Factors associated with treatment nonadherence among US bipolar disorder patients. Non-adherence to medication in patients with psychotic disorders: epidemiology, contributing factors and management strategies. A prospective study of risk factors for nonadherence with antipsychotic medication in the treatment of schizophrenia. Unintentional non-adherence to chronic prescription medications: How unintentional is it really? The Prevalence and Burden of Psychiatric Disorders in Primary Health Care Visits in Qatar: Too Little Time? Adherence to Antidepressant Combinations and Monotherapy for Major Depressive Disorder: A CO-MED Report of Measurement-Based Care Prevalence and predictors of sub-optimal medication adherence among patients with severe mental illnesses in a tertiary psychiatric facility in Maiduguri, North-eastern Nigeria Financial incentives to improve adherence to antipsychotic maintenance medication in non-adherent patients: a cluster randomised controlled trial. Potentially Inappropriate Use of Psychotropic Medications in Hospitalized Elderly Patients in France Medication Compliance and Health Education Among Outpatients With Chronic Mental Disorders Increased prevalence of type 2 diabetes mellitus among psychiatric inpatients with bipolar I affective and schizoaffective disorders independent of psychotropic drug use. Identification of primary care patients at risk of nonadherence to antidepressant treatment Evaluation of an instructional program for improving medication compliance for chronically mentally ill outpatients. Treatment attitudes and adherence of psychiatric patients with major depressive disorder: a five-year prospective study. Guideline implementation and patient-tailoring strategies to improve medication adherence for schizophrenia. Predictors and consequences of adherence to the treatment of pediatric patients with attention-deficit/hyperactivity disorder in Central Europe and East Asia Using a treatment partner and text messaging to improve adherence to psychotropic medication: a qualitative formative study of service users and caregivers in Cape Town, South Africa.
OBJECTIVE Since sustained treatment-adherence is often problematic and may limit clinical outcomes among bipolar disorder ( BPD ) patients , we sought risk factors to guide clinical prediction of nonadherence . METHODS Data were from a 2005 US national sample providing question naire responses by 131 r and omly selected prescribing psychiatrists and their adult BPD patients . We contrasted demographic and clinical factors in treatment-adherent versus nonadherent patients ( strictly defined as missing > or = 1 dose within 10 days ) in univariate analyses followed by multivariate logistic-regression modeling . RESULTS Of 429 DSM-IV BPD patients ( 79 % type-I ; 62 % women ; 17 % minorities ) , 34 % reported missing > or = 1 dose of  psychotropic medication within 10 days , 20 % missed entire daily doses at least once , and only 2.5 % missed all doses for 10 days . However , their prescribing psychiatrists considered only 6 % as treatment-nonadherent . Factors significantly associated with nonadherence in multivariate modeling ranked : alcohol-dependence > youth > greater affective morbidity > various side effects > or = comorbid obsessive-compulsive disorder > or = recovering from mania-hypomania . Unrelated were sex , diagnostic subtype , and other comorbidities . Since most patients received > or = 2 psychotropics , potential relationships between treatment-complexity and adherence were obscured . CONCLUSIONS Prevalent treatment-nonadherence among American BPD patients , and striking underestimation of the problem by prescribing clinicians may encourage increasingly complex treatment-regimens of untested value , but added expense , risk of adverse effects , and uncertain impact on treatment-adherence itself Although non-adherence is common across all branches of medicine , psychotic disorders pose additional challenges that increase its risk . Despite the importance of non-adherence , clinicians generally spend too little time on assessing and addressing adherence attitudes and behaviors . Importantly , how adherence is measured significantly impacts the findings , and the most frequently employed methods of asking patients or judging adherence indirectly based on efficacy or tolerability information have poor validity . Novel technologies are being developed that directly assess adherence and that can also be used to both provide real-time feedback to clinicians and serve as an intervention with patients . Several treatments are available that can positively impact adherence . Among psychosocial interventions , those combining multiple approaches and involving multiple domains seem to be most effective . Although long-acting injectable antipsychotics are theoretically a very