsychotic medication in schizophrenia, a group of psychiatrists convened to discuss and develop a set of principles aimed at helping patients adhere to their medication. These principles were then refined and developed into the STAY (the Six principles to improve Treatment Adherence in Your patients) initiative following presentation to a wider group of psychiatrists from across Europe. This manuscript summarizes these principles and explains the rationale for their selection. These principles are: (1) recognizing that most patients with schizophrenia are at risk of partial/non-adherence at some time during the course of their illness; (2) the benefits of a good therapeutic alliance for identifying potential adherence issues; (3) tailored treatment plans to meet an individual’s needs, including the most suitable route of delivery of antipsychotic medication; (4) involving family/key persons in care and psychoeducation of the patient, assuming the patient agrees to this; (5) ensuring optimal effectiveness of care; and (6) ensuring continuity in the care of patients with schizophrenia. The application of these six principles should help to raise awareness of and address poor patient adherence, as well as generally improving care of patients with schizophrenia. In turn, this should lead to improved overall clinical outcomes for patients receiving long-term treatment for schizophrenia.
Literature
1.
Valenstein M, Ganoczy D, McCarthy JF, et al. Antipsychotic adherence over time among patients receiving treatment for schizophrenia: a retrospective review. J Clin Psychiatry. 2006;67(10):1542–50.PubMedCrossRef
2.
3.
Coldham EL, Addington J, Addington D. Medication adherence of individuals with a first episode of psychosis. Acta Psychiatr Scand. 2002;106(4):286–90.PubMedCrossRef
4.
Weiden PJ, Zygmut A. Medication noncompliance in schizophrenia. Part I: Assessment. J Pract Psych Behav Health. 1997;3:106–10.
5.
Peuskens J, Olivares JM, Pecanak J, et al. Treatment retention with risperidone long-acting injection: 24-month results from the Electronic Schizophrenia Treatment Adherence Registry (e-STAR) in six countries. Curr Med Res Opin. 2010;26(3):501–9.PubMedCrossRef
6.
Alonso J, Croudace T, Brown J, et al. Health-related quality of life (HRQL) and continuous antipsychotic treatment: 3-year results from the Schizophrenia Health Outcomes (SOHO) study. Value Health. 2009;12(4):536–43.PubMedCrossRef
7.
Perkins DO, Hongbin G, Weiden PJ, et al. Predictors of treatment discontinuation and medication nonadherence in patients recovering from a first episode of schizophrenia, schizophreniform disorder, or schizoaffective disorder: a randomized, double-blind, flexible-dose, multicenter study. J Clin Psychiatry. 2008;69(1):106–13.PubMedCrossRef
8.
Lacro JP, Dunn LB, Dolder CR, et al. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry. 2002;63(10):892–909.PubMedCrossRef
9.
Nosé M, Barbui C, Tansella M. How often do patients with psychosis fail to adhere to treatment programmes? A systematic review. Psychol Med. 2003;33(7):1149–60.PubMedCrossRef
10.
Ascher-Svanum H, Faries BE, Zhu B, et al. Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. J Clin Psychiatry. 2006;67(3):453–60.PubMedCrossRef
11.
Novick D, Haro JM, Suarez D, et al. Predictors and clinical consequences of non-adherence with antipsychotic medication in the outpatient treatment of schizophrenia. Psychiatry Res. 2010;176(2–3):109–13.PubMedCrossRef
12.
Wiersma D, Nienhuis FJ, Sloof CJ, et al. Natural course of schizophrenic disorders: a 15-year follow-up of a Dutch incidence cohort. Schizophr Bull. 1998;24(1):75–85.PubMedCrossRef
13.
Lieberman JA, Koreen AR, Chakos M, et al. Factors influencing treatment response and outcome of first-episode schizophrenia: implications for understanding the pathophysiology of schizophrenia. J Clin Psychiatry. 1996;57(Suppl. 9):5–9.PubMed
14.
Knapp M, King D, Pugner K, et al. Non-adherence to antipsychotic medication regimens: associations with resource use and costs. Br J Psychiatry. 2004;184(6):509–16.PubMedCrossRef
15.
Sun SX, Liu GG, Christensen DB, et al. Review and analysis of hospitalization costs associated with antipsychotic nonadherence in the treatment of schizophrenia in the United States. Curr Med Res Opin. 2007;23(10):2305–12.PubMedCrossRef
16.
17.
Velligan DI, Weiden PJ, Sajatovic M, et al. The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry. 2009;70(Suppl. 4):1–46.PubMed
18.
Masand PS, Roca M, Turner MS, et al. Partial adherence to antipsychotic medication impacts the course of illness in patients with schizophrenia: a review. Prim Care Companion J Clin Psychiatry. 2009;11(4):147–54.PubMedCrossRef
19.
