Predictors of medication discontinuation by patients with first-episode schizophrenia and schizoaffective disorder.
BACKGROUND
Enhancing medication adherence early in the course of schizophrenia and schizoaffective disorder may substantially improve long-term course. Although extensively studied in multi-episode patients, little data exist on medication adherence by first-episode patients.


METHODS
Medication adherence was assessed during the first year of treatment and following recovery from the first relapse in patients treated by a standardized medication algorithm.


RESULTS
During the first year of treatment, patients with poorer premorbid cognitive functioning were more likely to stop antipsychotics (t=-2.54, df=75, p=0.01). Parkinsonian side effects increased the likelihood (hazard ratio=41.22; 95% CI=2.30, 737.89; p=0.01), and better executive function decreased the likelihood (hazard ratio=0.40; 95% CI=0.18, 0.88; p=0.02) that patients discontinued maintenance medication after a first relapse.


CONCLUSIONS
Interventions to ameliorate cognitive deficits and Parkinsonian side effects may enhance treatment adherence.
Robinson
Delbert G
DG
Department of Psychiatry Research, Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York 11004, USA. robinson@lij.edu
Woerner
Margaret G
MG
Alvir
Jose Ma J
JM
Bilder
Robert M
RM
Hinrichsen
Gregory A
GA
Lieberman
Jeffrey A
JA
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000209:etiology; D004409:Dyskinesia, Drug-Induced; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D010349:Patient Compliance; D016016:Proportional Hazards Models; D011618:Psychotic Disorders / Q000188:drug therapy*; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy*; D012959:Socioeconomic Factors; D014481:United States
D014150:Antipsychotic Agents