Assessing patient-rated vs. clinician-rated adherence to the therapy in treatment resistant schizophrenia, schizophrenia responders, and non-schizophrenia patients. (March 2017)

• Record Type: Journal Article
• Authors: Iasevoli, Felice; Fagiolini, Andrea; Formato, Maria Vittoria; Prinzivalli, Emiliano; Giordano, Sara; Balletta, Raffaele; De Luca, Vincenzo; de Bartolomeis, Andrea
• Is Part Of: Psychiatry research. Volume 249(2017)
• Page Start: 159
• Page End: 166
• Publication Date: 2017-03
• Subjects: Psychosis -- Antipsychotic -- Cognition -- Positive symptoms -- Negative symptoms -- Social functioning -- Quality of life; Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2017.01.015
• Languages: English
• ISSNs: 0165-1781

Abstract

Abstract: The present study evaluated consistency, reliability, and determinants of two real-world measures of adherence to prescription in 57 schizophrenia and 61 non-schizophrenia patients. Treatment resistant schizophrenia (TRS) was additionally diagnosed in 28 of the schizophrenia patients. Patients were screened for clinical severity, cognitive functioning, and adherence by 10-item Drug Attitude Inventory (DAI-10) or Adherence-to-Therapy (AtT), a clinician-rated tool developed by our group. DAI-10 and AtT scores showed a significant correlation (p=0.039; ρ=0.21; df=103). Compared to the DAI-10 scale, a higher number of variables were associated with AtT. In schizophrenia and TRS patients, substance abuse was the only significant predictor of lower DAI-10 score (p=0.027, F=5.2, R 2 =0.07, and p=0.06, F=8.9, R 2 =0.23, respectively). Lower AtT score was significantly associated with first-generation antipsychotic use (p=0.001, RR: 2.00 [1.40–2.87]), positive symptoms (p=0.02, RR: 1.63 [1.05–2.53]), impaired verbal fluency (p=0.01, RR: 1.88 [0.81–4.32]) or problem solving (p=0.01, RR: 2.14 [0.92–4.98]). AtT, but not DAI-10, score correlated with the score on the Personal and Social Performance scale (p=0.02, F=5.86, R 2 =0.08). Overall, AtT score was predicted by pharmacological, psychopathological, and cognitive factors, and predictive of psychosocial functioning. Therefore, AtT measure may represent a convenient and practical tool to evaluate schizophrenia patients' adherence. Highlights: Adherence to therapy in schizophrenia patients is best captured by clinician rating than by patient's report. Clinician-rated adherence to therapy is predicted by multiple clinical features in schizophrenia patients. Clinician-rated adherence to therapy predicts social functioning and quality of life in schizophrenia patients.