Determination of Adherence Profiles in Schizophrenia Using Self-Reported Adherence: Results From the FACE-SZ Dataset

David Misdrahi, MDa,b,*; Arnaud Tessier, MSca,b; Joel Swendsen, PhDb; Fabrice Berna, MD, PhDa,c; Lore Brunel, MSca,d; Delphine Capdevielle, MD, PhDa,e; Isabelle Chereau, MDa,f; Jean-Marie Danion, MDa,c; Marie De Pradier, MDa,g; Jean-Michel Dorey, MDa,h; Caroline Dubertret, MD, PhDa,g; Julien Dubreucq, MDa,i; Catherine Faget, MDa,j; Franck Gabayet, MSca,i; Romain Rey, MDa,h; Raphaelle Richieri, MD, PhDa,j; Christine Passerieux, MD, PhDa,k; Aurélie Schandrin, MDa,e; Franck Schurhoff, MD, PhDa,d; Anne Marie Tronche, MDa,f; Mathieu Urbach, MDa,k; Pierre Michel Llorca, MD, PhDa,f; and Guillaume Fond, MDa,d; for the FACE-SZ (FondaMental Academic Centers of Expertise for Schizophrenia) Groupl  

Published: September 28, 2016

Article Abstract

Objective: Medication nonadherence is one of the most important, and potentially modifiable, prognostic factors in the outcome of patients with schizophrenia. The aim of this article is to propose a new classification of adherence profiles according to the Medication Adherence Rating Scale (MARS) in a large community-dwelling sample of French patients with schizophrenia to provide a new tool to help clinicians in daily practice.

Methods: 319 community-dwelling patients from a national network of 10 Schizophrenia Expert Centers were interviewed between January 2009 and January 2014. Assessments were conducted with a dedicated electronic medical record including the Structured Clinical Interview for DSM-IV Disorders. A cluster analysis was performed to explore clinical variables associated with poor adherence.

Results: Two distinct groups of patients were identified relative to their main adherence style. Items about medications’ subjective negative effects constituted the greatest discriminating factor between the 2 clusters. Patients with poor adherence (n = 117) were significantly younger (adjusted OR [aOR] = 1.036; 95% CI, 1.004-1.069) and had higher levels of current depression (aOR = 0.894; 95% CI, 0.829-0.964) and lower insight (aOR = 0.820; 95% CI, 0.693-0.970).

Conclusions: The MARS provides a useful tool for clinicians and can also aid in the evaluation of adherence styles and their determinants in patients with schizophrenia. The element providing the greatest discriminative power between the 2 clusters was a subjective negative attitude toward medication. The findings also suggest that depression is more frequent in schizophrenia patients with poor adherence and that improving insight into illness might be suggested as a first-line intervention to improve adherence in this population.

Volume: 77

Quick Links: Schizophrenia and Schizoaffective Disorders

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