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
Despite important advances in the management of schizophrenia in recent decades, nonadherence remains a common phenomenon, with prevalence rates of approximately 40%-50%. The heterogeneity of findings regarding several risk factors for nonadherence could also be due to real heterogeneity among nonadherent patients.
The existence of two main subtypes according to intentionality has been hypothesized: Intentional and unintentional. Identification of subtypes as well as specific reasons for nonadherence would provide guidance in terms of different types of interventions.
To evaluate possible subtypes of nonadherence according to intentionality and to determine whether identified subtypes show a differential profile.
This naturalistic, observational, and 6-mo follow-up prospective study included 110 admitted patients diagnosed with schizophrenia or schizoaffective disorder. Baseline evaluation included sociodemographic, clinical, psychopathologic and treatment-related variables. 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. Subtypes were assigned at 6 mo follow-up based on a set of reasons for nonadherence.
Sixty-four patients (58%; n = 64) fulfilled nonadherence criteria at the end of the follow-up period and were categorized according to subtype of nonadherence: 32 (50%) fulfilled criteria of intentional nonadherence, and 32 (50%) unintentional nonadherence (UNA). Several variables were independently associated with UNA: 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).
This study specifically tests the subtypes hypothesis in psychotic disorders. We found two subtypes of nonadherence according to intentionality, as well as differentiated profiles. Our results support the nonadherence subtypes hypothesis in psychotic disorders.
We propose some directions for future research: (1) Replication studies to confirm the existence of differentiated subtypes of nonadherence in psychotic disorders; and (2) If confirmed, adoption of a differentiated approach, both in future research and clinical practice.