powerful tool to assure adherence and signal non-adherence , recent results from r and omized controlled trials failed to show superiority compared to oral antipsychotics . These data are in contrast to nationwide cohort studies and mirror-image studies , which arguably include more representative patients receiving long-acting antipsychotics in clinical practice . This disconnect suggests that traditional r and omized controlled trials are not necessarily the best way to study interventions that are thought to work via reducing non-adherence . Clearly , non-adherence is likely to remain a major public health problem despite treatment advances . However , increasing knowledge about factors affecting adherence and leveraging novel technologies can enhance its early assessment and adequate management , particularly in patients with psychotic disorders OBJECTIVES This study aim ed to prospect ively identify the best single predictor and the best set of predictors of risk for nonadherence with anti-psychotic medication in the treatment of patients with schizophrenia . METHOD We used data from 1579 patients in a 3-year , prospect i ve , naturalistic , nonr and omized , multisite study of schizophrenia patients conducted from July 1997 to September 2003 ( U.S. Schizophrenia Care and Assessment Program ) . Adherence with any oral antipsychotic medication was assessed using  patient-reported medication adherence and an indirect adherence measure  based on medical record prescription information . Patients who reported poor medication adherence or had a medication possession ratio < or = 80 % ( percentage of days with prescriptions for any oral antipsychotic ) during the first year after enrollment were defined as nonadherent ( N = 296 , 18.8 % ) . Thirty-nine previously reported potential risk factors of nonadherence with antipsychotic medication were assessed at enrollment with valid and reliable measures . Risk factors represented patient- , environment- , and treatment-related domains , including sociodemographics , symptom severity , substance use , threat to safety of self and others , other illness-related factors , need for supervision , medication-related adverse events , and prior medication-utilization patterns . RESULTS The best single predictor of future nonadherence was nonadherence during the 6 months prior to enrollment ( odds ratio = 4.1 , 95 % confidence interval = 3.1 to 5.6 , p < .001 ) . The best set of predictors of nonadherence , ordered by strength of association , included prior non-adherence , recent illicit drug use , recent alcohol use , prior treatment with antidepressants , and greater patient-reported , medication-related cognitive impairment . CONCLUSION Nonadherence with antipsychotic medication is associated with a well-defined set of risk factors that can be used to identify patients who are predisposed to poor adherence Background Unintentional non-adherence has been characterized as passively inconsistent medication-taking behavior ( forgetfulness or carelessness ) . Our objectives were to : ( 1 ) study the prevalence and predictors of unintentional non-adherence ; and ( 2 ) explore the interrelationship between intentional and unintentional non-adherence in relation to patients ’ medication beliefs . Methods We conducted a cross-sectional survey of adults with asthma , hypertension , diabetes , hyperlipidemia , osteoporosis , or depression from the Harris Interactive Chronic Illness Panel . The analytic sample for this study included 24,017 adults who self-identified themselves as persistent to prescription medications for their index disease . They answered three questions on unintentional non-adherence ( forgot , ran out , being careless ) , 11 questions on intentional non-adherence , and three multi-item scales assessing perceived need for medication ( k = 10 ) , perceived medication concerns ( k = 6 ) , and perceived  medication  affordability ( k = 4 ) . Logistic regression was used to model predictors of each unintentional non-adherence behavior . Baron and Kenny ’s regression approach was used to test the mediational effect of unintentional non-adherence on the relationship between medication beliefs and intentional non-adherence . Bootstrapping was employed to confirm the statistical significance of these results . Results For the index disease , 62 % forgot to take a medication , 37 % had run out of the medication , and 23 % were careless about taking the medication . Common multivariate predictors ( p < .001 ) of the three behaviors were : ( 1 ) lower perceived need for medications ; ( 2 ) more medication affordability problems ; ( 3 ) worse self-rated health ; ( 4 ) diabetes or osteoporosis ( relative to hypertension ) ; and ( 5 ) younger age . Unique statistically-significant predictors of the three behaviors were : ( a ) ‘ forgot