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Drug attitude and other predictors of medication adherence in schizophrenia : 12 months of electronic monitoring (MEMS(®)) in the Swedish COAST-study

Brain, Cecilia; Allerby, Katarina; Sameby, Birgitta; Quinlan, Patrick; Joas, Erik; Karilampi, Ulla; Lindström, Eva; Eberhard, Jonas LU ; Burns, Tom and Waern, Margda (2013) In European Neuropsychopharmacology 23(12). p.62-1754
Abstract

The aim was to investigate clinical predictors of adherence to antipsychotics. Medication use was electronically monitored with a Medication Event Monitoring System (MEMS(®)) for 12 months in 112 outpatients with schizophrenia and schizophrenia-like psychosis according to DSM-IV. Symptom burden, insight, psychosocial function (PSP) and side effects were rated at baseline. A comprehensive neuropsychological test battery was administered and a global composite score was calculated. The Drug Attitude Inventory (DAI-10) was filled in. A slightly modified DAI-10 version for informants was distributed as a postal questionnaire. Non-adherence (MEMS(®) adherence ≤0.80) was observed in 27%. In univariate regression models low scores on DAI-10... (More)

The aim was to investigate clinical predictors of adherence to antipsychotics. Medication use was electronically monitored with a Medication Event Monitoring System (MEMS(®)) for 12 months in 112 outpatients with schizophrenia and schizophrenia-like psychosis according to DSM-IV. Symptom burden, insight, psychosocial function (PSP) and side effects were rated at baseline. A comprehensive neuropsychological test battery was administered and a global composite score was calculated. The Drug Attitude Inventory (DAI-10) was filled in. A slightly modified DAI-10 version for informants was distributed as a postal questionnaire. Non-adherence (MEMS(®) adherence ≤0.80) was observed in 27%. In univariate regression models low scores on DAI-10 and DAI-10 informant, higher positive symptom burden, poor function, psychiatric side effects and lack of insight predicted non-adherence. No association was observed with global cognitive function. In multivariate regression models, low patient-rated DAI-10 and PSP scores emerged as predictors of non-adherence. A ROC analysis showed that DAI-10 had a moderate ability to correctly identify non-adherent patients (AUC=0.73, p<0.001). At the most "optimal" cut-off of 4, one-third of the adherent would falsely be identified as non-adherent. A somewhat larger AUC (0.78, p<0.001) was observed when the ROC procedure was applied to the final regression model including DAI-10 and PSP. For the subgroup with informant data, the AUC for the DAI-10 informant version was 0.68 (p=0.021). Non-adherence cannot be properly predicted in the clinical setting on the basis of these instruments alone. The DAI-10 informant questionnaire needs further testing.

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author
publishing date
type
Contribution to journal
publication status
published
keywords
Adult, Aged, Antipsychotic Agents, Area Under Curve, Attitude to Health, Female, Follow-Up Studies, Humans, Male, Medication Adherence, Micro-Electrical-Mechanical Systems, Middle Aged, Neuropsychological Tests, Predictive Value of Tests, Psychiatric Status Rating Scales, Schizophrenia, Schizophrenic Psychology, Surveys and Questionnaires, Sweden, Young Adult
in
European Neuropsychopharmacology
volume
23
issue
12
pages
9 pages
publisher
Elsevier
external identifiers
  • Scopus:84887608510
ISSN
1873-7862
DOI
10.1016/j.euroneuro.2013.09.001
language
English
LU publication?
no
id
3c57db5f-8331-4e64-b032-59ecea1f3841
date added to LUP
2016-07-07 06:29:38
date last changed
2016-10-27 09:23:29
@misc{3c57db5f-8331-4e64-b032-59ecea1f3841,
  abstract     = {<p>The aim was to investigate clinical predictors of adherence to antipsychotics. Medication use was electronically monitored with a Medication Event Monitoring System (MEMS(®)) for 12 months in 112 outpatients with schizophrenia and schizophrenia-like psychosis according to DSM-IV. Symptom burden, insight, psychosocial function (PSP) and side effects were rated at baseline. A comprehensive neuropsychological test battery was administered and a global composite score was calculated. The Drug Attitude Inventory (DAI-10) was filled in. A slightly modified DAI-10 version for informants was distributed as a postal questionnaire. Non-adherence (MEMS(®) adherence ≤0.80) was observed in 27%. In univariate regression models low scores on DAI-10 and DAI-10 informant, higher positive symptom burden, poor function, psychiatric side effects and lack of insight predicted non-adherence. No association was observed with global cognitive function. In multivariate regression models, low patient-rated DAI-10 and PSP scores emerged as predictors of non-adherence. A ROC analysis showed that DAI-10 had a moderate ability to correctly identify non-adherent patients (AUC=0.73, p&lt;0.001). At the most "optimal" cut-off of 4, one-third of the adherent would falsely be identified as non-adherent. A somewhat larger AUC (0.78, p&lt;0.001) was observed when the ROC procedure was applied to the final regression model including DAI-10 and PSP. For the subgroup with informant data, the AUC for the DAI-10 informant version was 0.68 (p=0.021). Non-adherence cannot be properly predicted in the clinical setting on the basis of these instruments alone. The DAI-10 informant questionnaire needs further testing.</p>},
  author       = {Brain, Cecilia and Allerby, Katarina and Sameby, Birgitta and Quinlan, Patrick and Joas, Erik and Karilampi, Ulla and Lindström, Eva and Eberhard, Jonas and Burns, Tom and Waern, Margda},
  issn         = {1873-7862},
  keyword      = {Adult,Aged,Antipsychotic Agents,Area Under Curve,Attitude to Health,Female,Follow-Up Studies,Humans,Male,Medication Adherence,Micro-Electrical-Mechanical Systems,Middle Aged,Neuropsychological Tests,Predictive Value of Tests,Psychiatric Status Rating Scales,Schizophrenia,Schizophrenic Psychology,Surveys and Questionnaires,Sweden,Young Adult},
  language     = {eng},
  number       = {12},
  pages        = {62--1754},
  publisher    = {ARRAY(0xb582678)},
  series       = {European Neuropsychopharmacology},
  title        = {Drug attitude and other predictors of medication adherence in schizophrenia : 12 months of electronic monitoring (MEMS(®)) in the Swedish COAST-study},
  url          = {http://dx.doi.org/10.1016/j.euroneuro.2013.09.001},
  volume       = {23},
  year         = {2013},
}