title: Reasons for adherence and nonadherence: a pilot study comparing first- and multi-episode schizophrenia patients.
abstract: BACKGROUND
  Most first-episode schizophrenia patients will stop their medication after their acute symptoms improve. Understanding the salient motivations and attitudes that drive adherence--as well as nonadherence--is an important part of developing strategies to prevent or delay nonadherence during the early phases of the illness.
  
  
  METHODS
  Self-reported reasons for adherence and nonadherence among first-episode and multi-episode patients with schizophrenia were obtained from cross-sectional adherence interviews from two prospective adherence studies: one composed of a first-episode sample (n=33) and the other with recently relapsing multi-episode patients (n=16). Both groups received the Rating of Medication Influences (ROMI) Scale at approximately 16 to 20 weeks after an acute psychotic episode. The specific ROMI items were ranked in order of percentage (%) strong, and were compared both within each patient group for rank order of importance, and also compared between groups to determine the differences in specific adherence and nonadherence influences.
  
  
  RESULTS
  The doctor-patient relationship was more likely to be endorsed as a strong adherence influence in the first-episode sample (74%) than in the multi-episode sample (13%, X²=18.07, p<.01). Change in physical appearance attributed to medication was a more commonly endorsed nonadherence influence for the multi-episode sample (25%) relative to the first-episode sample (0%, X²=9.2, p<.01).
  
  
  CONCLUSIONS
  The doctor-patient relationship stands out as being the major reason for ongoing adherence for first-episode schizophrenia patients. Our post hoc interpretation is that lack of prior experience with medication and treatment elevates the importance of the relationship with the treating clinician for first-episode patients.
authors: Department of Psychiatry, Salem VA Medical Center, 1970 Roanoke Blvd., Salem, VA 24153.
authors: Mamta
authors: M
authors: Sapra
authors: Center for Cognitive Medicine, University of Illinois, Chicago.
authors: Peter J
authors: PJ
authors: Weiden
authors: Department of Psychiatry & Behavioral Sciences, SUNY Downstate Medical Center.
authors: Nina R
authors: NR
authors: Schooler
authors: Department of Psychiatry & Behavioral Sciences, SUNY Downstate Medical Center.
authors: Ayako
authors: A
authors: Sunakawa-McMillan
authors: Department of Psychology, University of North Carolina, Chapel Hill.
authors: Sarah
authors: S
authors: Uzenoff
authors: Department of Behavioral Health,, Kings County Hospital Center.
authors: Page
authors: P
authors: Burkholder
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology*; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Adherence; Antipsychotics; First-Episode Schizophrenia; Subjective Reasons