Predictors of medication adherence in early psychosis

Abstract

Medication adherence is a well-known barrier in hindering successful pharmacological treatment, particularly in early psychosis patients. The aims of promotion and implementation of early intervention service not only change patient’s trajectory of long-term outcome positively but also broaden a therapeutic window by detecting patient’s medication non-adherence attitudes and behaviors in the very early stage of illness. Needless to say, the rate of non-adherent to medication in early psychosis is high due to a variety of potential risk factors. The consequences of medication non-adherence are devastating. In adherence research, the researchers devote their life to investigate in this aspect.

As suggested by previous studies, a basket of consistent and inconsistent as well as strong or weak predictors are relevant to medication adherence. However, they tend to examine the medication adherence attitudes and behaviors together. Since someone behavior is not the same as his/her attitude toward medication adherence, the current study thus explores them separately. Given very scanty studies addressing the issue, this study focuses on asking whether different sets of baselines predictors contribute to medication adherence attitudes and behaviors differently are true.

Within a six-month period of follow-up, 340 first episode psychosis patients have been included in the sample. We assessed various patient-related, medication-related, and environmental-related constructs (age, gender, martial status, education level, occupation, living condition, family history of mental illness, mode of onset, premorbid functioning, DUP, hospitalization, symptoms severity, level of insight, type of medication, medication side effects, and therapeutic alliance) at baseline as well as measured their medication adherence attitude and behaviors at six-month follow-up period. The result of the study are in accord with our hypothesis that different groups of risk factors contribute to medication adherence attitude and behaviors differently in the first six months of treatment of early psychosis patients. After putting the same set of variables into analyses on medication adherence attitudes and behaviors separately, findings reveal that DUP, insight, side effect on psychic aspect, and patients’ rating on communication effectiveness with clinicians are the significant predictors for medication adherence attitudes while gender, experienced hospitalization, and psychopathology severity are the influential indicators in predicting medication adherence behaviors. Our data indeed fills in the adherence research gap to address what predictors affect medication adherence attitude and behavior differently.

The implication is that if we just put medication adherence attitude and behavior together into the discussion, it would oversimplify the medication adherence phenomenon. Our study serves as a cornerstone to obtain a better understanding in the dynamic process of medication treatment decision-making in terms of patients’ medication adherence attitudes and behaviors separately. We hope our findings as the stimuli to move on to next step by exploring whether a wider context of speculation, the structural barriers in our mental healthcare services delivery system and family involvement, influences medication adherence in early psychosis.