Weiden PJ, Kozma C, Grogg A, et al. Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiatr Serv. 2004;55(8):886–91.PubMedCrossRef
20.
Perkins DO. Adherence to antipsychotic medication. J Clin Psychiatry. 1999;60(Suppl. 21):25–30.PubMed
21.
Hogan TP, Awad AG, Eastwood R. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med. 1983;13(1):177–83.PubMedCrossRef
22.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.PubMedCrossRef
23.
Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res. 2000;42(3):241–7.PubMedCrossRef
24.
Dolder CR, Lacro JP, Warren KA, et al. Brief evaluation of medication influences and beliefs: development and testing of a brief scale for medication adherence. J Clin Psychopharmacol. 2004;24(4):404–9.PubMedCrossRef
25.
Byerly MJ, Nakonezny PA, Rush AJ. The Brief Adherence Rating Scale (BARS) validated against electronic monitoring in assessing the antipsychotic medication adherence of outpatients with schizophrenia and schizoaffective disorder. Schizophr Res. 2008;100(1–3):60–9.PubMedCrossRef
26.
Clayton CD, Veach J, Macfadden W, et al. Assessment of clinician awareness of nonadherence using a new structured rating scale. J Psychiatr Pract. 2010;16(3):164–9.PubMedCrossRef
27.
Kemp R, Hayward P, Applewhaite G, et al. Compliance therapy in psychotic patients: randomised controlled trial. BMJ. 1996;312(7027):345–9.PubMedCrossRef
28.
Sikka R, Xia F, Aubert RE. Estimating medication persistency using administrative claims data. Am J Manag Care. 2005;11(7):449–57.PubMed
29.
Baumann P, Hiemke C, Ulrich S, et al. The AGNP-TDM expert group consensus guidelines: therapeutic drug monitoring in psychiatry. Pharmacopsychiatry. 2004;37(6):243–65.PubMedCrossRef
30.
Cramer JA, Rosenheck R. How often is medication taken as prescribed? A novel assessment technique. JAMA. 1989;261(22):3273–7.PubMedCrossRef
31.
Misdrahi D, Verdoux H, Lançon C, et al. The 4-point ordinal Alliance Self-report: a self-report questionnaire for assessing therapeutic relationships in routine mental health. Compr Psychiatry. 2009;50(2):181–5.PubMedCrossRef
32.
Weiss KA, Smith TE, Hull JW, et al. Predictors of risk of nonadherence in outpatients with schizophrenia and other psychotic disorders. Schizophr Bull. 2002;28(2):341–9.PubMedCrossRef
33.
Frank AF, Gunderson JG. The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome. Arch Gen Psychiatry. 1990;47(3):228–36.PubMedCrossRef
34.
Davis LW, Lysaker PH. Therapeutic alliance and improvements in work performance over time in patients with schizophrenia. J Nerv Ment Dis. 2007;195(4):353–7.PubMedCrossRef
35.
Wittorf A, Jakobi U, Bechdolf A, et al. The influence of baseline symptoms and insight on the therapeutic alliance early in the treatment of schizophrenia. Eur Psychiatry. 2009;24(4):259–67.PubMedCrossRef
36.
Karow A, Pajonk FG, Reimer J, et al. The dilemma of insight into illness in schizophrenia: self- and expert-rated insight and quality of life. Eur Arch Psychiatry Clin Neurosci. 2008;258(3):152–9.PubMedCrossRef
37.
Fleischhacker WW, Hofer A, Hummer M. Managing schizophrenia: the compliance challenge. 2nd ed. London: Science Press; 2007.
38.
Amador XF, Johanson A-L. I am not sick I don’t need help! How to help someone with mental illness accept treatment. 2nd ed. Peconic: Vida Press; 2006.
39.
Aquila R, Weiden PJ, Emanuel M. Compliance and the rehabilitation alliance. J Clin Psychiatry. 1999;60(Suppl. 19):23–7.PubMed
40.
Green CA, Polen MR, Janoff SL, et al. Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results. Psychiatr Rehab J. 2008;32(1):9–22.CrossRef
41.
Llorca PM. Partial compliance in schizophrenia and the impact on patient outcomes. Psychiatry Res. 2008;161(2):235–47.PubMedCrossRef
42.
Chakos M, Lieberman J, Hoffman E, et al. Effectiveness of second-generation antipsychotics in patients with treatment-resistant schizophrenia: a review and meta-analysis of randomized trials. Am J Psychiatry. 2001;158(4):518–26.PubMedCrossRef
43.
Bagnall AM, Jones L, Ginnelly L, et al. A systematic review of atypical antipsychotic drugs in schizophrenia. Health Technol Assess. 2003;7(13):1–193.PubMed
44.
