Drug attitude and other predictors of medication adherence in schizophrenia: 12 months of electronic monitoring (MEMS®) in the Swedish COAST-study

被引:53
作者
Brain, Cecilia [1 ,2 ]
Allerby, Katarina [2 ]
Sameby, Birgitta [2 ]
Quinlan, Patrick [1 ,2 ]
Joas, Erik [1 ]
Karilampi, Ulla [3 ]
Lindstrom, Eva [4 ]
Eberhard, Jonas [5 ]
Burns, Tom [6 ]
Waern, Margda [1 ]
机构
[1] Univ Gothenburg, Sahlgrenska Acad, Dept Psychiat & Neurochem, Inst Neurosci & Physiol, Gothenburg, Sweden
[2] Sahlgrens Univ Hosp, Psychosis Clin, Na Ut Teamet, SE-41113 Gothenburg, Sweden
[3] Sahlgrens Univ Hosp, Psychosis Clin, Gothenburg, Sweden
[4] Univ Uppsala Hosp, Dept Neurosci, Uppsala, Sweden
[5] Kings Coll London, Inst Psychiat Maudsley, Dept Psychosis Studies, London, England
[6] Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford, England
基金
瑞典研究理事会;
关键词
Adherence; Predictors; Schizophrenia; Antipsychotics; Medication Event Monitoring Systein; Drug Attitude Inventory; ANTIPSYCHOTIC MEDICATION; SCHIZOAFFECTIVE DISORDER; GLOBAL ASSESSMENT; BIPOLAR DISORDER; ASSESSMENT SCALE; 1ST EPISODE; OUTPATIENTS; NONADHERENCE; RELIABILITY; PERFORMANCE;
D O I
10.1016/j.euroneuro.2013.09.001
中图分类号
R74 [神经病学与精神病学];
学科分类号
100204 [神经病学];
摘要
The aim was to investigate clinical predictors of adherence to antipsychotics. Medication use was electronically monitored with a Medication Event Monitoring System (MEMS (R)) for 12 months in 112 outpatients with schizophrenia and schizophrenia-like psychosis according to DSM-IV. Symptom burden, insight, psychosocial function (PSP) and side effects were rated at baseline. A comprehensive neuropsychological test battery was administered and a global composite score was calculated. The Drug Attitude Inventory (DAI-10) was filled in. A slightly modified DAI-10 version for informants was distributed as a postal questionnaire. Nonadherence (MEMS (R) adherence <= 0.80) was observed in 27%. In univariate regression models low scores on DAI-10 and DAI-10 informant, higher positive symptom burden, poor function, psychiatric side effects and lack of insight predicted non-adherence. No association was observed with global cognitive function. In multivariate regression models, low patient-rated DAI-10 and PSP scores emerged as predictors of non-adherence. A ROC analysis showed that DAI-10 had a moderate ability to correctly identify non-adherent patients (AUC=0.73, p<0.001). At the most "optimal" cut-off of 4, one-third of the adherent would falsely be. identified as non-adherent. A somewhat larger AUC (0.78, p<0.001) was observed when the ROC procedure was applied to the final regression model including DAI-10 and PSP. For the subgroup with informant data, the AUC for the DAI-10 informant version was 0.68 (p=0.021). Non-adherence cannot be properly predicted in the clinical setting on the basis of these instruments alone. The DAI-10 informant questionnaire needs further testing. (C) 2013 Elsevier B.V. and ECNP. All rights reserved.
引用
收藏
页码:1754 / 1762
页数:9
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