Published online Nov 19, 2020. doi: 10.5498/wjp.v10.i11.260
Peer-review started: August 4, 2020
First decision: September 21, 2020
Revised: October 2, 2020
Accepted: October 20, 2020
Article in press: October 20, 2020
Published online: November 19, 2020
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.
To test the hypothesis of subtypes of nonadherence in schizophrenia and schizoaffective disorder.
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 follow-up period and were categorized according to their subtype of nonadherence.
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.
Differentiated subtypes of nonadherence according to intentionality seem to exist in patients with schizophrenia and schizoaffective disorder. Our findings suggest the need for differentiated approach, both in future research and in clinical practice.
Core Tip: Nonadherence is a major problem in the treatment of psychotic disorders. The scarcity of consistently identified variables associated with nonadherence could be due, at least in part, to real heterogeneity among nonadherent patients. Although in recent years the existence of two main subtypes according to intentionality has been hypothesized, no previous studies have specifically tested this hypothesis. This research aimed to fill this gap. We found differentiated profiles in nonadherent patients according to intentionality. Our results support the nonadherence subtypes hypothesis in psychotic disorders.