Nonadherence to medication four years after a first episode of psychosis and associated risk factors.
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.
Hill
Michele
M
St. John of God Adult Psychiatric Service, Cluain Mhuire Family Centre, Dublin, Ireland.
Crumlish
Niall
N
Whitty
Petter
P
Clarke
Mary
M
Browne
Stephen
S
Kamali
Moayyad
M
Kinsella
Anthony
A
Waddington
John L
JL
Larkin
Conall
C
O'Callaghan
Eadbhard
E
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
D014150:Antipsychotic Agents