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. 2019 Apr;139(4):336-347.
doi: 10.1111/acps.13011.

Medication adherence in first episode psychosis: the role of pre-onset subthreshold symptoms

J-G Daneault  1   2   3 , A Maraj  1 , M Lepage  1   4   5 , A Malla  1   5 , N Schmitz  5 , S N Iyer  1   5 , R Joober  1   5 , J L Shah  1   4   5
Affiliations

Medication adherence in first episode psychosis: the role of pre-onset subthreshold symptoms

J-G Daneault et al. Acta Psychiatr Scand. 2019 Apr.

Abstract

Objective: The experience of pre-onset subthreshold psychotic symptoms (STPS, signifying a clinical high-risk state) in first episode psychosis (FEP) predicts poorer outcomes during treatment, possibly through differential adherence to medication. We explored whether adherence differs between FEP patients with and without pre-onset STPS.

Methods: Antipsychotic medication adherence was compared in 263 STPS+ and 158 STPS- subjects in a specialized early intervention program for FEP. Data were gathered from a larger observational study conducted between 2003 and 2016. STPS status, sociodemographic, and baseline clinical variables were tested as predictors of non-adherence using univariate and multivariate logistic regressions. Time to onset of non-adherence was analyzed using Kaplan-Meier curves. The same predictors were tested as predictors of time to onset of non-adherence using Cox regression models.

Results: Medication non-adherence was higher in STPS+ participants (78.9% vs. 68.9%). STPS status (OR 1.709), substance use disorder (OR 1.767), and milder positive symptoms (OR 0.972) were significant baseline predictors of non-adherence. Substance use disorder (HR 1.410), milder positive symptoms (HR 0.990), and lack of contact between the clinical team and relatives (HR 1.356) were significant baseline predictors of time to non-adherence.

Conclusion: FEP patients who experience pre-onset STPS are more likely to be non-adherent to antipsychotic medication over 2 years of intervention. FEP programs should routinely evaluate pre-onset symptomatology to deliver more personalized treatments, with emphasis on engaging both patients and family members from the beginning of care.

Keywords: clinical high risk; family involvement; first episode psychosis; medication adherence; substance use disorder.

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Figures

Figure 1:
Figure 1:
Time to medication nonadherence curves
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