to take medications ’ - greater concerns about the index medication and male gender ; ( b ) ‘ run out of medications ’ - non-white race , asthma , and higher number of total prescription medications ; ( c ) ‘ being careless ’ - greater medication concerns . Mediational tests confirmed the hypothesis that the effect of medication beliefs ( perceived need , concerns , and affordability ) on intentional non-adherence is mediated through unintentional non-adherence . Conclusions For our study sample , unintentional non-adherence does not appear to be r and om and is predicted by medication beliefs , chronic disease , and sociodemographics . The data suggests that the importance of unintentional non-adherence may lie in its potential prognostic significance for future intentional non-adherence . Health care providers may consider routinely inquiring about unintentional non-adherence in order to proactively address patients ’ suboptimal medication beliefs before they choose to discontinue therapy all together Background : Psychiatric disorders including anxiety , depression , somatization , obsessive compulsive , and bipolar disorders are recognized as causing the biggest burden of disease worldwide . Aim : In this study , we aim ed to assess the prevalence and burden of common mental disorders at Primary Health Care Centers ( PHCC ) using the World Health Organization Composite International Diagnostic Interview ( WHO-CIDI ) in the Qatari population , aged 18–65 who attended Primary Health Care ( PHC ) setting s. Design : A prospect i ve cross-sectional study conducted during November 2011 to October 2012 . Setting : Primary Health Care Centers of the Supreme Council of Health , Qatar . Subjects : A total of 2,000 Qatari subjects aged 18–65 years were approached ; 1475 ( 73.3 % ) agreed to participate . Methods : Prevalence and severity of International Classification of Disease-10 disorders were assessed with the WHO-CIDI ( Version 3.0 ) . Results : Of the 1475 participants , 830 ( 56.3 % ) were females and 645 ( 43.7 % ) was males . One-third were aged 35–49 years 558 ( 37.8 % ) . The three most common disorders were major depression disorders ( 18.31 % ) , any anxiety disorders ( 17.3 % ) , any mood disorders ( 16.95 % ) , followed by separation anxiety disorders ( 15.25 % ) , personality disorder ( 14.1 % ) . In the present study , prevalence in women was significantly higher than men for the most common psychiatric disorders , specifically generalized anxiety disorder , panic disorder , social phobia , specific phobias , obsessive compulsive disorders , posttraumatic disorder , somatization , major depressive disorder , bipolar disorder , dysthymia , and oppositional defiant disorder . Of the total 20 % had only one psychiatric diagnosis and 12 % had two disorders , 9.7 % respondents with three diagnoses , and finally 4.3 % of respondents had four or more diagnoses . Conclusion : One-fifth of all adults who attended the PHCC ( 20 % ) had at least one psychiatric diagnosis . The CIDI is a useful instrument for psychiatric diagnosis in community setting s such as PHC clinics , clinical research and intervention studies . There is an urgent need to not only assess prevalence , but also risk factors , burden , treatment gaps and outcomes to obtain evidence for policy making Background . Non-adherence to antidepressant treatment is not routinely measured in practical clinical trials . It has not been related to outcomes in a large sample of adults with chronic and /or recurrent major depressive disorder ( MDD ) or any sample treated with antidepressant combinations . Methods . Adult out patients with chronic and /or recurrent MDD were r and omized to 12 weeks of treatment with bupropion-SR plus escitalopram , venlafaxine – XR plus mirtazapine , or escitalopram plus placebo . We compared non-adherence ( the frequency with which daily medications were not taken ) and specifically the frequency of temporarily stopping and /or skipping medication , or reducing or increasing the dose across treatments in 567 participants using a self-report question naire collected at each visit . We tested the association between non-adherence , and both treatment type and outcomes . Results . A non-adherence rate under 10 % was reported by 77.9 % , 70.9 % , and 71.6 % of participants during weeks 1–4 , 5–12 , and 1–12 , respectively . Antidepressant combinations were associated with a higher non-adherence rate than monotherapy during weeks 1–4 and 1–12 . During weeks 1–4 , 24.1 % stopped/skipped doses and 6.1 % reduced the dose . During weeks 5–12 , 34.7 % stopped/skipped doses and 9.4 % reduced the dose . Across 12 weeks , 43.2 % stopped/skipped doses , and 12.9 % reduced the dose . Stopping/skipping doses during all time frames and dose decreases during weeks 1–12 occurred most frequently