Medication Adherence and Long-Term Functional Outcomes in the Treatment of Schizophrenia in Usual Care
J Clin Psychiatry 2006;67:453-460
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Relatively little is known
about the relationships between medication
adherence and long-term functional outcomes in the
treatment of schizophrenia. To extend previous research, we prospectively examined the
relationships between adherence with any
antipsychotic medication and functional outcomes
among schizophrenia patients treated over a 3-year
period, assessed the stability of adherence over time, and examined whether adherence in the
first year predicts changes in functional outcomes
over the following 2 years.
Method: Analyses included 1906
participants with DSM-IV diagnoses of schizophrenia
or schizoaffective or schizophreniform disorder in
a multi-site, 3-year, prospective, naturalistic
study conducted in the United States between July
1997 and September 2003. Outcome measures were assessed at 6-month intervals using
systematic medical record abstraction and structured
interview of patients. Adherence with
antipsychotic regimen was assessed using patient-reported
adherence and the medication possession ratio (percent days with prescription for any
antipsychotic), dichotomized into adherence and
nonadherence. Analyses employed generalized estimating
equations and mixed models with repeated measures.
Results: Nonadherence was associated
with poorer functional outcomes, including greater risks of psychiatric hospitalizations, use of
emergency psychiatric services, arrests, violence,
victimizations, poorer mental functioning, poorer
life satisfaction, greater substance use, and more
alcohol-related problems (all p < .001). Adherence
was relatively stable, with 77.3% of patients
maintaining the same adherence status from the
first year to the second year. Nonadherence in the
first year predicted significantly poorer outcomes
in the following 2 years.
Conclusions: Findings highlight the
importance of adherence with antipsychotic
medication in the long-term treatment of schizophrenia
and its potential beneficial impact on the mental health and criminal justice delivery systems.