Schulz SC, Thomson R, Brecher M. The efficacy of quetiapine vs haloperidol and placebo: a meta-analytic study of efficacy. Schizophr Res. 2003;62(1–2):1–12.PubMedCrossRef
45.
Haddad PM, Sharma SG. Adverse effects of atypical antipsychotics: differential risk and clinical implications. CNS Drugs. 2007;21(11):911–36.PubMedCrossRef
46.
Leucht S, Corves C, Arbter D, et al. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet. 2009;373(3):31–41.PubMedCrossRef
47.
Allison DB, Mentore JL, Heo M, et al. Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry. 1999;156(11):1686–96.PubMed
48.
Baptista T, Zárate J, Joober R, et al. Drug induced weight gain, an impediment to successful pharmacotherapy: focus on antipsychotics. Curr Drug Targets. 2004;5(3):279–99.PubMedCrossRef
49.
Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353(12):1209–23.PubMedCrossRef
50.
Oehl M, Hummer M, Fleishhacker WW. Compliance with antipsychotic treatment. Acta Psychiatr Scand. 2000;102(Suppl. 407):83–6.CrossRef
51.
Kane JM. Review of treatments that can ameliorate nonadherence in patients with schizophrenia. J Clin Psychiatry. 2006;67(Suppl. 5):9–14.PubMed
52.
Ereshefsky L, Mannaert E. Pharmacokinetic profile and clinical efficacy of long-acting risperidone potential benefits of combining an atypical antipsychotic and a new delivery system. Drugs. 2005;6(3):129–37.
53.
Kane JM. Introduction: methods, commentary, and summary. J Clin Psychiatry. 2003;64(Suppl. 12):1–100.
54.
55.
56.
57.
58.
Leucht C, Heres S, Kane JM, et al. Oral versus depot antipsychotic drugs for schizophrenia: a critical systematic review and meta-analysis of randomised long term trials. Schizophr Res. 2011;127(1–3):83–92.PubMedCrossRef
59.
Tiihonen J, Haukka J, Taylor M, et al. A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Am J Psychiatry. 2011;168(6):603–9.PubMedCrossRef
60.
Rosenheck RA, Krystal JH, Lew R, et al. Long-acting risperidone and oral antipsychotics in unstable schizophrenia. N Engl J Med. 2011;364(9):842–51.PubMedCrossRef
61.
Haddad P, Taylor M, Niaz OS. First-generation antipsychotic long-acting injections v. oral antipsychotics in schizophrenia: systematic review of randomised controlled trials and observational studies. Br J Psychiatry. 2009;195(52):S20–8.CrossRef
62.
Lehman AF, Kreyenbuhl J, Buchanan RW, et al. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull. 2004;30(2):193–217.PubMedCrossRef
63.
Canadian Psychiatric Association. Clinical practice guidelines: treatment of schizophrenia. Can J Psychiatry. 2005;50(13 Suppl. 1):7S–57S.
64.
Keith SJ, Kane JM. Partial compliance and patient consequences in schizophrenia: our patients can do better. J Clin Psychiatry. 2003;64(11):1308–15.PubMedCrossRef
65.
Jaeger M, Rossler W. Attitudes towards long-acting depot antipsychotics: a survey of patients, relatives and psychiatrists. Psychiatry Res. 2010;175(1–2):58–62.PubMedCrossRef
66.
Chue P. The relationship between patient satisfaction and treatment outcomes in schizophrenia. J Psychopharmacol. 2006;20(6 Suppl.):38–56.PubMedCrossRef
67.
Fujikawa M, Togo T, Yoshimi A, et al. Evaluation of subjective treatment satisfaction with antipsychotics in patients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32(3):755–60.PubMedCrossRef
68.
Weiden PJ, Schooler NR, Weedon JC, et al. A randomized controlled trial of long-acting injectable risperidone vs continuation on oral atypical antipsychotics for first-episode schizophrenia patients: initial adherence outcome. J Clin Psychiatry. 2009;70(10):1397–406.PubMedCrossRef
69.
Glazer WM, Byerly MJ. Tactics and technologies to manage nonadherence in patients with schizophrenia. Curr Psychiatry Rep. 2008;10(4):359–69.PubMedCrossRef
70.
Fanning F, Foley S, Lawlor E, et al. Group cognitive behavioural therapy for first episode psychosis: who’s referred, who attends and who completes it? Early Interv Psychiatry. 2012;6:432–41.PubMedCrossRef
71.
72.
Nosé M, Barbui C, Gray R, et al. Clinical interventions for treatment non-adherence in psychosis: meta-analysis. Br J Psychiatry. 2003;183:197–206.PubMedCrossRef
73.