with combination treatments . Non-adherence was unrelated to symptom remission , response , or symptom change . Conclusions . With closely monitored treatment , non-adherence is low and unrelated to depressive symptom outcome . Nonadherence is highest with antidepressant combinations . Specific non-adherent events are most often sporadic . ( Journal of Psychiatric Practice 2014;20:118–132 Introduction Sub-optimal adherence constitutes a significant impediment to the management of severe mental illnesses ( SMIs ) as it negatively impacts on the course of the illness and the treatment outcome . In this study , the levels of adherence , prevalence and the predictors of sub-optimal adherence were assessed in a sub-Saharan African setting . Methods Three hundred and seventy ( 370 ) respondents with diagnoses of schizophrenia , bipolar disorder or severe depression were r and omly enrolled and interviewed at the out-patient department of the Federal Neuropsychiatric Hospital , Maiduguri in northeastern Nigeria . An anonymous sociodemographic question naire and a clinical proforma design ed by the authors ,  Oslo social support scale  and the  8-item Morisky Medication Adherence Scale ( MMAS-8 ) were used for data collection . Results The prevalence of sub-optimal adherence was 55.7 % . The independent predictors of sub-optimal adherence were ; seeking for traditional/ spiritual treatment ( Odds Ratio ( O.R. ) = 6.523 , 95 % C.I. = 3.773 - 11.279 , P = < 0.001 ) , male gender ( O.R. = 3.307 , 95 % C.I. = 1.907 - 5.737 , P = < 0.001 ) , low levels of insight ( O.R. = 1.753 , 95 C.I. = 1.220 - 2.519 , P = 0.002 ) , and low social support levels ( O.R. = 1.528 , 95 % C.I. = 1.097 - 2.129 , P = 0.012 ) . Conclusion Based on the outcome of the study , we recommend the development of psycho-educational programmes on adherence and the active involvement of the relations and significant others in the management of patients with SMIs in sub-Saharan Africa BACKGROUND Poor adherence to long-term antipsychotic injectable ( LAI ) medication in patients with psychotic disorders is associated with a range of negative outcomes . No psychosocial intervention has been found to be consistently effective in improving adherence . OBJECTIVES To test whether or not offering financial incentives is effective and cost-effective in improving adherence and to explore patient and clinician experiences with such incentives . DESIGN A cluster r and omised controlled trial with economic and nested qualitative evaluation . The intervention period lasted for 12 months with 24 months ' follow-up . The unit of r and omisation was mental health teams in the community . SETTING Community teams in secondary mental health care . PARTICIPANTS Patients with a diagnosis of schizophrenia , schizoaffective psychosis or bipolar illness , receiving ≤ 75 % of their prescribed LAI medication . In total , 73 teams with 141 patients ( intervention n = 78 and control n = 63 ) were included . INTERVENTIONS Participants in the intervention group received £ 15 for each LAI medication . Patients in the control group  received treatment as usual . MAIN OUTCOME MEASURES PRIMARY OUTCOME adherence to LAI medication  ( the percentage of received out of those prescribed ) . SECONDARY OUTCOMES percentage of patients with at least 95 % adherence ; clinical global improvement ; subjective quality of life ; satisfaction with medication ; hospitalisation ; adverse events ; and costs . Qualitative evaluation : semistructured interviews with patients in the intervention group and their clinicians . RESULTS PRIMARY OUTCOME outcome data were available for 131 patients .  Baseline adherence was 69 % in the intervention group and 67 % in the control group . During the intervention period , adherence was significantly higher in the intervention group than in the control group ( 85 % vs. 71 % ) [ adjusted mean difference 11.5 % , 95 % confidence interval ( CI ) 3.9 % to 19.0 % ; p = 0.003 ] . Secondary outcome : patients in the intervention group showed statistically significant improvement in adherence of at least 95 % ( adjusted odds ratio 8.21 , 95 % CI 2.00 to 33.67 ; p = 0.003 ) and subjective quality of life ( difference in means 0.71 , 95 % CI 0.26 to 1.15 ; p = 0.002 ) . Follow-ups : after incentives stopped , adherence did not differ significantly between groups , neither during the first 6 months ( adjusted difference in means -7.4 % , 95 % CI -17.0 % to 2.1 % ; p = 0.175 ) nor during the period from month 7 to month 24 ( difference in means -5.7 % , 95 % CI -13.1 % to 1.7 % ; p = 0.130 ) . Cost-effectiveness : the average costs of the financial incentives was £ 303 . Overall costs per patient were somewhat higher in the intervention group , but the difference was not significant . Semistructured interviews : the majority of patients and