Singapore study shows high treatment adherence in first-episode psychosis
A majority of patients who are prescribed medications for first-episode psychosis adhere to treatment with various factors influencing compliance, according to a study conducted in Singapore.
Researchers assessed data of 445 patients aged 16–40 years (mean age 26.3 years, 51 percent male) enrolled in the Early Psychosis Intervention Programme in Singapore. Of these, 74.6 percent had schizophrenia spectrum and delusional disorders, 14 percent had affective psychosis, and 11.3 percent had brief or non-specified psychotic disorders. Patients were followed up to 1 year.
Regular adherence to medication was defined in this study as 75–100 percent compliance, while partial adherence and nonadherence were defined as 25–74 percent and 0–24 percent compliance, respectively.
At 1 year, 65.5 percent of patients were regularly adherent to their medications, while 18.7 percent were partially adherent and 15.8 percent nonadherent. [Early Interv Psychiatry 2018;doi:10.1111/eip.12559]
Men, individuals who lived alone, and those with poor judgment or insight* had an elevated risk of nonadherence (odds ratio [OR], 1.95, 95 percent confidence interval [CI], 1.00–3.80; p=0.050, OR, 5.63, 95 percent CI, 1.26–25.17; p=0.024, and OR, 1.30, 95 percent CI, 1.01–1.68; p=0.039, respectively).
Compared with those with regular adherence, those with partial adherence were more likely to be of Malay ethnicity (OR, 2.51, 95 percent CI, 1.14–5.49; p=0.022) or were undergoing national service (OR, 3.34, 95 percent CI, 1.08–10.35; p=0.037).
Researchers highlighted that the rate of adherence in this study was higher than that observed in several studies conducted in Western populations, [Acta Psychiatr Scand 2002;106:286-290; Acta Psychiatr Scand 2003;108:439-446] a reason for which may have been that the majority of patients in this study were living with their families who were requested to encourage medication adherence.
“Our study found that living alone was associated with higher rates of nonadherence as compared to individuals living with their parents. These findings highlight the need for caregivers and family members to be educated, supported, and actively involved in the treatment plan,” they said.
One of the reasons cited by the researchers for partial adherence in patients undergoing national service is the “limited family involvement” during this period.
“This suggests a role for military superiors and peers to be educated about mental illness and be more involved in supporting the needs of affected servicemen,” said the researchers.
The researchers acknowledged that the exclusion of patients with substance abuse may have affected the findings, given the risk of nonadherence to medications in this population.
“Our study [suggests] that adherence in patients with first-episode psychosis is associated with a wide range of demographic and clinical variables [and] also suggests a role for culturally appropriate interventions in addressing barriers to adherence,” said the researchers.
“Further studies are needed to understand the interaction between the various factors observed to contribute to medication adherence in this study and their resultant impact on functional outcomes,” they concluded.