The effect of motivational interviewing on medication adherence and hospitalization rates in nonadherent patients with multi-episode schizophrenia.
BACKGROUND
Medication nonadherence in patients with schizophrenia presents a serious clinical problem. Research on interventions incorporating motivational interviewing (MI) to improve adherence have shown mixed results.


OBJECTIVE
Primary aim is to determine the effectiveness of a MI intervention on adherence and hospitalization rates in patients, with multi-episode schizophrenia or schizoaffective disorder, who have experienced a psychotic relapse following medication nonadherence. Secondary aim is to evaluate whether MI is more effective in specific subgroups.


METHODS
We performed a randomized controlled study including 114 patients who experienced a psychotic relapse due to medication nonadherence in the past year. Participants received an adapted form of MI or an active control intervention, health education (HE). Both interventions consisted of 5-8 sessions, which patients received in adjunction to the care as usual. Patients were assessed at baseline and at 6 and 12 months follow-up.


RESULTS
Our results show that MI did not improve medication adherence in previously nonadherent patients who experienced a psychotic relapse. Neither were there significant differences in hospitalization rates at follow-up between MI and HE (27% vs 40%, P = .187). However, MI resulted in reduced hospitalization rates for female patients (9% vs 63%, P = .041), non-cannabis users (20% vs 53%, P = .041), younger patients (14% vs 50%, P = .012), and patients with shorter illness duration (14% vs 42%, P = .040).


CONCLUSIONS
Targeted use of MI may be of benefit for improving medication adherence in certain groups of patients, although this needs further examination.
*To whom correspondence should be addressed; Department of Psychiatry, Academic Medical Centre, Meibergdreef 5, Amsterdam 1105 AZ, The Netherlands; tel: 31-20-8913500, fax: 31-20-8913702, e-mail: e.barkhof@amc.uva.nl.
Emile
E
Barkhof
Carin J
CJ
Meijer
Leo M J
LM
de Sonneville
Don H
DH
Linszen
Lieuwe
L
de Haan
D000328:Adult; D000367:Age Factors; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D010353:Patient Education as Topic; D012008:Recurrence; D012559:Schizophrenia / Q000188:drug therapy / Q000628:therapy*; D012737:Sex Factors; D016896:Treatment Outcome; D016903:Drug Monitoring
RCT; intervention study; medication adherence; motivational interviewing; schizophrenia