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J Clin Psychiatry. 2016 Sep;77(9):e1130-e1136. doi: 10.4088/JCP.15m10115.

Determination of Adherence Profiles in Schizophrenia Using Self-Reported Adherence: Results From the FACE-SZ Dataset.

Author information

1
Centre Hospitalier Charles Perrens, CNRS UMR 5287-INCIA, 121 Rue de la Béchade, 33076 Bordeaux, France. david.misdrahi@u-bordeaux.fr.
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.

Abstract

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.

PMID:
27780318
DOI:
10.4088/JCP.15m10115
[Indexed for MEDLINE]

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