Experiences of antipsychotic use in patients with early psychosis: a two-year follow-up study.

BACKGROUND: Non-adherence is a major public health problem despite treatment advances. Poor drug adherence in patients with psychosis is associated with more frequent relapse, re-hospitalization, increased consumption of health services and poor outcomes on a variety of measures. Adherence rate in patients with first episode psychosis have been found to vary from 40 to 60%. However, most previous studies have addressed the consequences of non-adherence rather than its potential causes. The purpose of this study was, therefore, to investigate experiential factors which may affect adherence to medication in adults with psychotic disorders, during the 24-month period after the onset of treatment. METHODS: Twenty first episode patients (7 male, 13 female) were included in our qualitative sub-study from the ongoing TIPS2 (Early Intervention in Psychosis study). Each person participated in semi-structured interviews at 2-year follow-up. All had used antipsychotics, with some still using them. Data were analyzed within an interpretative-phenomenological framework using an established meaning condensation procedure. RESULTS: The textual analysis revealed four main themes that affected adherence largely: 1) Positive experiences of admission, 2) Sufficient timely information, 3) Shared decision-making and 4) Changed attitudes to antipsychotics due to their beneficial effects and improved insight into illness. CONCLUSION: Patients reported several factors to have a prominent impact on adherence to their antipsychotics. The patients do not independently choose to jeopardize their medication regime. Health care staff play an important role in maintaining good adherence by being empathetic and supportive in the admission phase, giving tailored information according to patients' condition and involving patients when making treatment decisions.

Use of medication algorithms in first episode psychosis: a naturalistic observational study.

AIMS: Medical algorithms are evidence-based guidelines which help physicians to make their decisions regarding treatment. Non-adherence to medical algorithms is a matter of concern. The aims of this study were to investigate physicians' adherence to an algorithm for antipsychotics, patients' adherence to the physicians' recommendations and whether these factors influence one year outcome. METHOD: An extensive file audit survey was conducted among 55 consecutively first admitted inpatients and outpatients from three units of a university hospital; looking at the prescription of antipsychotics to patients (15-65 years) experiencing first episode psychosis (F19.5, F20.0-F29.0 according to ICD-10). Inclusion period was 2 years. Data on clinical condition and use of drugs were collected from the electronic patient administrative record system and from each patient's medical record for 12 months. RESULTS: Only 62% of the physicians adhered to the medical algorithm, although all first choices of drugs were made according to international standards. Fifty-six percent of patients used their medicine more than 75% of the time, 22% had between 26% and 74% adherence and 22% adhered less than 25%. Patient adherence was significantly associated with good outcome. Older patients and inpatients had more favourable outcomes than younger patients and outpatients. Physicians at inpatient wards initiated pharmacological treatment significantly earlier than physicians in outpatient departments. The most common first antipsychotic drug to prescribe was olanzapine followed by risperidone. CONCLUSION: Initial medical intervention followed international standards, but the physicians failed to adhere to algorithms in their follow-up of medication regimes. Adherence was associated with outcome.