Testing the hypothesis of subtypes of nonadherence in schizophrenia and schizoaffective disorder:A prospective study  

作　　者：Dulcinea Vega Francisco J Acosta Pedro Saavedra 

机构地区：[1]Department of Psychiatry,University of Las Palmas de Gran Canaria,Las Palmas de Gran Canaria 35016,Las Palmas,The Canary Islands,Spain [2]Department of Psychiatry,Insular University Hospital [3]Department of Mental Health General Management of Healthcare Programs,Canary Islands Health Service,Las Palmas de Gran Canaria 35004,Las Palmas,The Canary Islands,Spain [4]Research Network on Health Services for Chronic Conditions(REDISSEC),Carlos III Health Institute,Madrid 28029,Spain [5]Department of Mathematics,University of Las Palmas de Gran Canaria,Las Palmas de Gran Canaria 35016,Las Palmas,The Canary Islands,Spain

出　　处：《World Journal of Psychiatry》2020年第11期260-271,共12页世界精神病学杂志

基　　金：Supported by College of Physicians of Las Palmas,No.I03/19.

摘　　要：BACKGROUND Nonadherence is a major problem in the treatment of psychotic disorders.It has been hypothesized that nonadherent patients with schizophrenia are not a homogeneous population and subtypes of nonadherence might exist,but this hypothesis has not been specifically tested.AIM To test the hypothesis of subtypes of nonadherence in schizophrenia and schizoaffective disorder.METHODS This prospective study included 110 consecutively admitted patients diagnosed with schizophrenia or schizoaffective disorder.Assessments were performed at baseline and at 6 mo follow-up after discharge.Sociodemographic,clinical,psychopathological and treatment-related variables were evaluated.Adherence was defined as the concurrence of adherence to antipsychotic treatment and outpatient follow-up during the six-month period.Adherence to antipsychotic treatment was defined as the concurrence of objective and subjective adherence.Sixty-four patients(58%)fulfilled nonadherence criteria at the end of the followup period and were categorized according to their subtype of nonadherence.RESULTS In nonadherent patients(n=64),32(50%)fulfilled criteria of intentional nonadherence,and 32(50%)of unintentional nonadherence(UNA).Unintentional nonadherent patients,as compared to intentional nonadherent patients,are characterized by older age,lower educational level,worse cognitive and negative symptoms,greater severity,worse knowledge of their treatment regimen,greater prevalence of supervision of the treatment,lower number of prior hospitalizations and greater use of nonpsychiatric treatment,anticholinergics and hypnotics.Low educational level(OR=26.1;95%CI:2.819-241),worse treatment knowledge at six months(OR per unit=0.904;95%CI:0.853-0.957)and nonpsychiatric treatment at six months(OR=15.8;95%CI:1.790-139)were independently associated to UNA.CONCLUSION Differentiated subtypes of nonadherence according to intentionality seem to exist in patients with schizophrenia and schizoaffective disorder.Our findings suggest the need for differentiated app

关 键 词：Adherence HOSPITALIZATION PSYCHOSIS HYPOTHESIS Unintentional nonadherence Intentional nonadherence 

分 类 号：R749.3[医药卫生—神经病学与精神病学]