clinicians reported positive experiences with the incentives beyond their monetary value . These included improvement in the therapeutic relationship . The majority of both patients and clinicians perceived no negative impact after the intervention was stopped after 1 year . CONCLUSIONS Financial incentives are effective in improving adherence to LAI medication . Health-care costs ( including costs of the financial incentive ) are unlikely to be increased substantially by this intervention . Once the incentives stop , the advantage is not maintained . The experiences of both patients and clinicians are largely , but not exclusively , positive . Whether or not financial incentives are effective for patients with more favourable background , those on oral mediation or for shorter or longer time periods remains unknown . TRIAL REGISTRATION Current Controlled Trials IS RCT N77769281 . FUNDING This project was funded by the National Institute for Health Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 20 , No. 70 . See the NIHR Journals Library website for further project information Abstract Background : In France , there is evidence to suggest that 50 % of elderly individuals are prescribed psychotropic medications . However , it is known that use of these agents increases the risk of falls , fractures and delirium in older people . Objective : To study the consumption of ‘ potentially inappropriate medication ’ ( PIM ) among patients aged ≥75 years , paying particular attention to psychotropic drugs and the factors influencing the use of ‘ potentially inappropriate psychotropics ’ ( PIPs ) . Method : This was a cross-sectional analysis of a prospect i ve multicentre cohort of 1306 hospitalized French patients aged ≥75 years ( the SAFEs [ Sujet Âgé Fragile : Évaluation et suivi ( Frail Elderly Subjects : Evaluation and follow-up ) ] cohort ) . The present analysis involved the 1176 patients for whom there was information on the usual treatments being taken in the 2 weeks before hospitalization . The drugs were coded according to the Anatomical Therapeutic Chemical classification ; the Beers list as up date d in 2003 defined which medications were considered PIPs . St and ardized geriatric assessment variables were recorded on inclusion in the study . Logistic regression analysis was performed to identify factors linked to use of psychotropics and PIPs . Results : The mean number of drugs taken was 5.7 ± 2.9 per patient . Twenty-eight percent of patients took at least one PIM . The number of patients who had taken at least one psychotropic drug  in the 2 weeks before hospitalization ( mean 1.6 ± 0.9 psychotropics per patient ) was 589 ( 50.1 % ) . More than half of both the 510 patients with a depressive syndrome and the 543 patients affected by dementia were treated with psychotropics . Multivariate analysis showed that prescription of psychotropics was linked to the presence of a dementia syndrome ( odds ratio [ OR ] = 1.4 ; 95 % CI 1.1 , 1.9 ; p = 0.03 ) , the presence of a depressive syndrome ( OR = 1.7 ; 95 % CI 1.3 , 2.1 ; p < 0.001 ) , living in an institution ( OR = 2.2 ; 95 % CI 1.5 , 3.4 ; p < 0.001 ) , use of more than five drugs ( OR = 3.2 ; 95 % CI 2.5 , 4.2 ; p < 0.001 ) and Charlson ’s co-morbidity score > 1 ( OR = 0.6 ; 95 % CI 0.5 , 0.8 ; p = 0.001 ) . Nineteen percent of all psychotropics prescribed were PIPs . Of these PIPs , 66.5 % were anxiolytics , 28.4 % were antidepressants and 5.1 % were  antipsychotics  . Use of PIPs in the multivariate analysis was associated only with consumption of more than five drugs ( OR = 1.7 ; 95 % CI 1.1 , 2.5 ; p = 0.01 ) . Conclusion : PIM use is common among hospitalized older adults in France . The most important determinant of risk of receiving a psychotropic medication or a PIP was the number of drugs being taken . The elderly , who have multiple comorbidities , complex chronic conditions and are usually receiving polypharmacy , are at increased risk for adverse drug events . These adverse events are often linked to problems that could be preventable such as delirium , depression and falls . Regular review of prescriptions would help optimize prescription of psychotropics in the elderly . The Beers list is a good tool for evaluating PIMs but is too restrictive with respect to psychotropics ; in the latter respect , the list could usefully be widened Medication noncompliance occurs among as many as one-third to one-half of all medical and psychiatric out patients . Noncompliance has serious consequences for individuals diagnosed with schizophrenia , often result ing in higher rates of relapse and rehospitalization , and poorer community adjustment .  