Determination of Adherence Profiles in Schizophrenia Using Self-Reported Adherence: Results From the FACE-SZ Dataset.
J. Clin. Psychiatry. 2016-09-28; 77(09): e1130-e1136
DOI: 10.4088/jcp.15m10115
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Misdrahi D(1)(2)(3), Tessier A(2)(3), Swendsen J(3), Berna F(2)(4), Brunel
L(2)(5), Capdevielle D(2)(6), Chereau I(2)(7), Danion JM(2)(4), De Pradier
M(2)(8), Dorey JM(2)(9), Dubertret C(2)(8), Dubreucq J(2)(10), Faget C(2)(11),
Gabayet F(2)(10), Rey R(2)(9), Richieri R(2)(11), Passerieux C(2)(12), Schandrin
A(2)(6), Schurhoff F(2)(5), Tronche AM(2)(7), Urbach M(2)(12), Llorca PM(2)(7),
Fond G(2)(5); FACE-SZ (FondaMental Academic Centers of Expertise for
Schizophrenia) Group.
Author information:
(1)Centre Hospitalier Charles Perrens, CNRS UMR 5287-INCIA, 121 Rue de la
Béchade, 33076 Bordeaux, France. .
(2)Fondation FondaMental, Créteil, France.
(3)Department of Adult Psychiatry, Charles Perrens Hospital, University of
Bordeaux; CNRS UMR 5287-INCIA, Bordeaux, France.
(4)Strasbourg University Hospital, University of Strasbourg, INSERM U1114,
Federation of Translational Psychiatry, Strasbourg, France.
(5)University Department of Psychiatry, H. Mondor Hospital, INSERM U955,
Translational Psychiatry Team, Creteil, France, Paris Est University, DHU
Pe-PSY, Creteil, France.
(6)University Department of Adult Psychiatry, La Colombiere Hospital, University
of Montpellier 1, Inserm 1061, Montpellier, France.
(7)Clermont-Ferrand University Hospital, EA 7280, Clermont-Ferrand University,
Clermont-Ferrand, France.
(8)Department of Psychiatry, AP-HP Louis Mourier Hospital, Colombes, Inserm
U894, University of Paris Diderot, Sorbonne Paris Cité, France.
(9)University of Claude Bernard Lyon 1, Le Vinatier Hospital Pole Est, BRON
Cedex, France.
(10)Center of Reference for Psychosocial Rehabilitation, Alpes Isère Hospital,
Grenoble, France.
(11)Department of Psychiatry, Sainte-Marguerite University Hospital, AP-HM,
Marseille, France.
(12)Department of Adult Psychiatry, Versailles Hospital, UFR of Health Sciences
Simone Veil, University of Versailles, Versailles, France.
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.
© Copyright 2016 Physicians Postgraduate Press, Inc.
DOI: 10.4088/JCP.15m10115
PMID: 27780318 [Indexed for MEDLINE]