Risperidone Nonadherence and Return of Positive Symptoms in the Early Course of Schizophrenia

Objective:This study examined the effect of medication nonadherence on the return of positive symptoms among recent-onset schizophrenia patients. Method:Three sets of operational criteria for medication nonadherence with differing levels of severity were compared for their ability to predict relapse...

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Bibliographic Details
Published in:The American journal of psychiatry 2011-03, Vol.168 (3), p.286-292
Main Authors: Subotnik, Kenneth L., Nuechterlein, Keith H., Ventura, Joseph, Gitlin, Michael J., Marder, Stephen, Mintz, Jim, Hellemann, Gerhard S., Thornton, Leslie A., Singh, Indira R.
Format: Article
Language:English
Subjects:
Adult
Adult and adolescent clinical studies
Biological and medical sciences
Clinical medicine
Drug therapy
Female
Hospital costs
Hospitalization
Humans
Longitudinal Studies
Male
Medical sciences
Medication Adherence - psychology
Neuropharmacology
Pharmacology. Drug treatments
Psycholeptics: tranquillizer, neuroleptic
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Psychopharmacology
Psychoses
Psychotropic drugs
Risperidone - therapeutic use
Schizophrenia
Schizophrenia - diagnosis
Schizophrenia - drug therapy
Schizophrenia - prevention & control
Schizophrenic Psychology
Secondary Prevention
Studies
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Summary:Objective:This study examined the effect of medication nonadherence on the return of positive symptoms among recent-onset schizophrenia patients. Method:Three sets of operational criteria for medication nonadherence with differing levels of severity were compared for their ability to predict relapse. Explicit operational criteria are provided with the hope that they will be adopted by others. Psychotic symptoms were prospectively rated on a frequent basis, and systematic criteria were applied using a computer scoring program to identify periods of psychotic symptom return. In addition, a specialized statistical survival analysis method, optimal for examining risk periods and outcomes that can recur during the follow-up assessment, was used. Results:As hypothesized, medication nonadherence robustly predicted a return of psychotic symptoms during the early phase of schizophrenia (hazard ratios=3.7–28.5, depending on the severity of nonadherence). Conclusions:Even brief periods of partial nonadherence lead to greater risk of relapse than what is commonly assumed. Patients in the early phase of schizophrenia should be cautioned about the possible consequences of partial or relatively brief periods of antipsychotic medication nonadherence.
ISSN:0002-953X
1535-7228
DOI:10.1176/appi.ajp.2010.09010087