title: Determinants of adherence to treatment in first-episode psychosis: a comprehensive review.
abstract: OBJECTIVE
  To conduct a comprehensive review of current evidence on factors for nonadherence to treatment in individuals with first-episode psychosis (FEP).
  
  
  METHODS
  MEDLINE, LILACS, PsycINFO, and SciELO databases were searched with the keywords first episode psychosis, factor, adherence, nonadherence, engagement, disengagement, compliance, and intervention. References of selected studies were consulted for relevant articles.
  
  
  RESULTS
  A total of 157 articles were screened, of which 33 articles were retained for full review. The factors related to nonadherence were: a) patient-related (e.g., lower education level, persistent substance use, forensic history, unemployment, history of physical abuse); b) environment-related (e.g., no family involved in treatment, social adjustment difficulties); c) medication-related (e.g., rapid remission of negative symptoms when starting treatment, therapeutic alliance); and d) illness-related (e.g., more positive symptoms, more relapses). Treatment factors that improve adherence include a good therapeutic alliance and a voluntary first admission when hospitalization occurs.
  
  
  CONCLUSIONS
  The results of this review suggest that nonadherence to treatment in FEP is multifactorial. Many of these factors are modifiable and can be specifically targeted in early intervention programs. Very few studies have assessed strategies to raise adherence in FEP.
authors.affiliation: Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Emilie
authors.initials: E
authors.lastname: Leclerc
authors.affiliation: Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Noto
authors.affiliation: Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Rodrigo A
authors.initials: RA
authors.lastname: Bressan
authors.affiliation: Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Elisa
authors.initials: E
authors.lastname: Brietzke
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D016312:Treatment Refusal
chemical_list: D014150:Antipsychotic Agents