Predictors of Treatment Discontinuation and Medication Nonadherence in Patients Recovering From a First Episode of Schizophrenia, Schizophreniform Disorder, or Schizoaffective Disorder: A Randomized, Double-Blind, Flexible-Dose, Multicenter Study
J Clin Psychiatry 2008;69(1):106-113
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To evaluate predictors of treatment discontinuation
against medical advice and poor medication adherence among first-episode
patients treated with olanzapine, quetiapine, or risperidone.
Method: First-episode patients with schizophrenia,
schizophreniform disorder, or schizoaffective disorder (DSM-IV) were randomly
assigned to olanzapine (2.5-20 mg/day), quetiapine (100-800 mg/day), or
risperidone (0.5-4 mg/day) as part of a 52-week, randomized, double-blind,
flexible-dose, multicenter study. Patients were enrolled from 2002 to 2004 at
one of 26 sites in the United States and Canada. Survival analysis tested for
predictors of treatment discontinuation against medical advice, while mixed
models tested for predictors of poor medication adherence. Significant findings
from the final models were replicated in sensitivity analyses.
Results: Of the 400 patients randomly assigned to treatment,
115 patients who discontinued treatment against medical advice and 119 study
completers were compared in this analysis. Poor treatment response (p < .001)
and low medication adherence (p = .02) were independent predictors of
discontinuation against medical advice. Ongoing substance abuse, ongoing
depression, and treatment response failure significantly predicted poor
medication adherence (p < .01). Higher cognitive performance at baseline and
ethnicity (black) were also associated with lower medication adherence (p <
.05). An association between poor medication adherence and illness insight at
study entry was found at trend level (p = .059).
Conclusion: This study highlights the importance of treatment
response in predicting discontinuation against medical advice and poor
adherence to medication in first-episode patients. These results also support
interventions to improve adherence behavior, particularly by targeting
substance use disorders and depressive symptoms.