Schizophrenia adherence therapy improves symptoms, not adherence

From Clinical Psychiatry News, 23 April 2013:

Adherence therapy improves symptoms in patients with schizophrenia but does not appear to affect adherence, treatment attitudes. or functioning, according to results of a randomized controlled trial.

“We observed a small effect of AT [adherence therapy] on patient symptoms but not adherence, treatment attitudes, or functioning following an acute episode of schizophrenia,” wrote Dr. Michael Schulz of the University of Applied Sciences, Bielefeld, Germany, and his colleagues. “It was disappointing that we found no evidence to support our proposed mechanism of action for AT; there was no evidence of an effect of the intervention on either patients’ beliefs or adherence.”

The parallel-group trial involved 161 patients admitted for treatment of an acute exacerbation of schizophrenia – 123 of whom finished the trial – and randomized patients to receive either eight sessions of adherence therapy or treatment as usual (Schizophr. Res. 2013;146:59-63).

Outcomes were assessed with the positive and negative syndrome scale (PANSS) and serum concentration to dose ratio, with researchers suggesting this was the first such trial to use a biological marker to measure adherence.

The adherence therapy consisted of eight one-on-one sessions with a trained therapist, designed to explore, assess, and test patients’ history, experience, and beliefs about medication and treatment. Treatment as usual followed national guidelines.

Previous studies of adherence therapy had produced mixed results, although trials that intervened just after an acute episode generally had more positive outcomes.

“We hypothesized that AT initiated whilst patients with schizophrenia are inpatient and followed up in the community will be effective in enhancing adherence and reducing psychopathology compared to usual care,” the researchers wrote. Read more. 

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