title: The development and trial of a medication discontinuation program in the department of forensic psychiatry.
abstract: BACKGROUND
  When treating mentally ill criminal offenders, improving medication adherence is essential to achieving goals, such as long-term stabilization of symptoms and the prevention of recidivism. Most subjects who are treated under the Medical Treatment and Supervision Act have schizophrenia, which is considered a particularly difficult disorder for which to improve medication adherence. For such patients, we developed a Medication Discontinuation Program (MDP) that aims to improve medication adherence by discontinuing antipsychotic drugs and monitoring changes in psychiatric symptoms. We examined whether there was any utility for the MDP on a trial basis as well as whether it would be worthwhile to introduce the MDP to psychiatric programs.
  
  
  METHODS
  We conducted the MDP with an intervention group (n = 7) and compared Drug Attitude Inventory-30 (DAI-30) scores before and after implementation of the MDP. We also categorized 30 questions of the DAI-30 into three subscales: "awareness of the need for medication", "awareness of the effects of psychiatric drugs", and "impression of medication", and examined factors affecting improvement in medication adherence.
  
  
  RESULTS
  The total DAI-30 score significantly increased after completion of the MDP (P = 0.002). Significant elevations after completion of the MDP were also observed in the scores for three subscales of the DAI-30.
  
  
  CONCLUSIONS
  Our study suggests that the MDP has a possibility of improving medication adherence, and this program might have multidirectional and stimulatory effects on each factor related to the improvement of medication adherence.
authors: Department of Psychiatry, National Hospital Organization, Komoro Kogen Hospital, 4598 Kou, Komoro, Nagano 384-8540 Japan ; Department of Psychiatry, Shinshu University School of Medicine, Nagano, Japan.
authors: Kenji
authors: K
authors: Murasugi
authors: Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Nagano, Japan.
authors: Teruomi
authors: T
authors: Tsukahara
authors: Department of Psychiatry, Shinshu University School of Medicine, Nagano, Japan.
authors: Shinsuke
authors: S
authors: Washizuka
keywords: Adherence; Drug Attitude Inventory-30; Medical Treatment and Supervision Act; Medication Discontinuation Program; Schizophrenia