Medication Adherence in a Transdiagnostic First-Episode Psychosis Sample

Stephanie M. London, MD; Philip B. Cawkwell, MD; Ann K. Shinn, MD, MPH

J Clin Psychiatry 2023;84(6):23m14947

ABSTRACT

Objective: Medication adherence is an important component of treatment and has the potential to influence illness trajectory in individuals with first-episode psychosis (FEP). We sought to examine time to medication non-adherence as well as factors related to non-adherence in a real-world FEP clinic.

Methods: We conducted a survival analysis to examine time to medication non-adherence using data extracted from medical records of patients admitted to a FEP clinic at an academic psychiatric hospital between May 2012 and October 2017 (n = 219). The risk pool included patients who were adherent during the first 6 months in the clinic (n = 122). Data were extracted for the entire length of participants’ time in the clinic, up to 66 months. Pre-selected clinical and demographic variables of interest were extracted and entered into a Cox proportional hazards model.

Results: Of the risk pool of 122 patients, 37 (30%) had documented non-adherence events. The risk of non-adherence was 0.35 (95% CI, 0.25–0.46) and 0.49 (95% CI, 0.37–0.63) at the 24- and 36-month time points, respectively, and plateaued after 36 months. Non-White race (adjusted HR = 3.69; P = .003; 95% CI, 1.57–8.70), lack of insight in the prior 6 months (adjusted HR = 3.24; P = .005; 95% CI, 1.43–7.35), and substance use in the prior 6 months (adjusted HR = 2.58; P = .022; 95% CI, 1.15–5.81) were significant predictors of non-adherence.

Conclusions: Clinicians should consider efforts to strengthen therapeutic alliance with non-White patients, improve insight, and help patients reduce or cease substance use when supporting medication adherence in the FEP population.

J Clin Psychiatry 2023;84(6):23m14947

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