title: Use of medication algorithms in first episode psychosis: a naturalistic observational study.
abstract: Medical algorithms are evidence-based guidelines which help physicians to make their decisions regarding treatment. Non-adherence to medical algorithms is a matter of concern. The aims of this study were to investigate physicians' adherence to an algorithm for antipsychotics, patients' adherence to the physicians' recommendations and whether these factors influence one year outcome.
  
  
  
  An extensive file audit survey was conducted among 55 consecutively first admitted inpatients and outpatients from three units of a university hospital; looking at the prescription of antipsychotics to patients (15-65 years) experiencing first episode psychosis (F19.5, F20.0-F29.0 according to ICD-10). Inclusion period was 2 years. Data on clinical condition and use of drugs were collected from the electronic patient administrative record system and from each patient's medical record for 12 months.
  
  
  
  Only 62% of the physicians adhered to the medical algorithm, although all first choices of drugs were made according to international standards. Fifty-six percent of patients used their medicine more than 75% of the time, 22% had between 26% and 74% adherence and 22% adhered less than 25%. Patient adherence was significantly associated with good outcome. Older patients and inpatients had more favourable outcomes than younger patients and outpatients. Physicians at inpatient wards initiated pharmacological treatment significantly earlier than physicians in outpatient departments. The most common first antipsychotic drug to prescribe was olanzapine followed by risperidone.
  
  
  
  Initial medical intervention followed international standards, but the physicians failed to adhere to algorithms in their follow-up of medication regimes. Adherence was associated with outcome.
authors.affiliation: Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway. rafal.yeisen@sus.no.
authors.forename: Rafal A H
authors.initials: RA
authors.lastname: Yeisen
authors.affiliation: Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.|Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.
authors.forename: Inge
authors.initials: I
authors.lastname: Joa
authors.affiliation: Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.|Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.
authors.forename: Jan Olav
authors.initials: JO
authors.lastname: Johannessen
authors.affiliation: Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.|Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Stein
authors.initials: S
authors.lastname: Opjordsmoen
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D014150:Antipsychotic Agents / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: adherence; algorithm; antipsychotics; early intervention; outcome