title: Treatment adherence in schizophrenia: a patient-level meta-analysis of combined CATIE and EUFEST studies.
abstract: The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) obtained a sample of 1493 chronic schizophrenia patients. The European First Episode Schizophrenia Trial (EUFEST) studied a sample of 498 patients. We have combined these two samples to study the predictors and correlates of adherence to treatment. Here we report on adherence to pharmacological treatment at the six and twelve month assessments of these trials with a combined subsample of 1154 schizophrenia patients. Individual patients׳ data were used for analyses. We used logistic regression to examine the effects of substance use, akathisia, parkinsonism, dyskinesia, hostility, and insight on pharmacological adherence. The results showed that reduced adherence to pharmacological treatment was associated with substance use (p=0.0003), higher levels of hostility (p=0.0002), and impaired insight (p<0.0001). Furthermore, poor adherence to study medication was associated with earlier discontinuation in the combined data. The clinical implications of the results point to the importance of routine assessments and interventions to address patients׳ insight and comorbid substance use and the establishment of therapeutic alliance.
authors.affiliation: Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa u. 6, 1083 Budapest, Hungary. Electronic address: czobor.pal@med.semmelweis-univ.hu.
authors.forename: Pál
authors.initials: P
authors.lastname: Czobor
authors.affiliation: Behavioral Health Epidemiology Program, RTI International, 3040 E. Cornwallis Road, P.O. Box 12194 Research Triangle Park, NC 27709-2194, USA. Electronic address: rvandorn@rti.org.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Van Dorn
authors.affiliation: Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY USA 11 Medical Park Drive, Suite 106, Pomona, NY 10970, USA. Electronic address: citrome@cnsconsultant.com.
authors.forename: Leslie
authors.initials: L
authors.lastname: Citrome
authors.affiliation: Brain Center Rudolf Magnus UMC Utrecht (University Medical Center), P.O. box 85500, 3508 GA Utrecht, The Netherlands. Electronic address: r.kahn@umcutrecht.nl.
authors.forename: Rene S
authors.initials: RS
authors.lastname: Kahn
authors.affiliation: Biological Psychiatry Division Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Electronic address: wolfgang.fleischhacker@i-med.ac.at.
authors.forename: W Wolfgang
authors.initials: WW
authors.lastname: Fleischhacker
authors.affiliation: Department of Psychiatry, New York University School of Medicine, New York, NY, PO Box 160663, Big Sky, MT 59716, USA. Electronic address: janvolavka@gmail.com.
authors.forename: Jan
authors.initials: J
authors.lastname: Volavka
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D006801:Humans; D055118:Medication Adherence / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D016903:Drug Monitoring
chemical_list: D014150:Antipsychotic Agents
keywords: Adherence; Antipsychotic; Compliance; Hostility; Insight; Schizophrenia