title: Nonadherence to medication four years after a first episode of psychosis and associated risk factors.
abstract: OBJECTIVE
  This study examined concurrent associations and predictors at first indication of nonadherence to antipsychotic medication four years after a first episode of psychosis.
  
  
  METHODS
  A prospective cohort of 171 patients in urban Ireland with a first episode of psychosis was followed up four years after inception (follow-up primary analysis, N=84; secondary analysis, N=104).
  
  
  RESULTS
  At the four-year follow-up 76% were adherent and 24% were not. Nonadherence was concurrently associated with substance misuse (p<.01), increased symptomatology (p<.01), less insight (p=.01), lower global functioning (p<.01), and negative attitudes toward medication (p<.01). Compared with other patients, those who were nonadherent had more readmissions (p=.01). Predictors of future nonadherence were substance misuse (p=.02) and duration of untreated psychosis (p=.04).
  
  
  CONCLUSIONS
  This prospective investigation confirms previous cross-sectional studies. The association between longer duration of untreated psychosis and nonadherence warrants further research because it could be interpreted as further evidence of the importance of early intervention.
authors.affiliation: St. John of God Adult Psychiatric Service, Cluain Mhuire Family Centre, Dublin, Ireland.
authors.forename: Michele
authors.initials: M
authors.lastname: Hill
authors.forename: Niall
authors.initials: N
authors.lastname: Crumlish
authors.forename: Petter
authors.initials: P
authors.lastname: Whitty
authors.forename: Mary
authors.initials: M
authors.lastname: Clarke
authors.forename: Stephen
authors.initials: S
authors.lastname: Browne
authors.forename: Moayyad
authors.initials: M
authors.lastname: Kamali
authors.forename: Anthony
authors.initials: A
authors.lastname: Kinsella
authors.forename: John L
authors.initials: JL
authors.lastname: Waddington
authors.forename: Conall
authors.initials: C
authors.lastname: Larkin
authors.forename: Eadbhard
authors.initials: E
authors.lastname: O'Callaghan
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007494:Ireland; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000453:epidemiology; D012917:Social Adjustment; D019966:Substance-Related Disorders / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents