Predicting Medication Noncompliance After Hospital Discharge Among Patients With Schizophrenia

• Published in: Psychiatric services (Washington, D.C.) Vol. 51; no. 2; pp. 216 - 222
• Main Authors: Olfson, Mark, Mechanic, David, Hansell, Stephen, Boyer, Carol A., Walkup, James, Weiden, Peter J.
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01.02.2000; American Psychiatric Association
• Subjects: Adult; Antipsychotic Agents - therapeutic use; Biological and medical sciences; Female; Follow-Up Studies; Hospitals, General - statistics & numerical data; Humans; Male; Medical sciences; Middle Aged; New York City; Patient Compliance - psychology; Patient Compliance - statistics & numerical data; Patient Discharge; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Schizophrenia - drug therapy; Schizophrenia - rehabilitation; Secondary Prevention; Severity of Illness Index; Social Support; Substance-Related Disorders - psychology; Therapeutical relation and framework; Treatment Refusal - psychology; Treatment Refusal - statistics & numerical data; Treatments; New York City; Human; Schizoaffective psychosis; Hospital discharge; Treatment resistance; Self evaluation; Neuroleptic; Psychotropic; Acute; Prediction; Schizophrenia; Hospital environment; Therapeutic relation; Psychosis; Drug compliance; Symptomatology; Chemotherapy; Treatment; Follow up study; Sociodemographic factor; Comparative study
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/appi.ps.51.2.216

OBJECTIVE: The study sought to identify predictors of noncompliance with medication in a cohort of patients with schizophrenia after discharge from acute hospitalization. METHODS: Adult psychiatric inpatients with schizophrenia or schizoaffective disorder for whom oral antipsychotics were prescribed (N=213) were evaluated at hospital discharge and three months later to assess medication compliance. Comparisons were made between patients who reported stopping their medications for one week or longer and patients who reported more continuous medication use. RESULTS: Of the 213 patients, about a fifth (19.2 percent) met the criterion for noncompliance. Medication noncompliance was significantly associated with an increased risk of rehospitalization, emergency room visits, homelessness, and symptom exacerbation. Compared with the compliant group, the noncompliant group was significantly more likely to have a history of medication noncompliance, substance abuse or dependence, and difficulty recognizing their own symptoms. Patients who became medication noncompliant were significantly less likely to have formed a good therapeutic alliance during hospitalization as measured by inpatient staff reports and were more likely to have family members who refused to become involved in their treatment. CONCLUSIONS: Patients with schizophrenia at high risk for medication noncompliance after acute hospitalization are characterized by a history of medication noncompliance, recent substance use, difficulty recognizing their own symptoms, a weak alliance with inpatient staff, and family who refuse to become involved in inpatient treatment.