Health education interventions have been shown to be effective in promoting compliance among patients with chronic medical illnesses such as hypertension or diabetes , but there have been few r and omized trials of this approach among patients with chronic psychiatric disorders . This paper presents the results of an application of health education among a group of male psychiatric out patients . Two interventions were developed which used health education techniques to 1 ) engage families or significant others as active participants in the aftercare process , and 2 ) train patients to become effective health care consumers . A total of 418 individuals participated in a six-month trial over a four-year study . Both interventions significantly improved medication compliance among those who received them . The results show that comparatively brief interventions can significantly alter medication compliance behavior and improve the quality of life for patients with chronic psychiatric disorders BACKGROUND There are numerous reports of abnormal glucose metabolism , including increased rates of type 2 diabetes mellitus , in psychiatric patients . It remains unclear , however , whether there is an intrinsic relationship between abnormal glucose metabolism and particular psychiatric disorders , because the relationship is complicated by treatment with psychotropic medications that promote weight gain and hyperglycemia . This study aim ed to clarify this relationship . METHODS The medical records of 243 in patients , aged 50 - 74 years , with diagnoses of major depression , bipolar I disorder , schizoaffective disorder , schizophrenia , and dementia were review ed . Psychiatric and type 2 diabetes mellitus diagnoses , medications , body mass index ( BMI ) , age , gender , and race were recorded . Diabetes rates were compared to age , race , and gender-matched rates in the US general population . RESULTS Rates of type 2 diabetes mellitus were : schizoaffective ( 50 % ) > bipolar I ( 26 % ) > major depression ( 18 % ) = dementia ( 18 % ) > schizophrenia ( 13 % ) ( p < 0.006 ) . Diabetic patients had a higher mean BMI ( p = 0.01 ) , but not a significantly higher use of psychotropic medications previously reported to be associated with new-onset type 2 diabetes ( e.g. , phenothiazines , clozapine , olanzapine ) . Logistic regression revealed that psychiatric diagnosis and BMI were the only significant and independent predictors of diabetes diagnosis . Compared to national norms , diabetes rates were significantly elevated only in bipolar I affective and schizoaffective patients . LIMITATIONS This study was a retrospective chart review of older , hospitalized patients . CONCLUSIONS This is the first published study to show an increased prevalence of type 2 diabetes mellitus among psychiatric patients with particular psychiatric illnesses independent of the effects of age , race , gender , medication , and body mass . This finding , which requires replication in a larger scale , prospect i ve study , suggests an intrinsic relationship between abnormal glucose metabolism and bipolar I affective and schizoaffective disorders Introduction Poor adherence to antidepressant treatment is common , and results in increased disability and costs . Several factors are thought to influence patients ’ ability and willingness to adhere . So far , however , consensus is lacking regarding patient characteristics that predict nonadherence . The purpose of this study was to identify predictors of nonadherence to antidepressant treatment that can be ascertained at treatment start . Method The present study used data from a r and omized controlled trial with the main objective of study ing the effect of two different compliance-enhancing programs on treatment adherence  and treatment response in 1031 primary care patients with major depression . In this study , logistic regression analyses were performed to examine patient- and illness-related characteristics potentially associated with nonadherence . Results Nonadherence to antidepressant treatment  was predicted by age under 35 or over 64 years , presence of personality disorder , sensation-seeking personality traits , substance abuse , and absence of concomitant medications . Conclusion Certain patient- and illness-related characteristics may imply an increased risk of nonadherence to antidepressant treatment . Giving special attention to subjects with such characteristics may improve adherence Outpatient medication adherence is a major problem , especially for patients repeatedly hospitalized for psychiatric disorders . This study included 39 such patients who were receiving case management services from a community mental health center . Patients were matched and r and omly assigned to receive in a single session either ( 1 ) information regarding medication and its benefits , ( 2 ) guidelines for assuring adherence which encompassed all phases related to pill-taking including filling prescriptions , use of