Giner J, Cañas J, Olivares JM, et al. Treatment adherence in schizophrenia: a comparison between patient’s, relative’s and psychiatrist’s opinions [in Spanish]. Actas Esp Psiquiatr. 2006;34(6):386–92.PubMed
74.
Smerud PE, Rosenfarb IS. The therapeutic alliance and family psychoeducation in the treatment of schizophrenia: an exploratory prospective change process study. J Consult Clin Psychol. 2008;76(3):505–10.PubMedCrossRef
75.
Guo X, Zhai J, Liu Z, et al. Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: a randomized, 1-year study. Arch Gen Psychiatry. 2010;67(9):895–904.PubMedCrossRef
76.
Buckley PF, Wirshing PA, Bhushan P, et al. Lack of insight in schizophrenia impact on treatment adherence. CNS Drugs. 2007;21(2):129–41.PubMedCrossRef
77.
Leucht S, Heres S. Epidemiology, clinical consequences, and psychosocial treatment of nonadherence in schizophrenia. J Clin Psychiatry. 2006;67(Suppl. 5):3–8.PubMed
78.
Pitschel-Walz G, Leucht S, Bäuml J, et al. The effect of family interventions on relapse and rehospitalization in schizophrenia: a meta-analysis. Schizophr Bull. 2001;27(1):73–92.PubMedCrossRef
79.
Stroup TS, McEvoy JP, Swartz MS, et al. The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project: schizophrenia trial design and protocol development. Schizophr Bull. 2003;29(1):15–31.PubMedCrossRef
80.
Fleischhacker WW, Keet IPM, Kahn RS. The European First Episode Schizophrenia Trial (EUFEST): rationale and design of the trial. Schizophr Res. 2005;78(2–3):147–56.PubMedCrossRef
81.
McEvoy JP, Lieberman JA, Perkins DO, et al. Efficacy and tolerability of olanzapine, quetiapine, and risperidone in the treatment of early psychosis: a randomized, double-blind 52-week comparison. Am J Psychiatry. 2007;164(7):1050–60.PubMedCrossRef
82.
Kikkert MJ, Schene AH, Koerte MW, et al. Medication adherence in schizophrenia: exploring patients’, carers’ and professionals’ views. Schizophr Bull. 2006;32(4):786–94.PubMedCrossRef
83.
Johnsen E, Jørgensen HA. Effectiveness of second generation antipsychotics: a systematic review of randomized trials. BMC Psychiatry. 2008;8:31.PubMedCrossRef
84.
Dolder CR, Lacro JP, Leckband S, et al. Interventions to improve antipsychotic medication adherence: review of recent literature. J Clin Psychopharmacol. 2003;23(4):389–99.PubMedCrossRef
85.
Brekke JS, Ansel M, Long J, et al. Intensity and continuity of services and functional outcomes in the rehabilitation of persons with schizophrenia. Psychiatr Serv. 1999;50(2):248–56.PubMed
86.
Dirani R, Lindenmayer J-P, Crivera C, et al. Continuity of care in patients with schizophrenia and schizoaffective disorder. Clearwater Beach, Florida, USA. Poster presented at Quality of Behavioral Health Care Conference; 2010 April 13–14.
87.
88.
89.
90.
Gaebel W, Riesbeck M, Wölwer W, et al. Relapse prevention in first-episode schizophrenia-maintenance vs intermittent drug treatment with prodrome-based early intervention: results of a randomized controlled trial within the German research network on schizophrenia. J Clin Psychiatry. 2011;72(2):205–18.PubMedCrossRef
91.
Gaebel W, Jänner M, Frommann N, et al. First vs multiple episode schizophrenia: two-year outcome of intermittent and maintenance medication strategies. Schizophr Res. 2002;53(1–2):145–59.PubMedCrossRef
92.
dos Reis S, Johnson E, Steinwachs D, et al. Antipsychotic treatment patterns and hospitalizations among adults with schizophrenia. Schizophr Res. 2008;101(1–3):304–11.CrossRef
Metadata
Title
Improving Treatment Adherence in Your Patients with Schizophrenia
The STAY Initiative
Authors
Fernando Cañas
Koksal Alptekin
Jean Michel Azorin
Vincent Dubois
Robin Emsley
Antonio G. García
Philip Gorwood
Peter M. Haddad
Dieter Naber
José M. Olivares
Georgios Papageorgiou
Miquel Roca
Publication date
01-02-2013
Publisher
Springer International Publishing AG
Published in
Clinical Drug Investigation / Issue 2/2013
Print ISSN: 1173-2563
Electronic ISSN: 1179-1918
DOI
https://doi.org/10.1007/s40261-012-0047-8

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