Evaluation of factors influencing medication compliance in inpatient treatment of psychotic disorders.
BACKGROUND
Short- and long-term compliance to prescribed antipsychotic drugs is of particular concern in regard to medication choice and treatment outcome in the care of psychotic disorders.


OBJECTIVE
We evaluated patient-related and treatment-related factors associated with medication compliance in inpatients with a diagnosis of schizophrenia, schizoaffective disorder, or other psychotic disorder.


METHODS
Within a naturalistic study in seven psychiatric hospitals, individuals with a psychotic disorder were assessed weekly on mental state, social functioning, side effects, and medication compliance. Logistic regression analyses were computed to assess patient and clinical predictors of medication compliance.


RESULTS
We found a significant association between medication compliance and substance abuse (OR 0.52, CI 0.32-0.85), involuntary admission (OR 0.60, CI 0.41-0.89), history of aggressive behavior (OR 0.57, CI 0.38-0.85), and no school graduation (OR 0.59, CI 0.41-0.86). Individuals with pronounced paranoid or negative symptoms were also less compliant in taking their prescribed medication. There was no association between the initial inpatient antipsychotic medication regime and patients' compliance. Individuals who switched from a typical to an atypical antipsychotic drug were more compliant than those with their typical antipsychotic drug maintained. Those with higher medication compliance showed significantly greater improvement of their psychiatric symptoms during the inpatient stay.


CONCLUSIONS
Patient-related in addition to disease-related factors may strongly influence medication compliance. Besides more compliance with atypicals supposed by the literature, there may be a higher propensity for atypical drugs to be prescribed to those assumed to be more compliant.
Janssen
Birgit
B
Department of Psychiatry and Psychotherapy, Heinrich Heine-University Duesseldorf, Bergische Landstr. 2, 40629 Duesseldorf, Germany. Birgit.Janssen@lvr.de
Gaebel
Wolfgang
W
Haerter
Martin
M
Komaharadi
F
F
Lindel
Birgit
B
Weinmann
Stefan
S
D000328:Adult; D000339:Affect / Q000187:drug effects; D000374:Aggression / Q000187:drug effects / Q000523:psychology; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D003134:Commitment of Persons with Psychiatric Disorders; D015897:Comorbidity; D004522:Educational Status; D005260:Female; D005858:Germany; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology; D012565:Schizophrenic Psychology; D012917:Social Adjustment; D012959:Socioeconomic Factors; D013223:Statistics as Topic; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000523:psychology* / Q000706:statistics & numerical data
D014150:Antipsychotic Agents