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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.

Publication ,  Journal Article
Perkins, DO; Gu, H; Weiden, PJ; McEvoy, JP; Hamer, RM; Lieberman, JA; Comparison of Atypicals in First Episode study group,
Published in: J Clin Psychiatry
January 2008

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. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00034892 (http://www.clinicaltrials.gov).

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Published In

J Clin Psychiatry

DOI

EISSN

1555-2101

Publication Date

January 2008

Volume

69

Issue

1

Start / End Page

106 / 113

Location

United States

Related Subject Headings

  • Treatment Refusal
  • Surveys and Questionnaires
  • Schizophrenia
  • Risperidone
  • Quetiapine Fumarate
  • Psychotic Disorders
  • Psychiatry
  • Prospective Studies
  • Olanzapine
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Perkins, D. O., Gu, H., Weiden, P. J., McEvoy, J. P., Hamer, R. M., Lieberman, J. A., & Comparison of Atypicals in First Episode study group, . (2008). 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, 69(1), 106–113. https://doi.org/10.4088/jcp.v69n0114
Perkins, Diana O., Hongbin Gu, Peter J. Weiden, Joseph P. McEvoy, Robert M. Hamer, Jeffrey A. Lieberman, and Jeffrey A. Comparison of Atypicals in First Episode study group. “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 69, no. 1 (January 2008): 106–13. https://doi.org/10.4088/jcp.v69n0114.

Published In

J Clin Psychiatry

DOI

EISSN

1555-2101

Publication Date

January 2008

Volume

69

Issue

1

Start / End Page

106 / 113

Location

United States

Related Subject Headings

  • Treatment Refusal
  • Surveys and Questionnaires
  • Schizophrenia
  • Risperidone
  • Quetiapine Fumarate
  • Psychotic Disorders
  • Psychiatry
  • Prospective Studies
  • Olanzapine
  • Male