a pill container , transportation , self-reminders , doctor 's appointments and so forth , or ( 3 ) the same guidelines as ( 2 ) above but given in the presence of a family member who was enlisted in support . The results showed that adherence increased to about 94 % after the guidelines were given for both the individual and family guideline procedure , whereas adherence remained unchanged at 73 % after the medication information procedure . These results suggest a practical means for assuring a high level of medication adherence for patients with psychiatric disorders BACKGROUND The prevalence , long-term temporal consistency and factors influencing negative attitudes and poor treatment adherence among psychiatric patients with major depressive disorder ( MDD ) are not well known . METHODS In the Vantaa Depression Study ( VDS ) , a prospect i ve 5-year study of psychiatric patients with DSM-IV MDD , 238 ( 88.5 % ) patients ' attitudes towards and adherence to both antidepressants and psychotherapeutic treatments at baseline , 6 months , 18 months and 5 years was investigated . RESULTS Throughout the follow-up , most patients reported positive attitudes towards pharmacotherapy and psychosocial treatments  , and good adherence . While attitudes became more critical over time , adherence to psychosocial treatment improved , but remained unchanged for pharmacotherapy . Employment predicted positive attitude ( OR=1.97 , 95 % CI 1.01 - 3.83 , P=0.046 ) , and larger social network good adherence ( OR=1.11 , 95 % CI 1.00 - 1.23 , P=0.042 ) to pharmacotherapy at the last follow-up . Cluster B personality disorder symptoms predicted negative attitude ( OR=0.82 , 95 % CI 0.70 - 0.96 , P=0.012 ) and poor adherence ( OR=0.83 , 95 % CI 0.72 - 0.95 , P=0.007 ) , but cluster C symptoms positive attitude ( OR=1.30 , 95 % CI 1.09 - 1.54 , P=0.003 ) , and living alone good adherence ( OR=3.13 , 95 % CI 1.10 - 9.09 , P=0.032 ) to psychosocial treatment . LIMITATIONS Patients may exaggerate their adherence to treatments . Attrition from follow-up may occur due to undetected negative change in treatment attitude or adherence . CONCLUSIONS Among psychiatric MDD patients in long-term follow-up , treatment attitudes and adherence to  pharmaco-  and psychotherapy were and remained mostly positive . They were significantly predicted by personality features and social support . Attention to adherence of those with cluster B personality disorders , or poor social support , may be needed OBJECTIVE To determine the effectiveness of an intervention to promote medication adherence . METHOD Data were collected for adults with exacerbation of schizophrenia who were treated at one of 6 U.S. Department of Veterans Affairs ( VA ) Medical Centers ( VAMCs ) in 3 regional VA networks ( Veterans Integrated Service Networks [ VISNs ] ) from March 1999 to October 2000 . All 6 VAMCs received a basic guideline implementation strategy for medication management of schizophrenia using usual VA procedures . One VAMC within each VISN was r and omly selected to receive an enhanced implementation strategy design ed to promote guideline -concordant prescribing by physicians and medication adherence by patients . In the enhanced strategy , a research nurse worked with study participants to identify medication adherence barriers and to develop patient-specific strategies to overcome those barriers . Participants ( N = 349 ) were interviewed at enrollment and 6 months later , using the Structured Clinical Interview for the Positive and Negative Syndrome Scale ( PANSS ) , the Barnes Akathisia Rating Scale , and the Schizophrenia Outcomes Module ( SCHIZOM ) . Medication adherence was measured via subjects ' self-report , using the SCHIZOM , and from data abstract ed from medical records . RESULTS Participants were primarily male ( 94 % ) and nonwhite ( 69 % , primarily African American ) with a mean age of 46 years .  Medication adherence at follow-up was modeled using logistic regression , controlling for adherence at baseline , demographic characteristics , PANSS total score , akathisia at baseline , family history of mental illness , and substance abuse . A logistic regression model for adherence at follow-up was significant ( likelihood ratio = 52.72 , df = 14 , p < .0001 ) . Patients enrolled at sites receiving the enhanced intervention were almost twice as likely to be adherent at follow-up . Those who were nonadherent at baseline were significantly less likely to be adherent at follow-up . In addition , adherence at follow-up was significantly greater at 2 of the VA networks as compared to the third network . CONCLUSIONS These data suggest that a patient-centered strategy to identify and overcome barriers to adherence can improve adherence to antipsychotic medications Purpose To assess baseline predictors and consequences of medication non-adherence in the treatment of pediatric patients with attention-deficit/hyperactivity disorder ( ADHD ) from Central Europe and East Asia . Patients and methods Data for this post-hoc analysis were taken from a 1-year prospect i ve , observational study that included a total of 1,068 newly-diagnosed pediatric patients with ADHD symptoms from Central Europe and East Asia .  