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A Trial of Compliance Therapy in Outpatients With Schizophrenia or Schizoaffective Disorder

Matthew J. Byerly, M.D.; Robert Fisher, B.S.; Thomas Carmody, Ph.D.; and A. John Rush, M.D.

Objective: To evaluate the efficacy of compliance therapy when delivered to outpatients with schizophrenia or schizoaffective disorder.

Method: Thirty patients with schizophrenia or schizoaffective disorder (DSM-IV criteria) were recruited from urban psychiatric outpatient clinics in an open trial of compliance therapy. Compliance therapy is a cognitive/psychoeducational approach consisting of 4 to 6 sessions lasting 30 to 60 minutes each. The primary outcome was electronically measured antipsychotic medication adherence. Adherence data were analyzed for effects during an initial treatment period (month -1 to month +1) and a subsequent 5-month follow-up period. Secondary outcome measures included clinician and patient ratings of adherence, symptoms, insight, and attitudes to medication treatment. Data were collected from August 2001 to January 2004.

Results: Compliance therapy was not associated with improvements in antipsychotic medication adherence. Patient ratings of adherence improved during the month -1 to month +1 period, but not in the subsequent 5-month follow-up. A diagnosis of schizoaffective disorder was associated with poorer adherence than was a diagnosis of schizophrenia during the month -1 to month +1 period. A higher degree of insight at baseline (end of month -1) was associated with greater adherence in the 5-month follow-up period. Symptoms, insight, and attitudes to medication treatment did not change significantly during the study.

Conclusion: In this uncontrolled trial, outpatients with schizophrenia or schizoaffective disorder did not benefit from compliance therapy.

(J Clin Psychiatry 2005;66:997-1001)

Received Oct. 22, 2004; accepted Feb. 8, 2005. From the University of Texas Southwestern Medical Center at Dallas, Dallas.

This study was partially supported by National Institute of Mental Health K-Award grant #5 K23 MH064930-03 and by Mental Health Connections, a partnership between Dallas County Mental Health and Mental Retardation and the Department of Psychiatry of the University of Texas Southwestern Medical Center, which receives funding from the state legislature and the Dallas County Hospital District.

Dr. Byerly, Mr. Fisher, and Drs. Carmody and Rush report no other financial affiliations relative to the subject of this article.

Corresponding author and reprints: Matthew J. Byerly, M.D., 6363 Forest Park Rd., Suite 651, Dallas, TX 75235-8828 (e-mail: