title: Prospective trial of customized adherence enhancement plus long-acting injectable antipsychotic medication in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder.
abstract: BACKGROUND
  Treatment nonadherence in people with schizophrenia is associated with relapse and homelessness. Building on the usefulness of long-acting medication and our work in psychosocial interventions to enhance adherence, we conducted a prospective uncontrolled trial of customized adherence enhancement (CAE) plus long-acting injectable antipsychotic (LAI) using haloperidol decanoate in 30 homeless or recently homeless individuals with DSM-IV-defined schizophrenia or schizoaffective disorder.
  
  
  METHODS
  Participants received monthly CAE and LAI (CAE-L) for 6 months. Primary outcomes were adherence, as measured by the Tablets Routine Questionnaire, and housing status. Secondary outcomes included psychiatric symptoms, functioning, side effects, and hospitalizations. The study was conducted from July 2010 to December 2012.
  
  
  RESULTS
  The mean age of participants was 41.8 years (SD = 8.6); they were mainly minorities (90%, n = 27 African-American) and mainly single/never married (70%, n = 21). Most (97%, n = 29) had past or current substance abuse and had been incarcerated (97%, n = 29). Ten individuals (33%) terminated the study prematurely. CAE-L was associated with good adherence to LAI (at 6 months, 76%) and dramatic improvement in oral medication adherence, which changed from missing 46% of medication at study enrollment to missing only 10% at study end (P = .03). There were significant improvements in psychiatric symptoms (P < .001) and functioning (P < .001). Akathisia was a major side effect with LAI.
  
  
  CONCLUSIONS
  While interpretation of findings must be tempered by the methodological limitations, CAE-L appears to be associated with improved adherence, symptoms, and functioning in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder. Additional research is needed on effective and practical approaches to improving health outcomes for homeless people with serious mental illness.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01152697.
authors.affiliation: Departments of Psychiatry and Neurology, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, OH martha.sajatovic@uhhospitals.org.
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
authors.forename: Jennifer
authors.initials: J
authors.lastname: Levin
authors.forename: Luis F
authors.initials: LF
authors.lastname: Ramirez
authors.forename: David Y
authors.initials: DY
authors.lastname: Hahn
authors.forename: Curtis
authors.initials: C
authors.lastname: Tatsuoka
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Bialko
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Cassidy
authors.forename: Edna
authors.initials: E
authors.lastname: Fuentes-Casiano
authors.forename: Tiffany D
authors.initials: TD
authors.lastname: Williams
mesh_terms: D000328:Adult; D017109:Akathisia, Drug-Induced / Q000209:etiology; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D006703:Ill-Housed Persons / Q000523:psychology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011580:Psychological Techniques; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D016896:Treatment Outcome; D014481:United States; D016903:Drug Monitoring
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; C033563:haloperidol decanoate; D006220:Haloperidol