Antipsychotic treatment dosing profile in patients with schizophrenia evaluated with electronic monitoring (MEMS®).

BACKGROUND: Although the Medication Event Monitoring System (MEMS®) device offers accurate information on treatment dosing profile, such profile has never been studied in patients with schizophrenia. Enhancing our knowledge on this issue would help in developing intervention strategies to improve adherence to antipsychotic treatment in these patients. METHODS: 74 outpatients with schizophrenia were monitored with the MEMS device for a 3-month period, for evaluation of antipsychotic treatment dosing profile, possible influence of medication schedule-related variables, adherence to treatment--considering dose intake within prescribed timeframes--and possible Hawthorne's effect of using the MEMS device. RESULTS: Dose-omission gaps occurred in 18.7% of monitoring days, most frequently during weekends, almost significantly. Almost one-third of prescribed doses were taken out of prescribed time. Neither the prescribed number of daily doses nor the indicated time of the day for dose intake (breakfast, dinner), were associated with correct antipsychotic dosing. Excess-dose was rare in general, and more frequent out of prescribed dose timeframe. No Hawthorne's effect was found for the MEMS device. Adherence reached only 35% according to a definition that included dose intake within prescribed timeframes. CONCLUSIONS: Antipsychotic treatment dosing was considerably irregular among patients with schizophrenia. Strategies to reduce dose-omission gaps and increase dosing within prescribed timeframes seem to be necessary. Gaining knowledge on precise oral antipsychotic dosing profiles or the influence of schedule-related variables may be useful to design strategies towards enhancing adherence. There appears to be no Hawthorne's effect associated with the use of MEMS devices in outpatients with schizophrenia.

Evaluation of noncompliance in schizophrenia patients using electronic monitoring (MEMS) and its relationship to sociodemographic, clinical and psychopathological variables.

BACKGROUND: Noncompliance is common in patients with schizophrenia and can have serious consequences; therefore research of the variables associated with noncompliance is a priority. Although the MEMS device is regarded as the "reference standard" for evaluating compliance, it has been used in very few published studies. METHODS: Compliance was evaluated in 102 outpatients diagnosed with schizophrenia according to ICD-10 criteria. Compliance was evaluated with the MEMS device for 3 months in 79 patients who were on oral antipsychotic treatments. Baseline evaluations included sociodemographic, clinical, treatment-related and psychopathological variables. The psychiatrist, patients and relatives also provided compliance estimates. RESULTS: Noncompliant behaviors were observed in 42.3% of patients. Agreement between estimations by the psychiatrist and the MEMS findings was fair, and agreements between those of both patients and relatives and the MEMS findings were slight. Noncompliant patients showed poor insight, conceptual disorganization, stereotyped thinking and poor attention as compared to compliant patients. CONCLUSIONS: A large percentage of schizophrenic patients failed to adequately comply with their prescribed treatment. Compliance was overestimated by the psychiatrist, by patients and by relatives. Poorer insight and increased conceptual disorganization were independently associated with noncompliance. Identification of factors associated with noncompliance and strategies to reduce these behaviors would help improve the prognosis of schizophrenia.