Medication adherence during the week prior to each visit was assessed by treating physicians using a 5-point Likert scale , and then dichotomized into either adherent or non-adherent . Clinical severity was measured by the Clinical Global Impressions-ADHD-Severity ( CGI-ADHD ) scale and the Child Symptom Inventory-4 ( CSI-4 ) Checklist . Health-Related Quality of Life ( HRQoL ) was measured using the Child Health and Illness Profile-Child Edition ( CHIP-CE ) . Regression analyses were used to assess baseline predictors of overall adherence during follow-up , and the impact of time-varying adherence on subsequent outcomes : response ( defined as a decrease of at least 1 point in CGI ) , changes in CGI-ADHD , CSI-4 , and the five dimensions of CHIP-CE . Results Of the 860 patients analyzed , 64.5 % ( 71.6 % in Central Europe and 55.5 % in East Asia ) were rated as adherent and 35.5 % as non-adherent during follow-up . Being from East Asia was found to be a strong predictor of non-adherence . In East Asia , a family history of ADHD and parental emotional distress were associated with non-adherence , while having no other children living at home was associated with non-adherence in Central Europe as well as in the overall sample . Non-adherence was associated with poorer response and less improvement on CGI-ADHD and CSI-4 , but not on CHIP-CE . Conclusion Non-adherence to medication is common in the treatment of ADHD , particularly in East Asia . Non-adherence was associated with poorer response and less improvement in clinical severity . A limitation of this study is that medication adherence was assessed by the treating clinician using a single item question OBJECTIVE Poor adherence to medications , including psychotropic medications contributes to the burden of disease . Mental health service users ( MHSU ) may also not attend follow-up appointments at their health care facilities where they could discuss adherence with their health care provider . This paper reports on preliminary qualitative research preceding a r and omised controlled trial that aims to improve adherence to psychotropic medication  and to follow up treatment visits . The intervention will entail the support of individuals with serious mental disorder by a treatment partner and short message service ( SMS ) text messaging . METHODS The preliminary research reported in this paper aim ed to extract views about the intervention from both mental health service users ( MHSU ) and caregivers through focus group discussion s and individual interviews . Data were analysed using ATLAS TI qualitative software . RESULTS The caregivers interviewed were all mothers of MHSU who took measures to encourage adherence . They held mixed opinions on whether the treatment partner should be a family member . Most participants expressed the view that due to living conditions , family members were natural treatment partners , but others stated that they would prefer a treatment partner who was not a family member . Similarly , while most MHSU supported the idea of a treatment partner , a minority were concerned that a treatment partner may potentially be too controlling and compromise their autonomy . The vast majority of participants supported SMS text messaging as a means of reminding MHSU to take their medication and attend follow-up appointments . One participant mentioned the importance of broader social inclusion issues that should be incorporated in the intervention . CONCLUSION Qualitative research may provide useful insights for the design of interventions of this nature related to social inclusion r and omised control trials with its focus on adherence
Individual patient ’s behaviors , lack of social support , clinical or treatment and illness-related , and health system factors influenced psychotropic medication non-adherence .
Conclusion Psychotropic medication non-adherence was high .
It was influenced by various factors operating at different levels .
Background Major psychiatric disorders are growing public health concern that attributed 14 % of the global burden of diseases .
The management of major psychiatric disorders is challenging mainly due to medication non-adherence .
However , there is a paucity of summarized evidence on the prevalence of psychotropic medication non-adherence and associated factors .
Therefore , we aim ed to summarize existing primary studies ’ finding to determine the pooled prevalence and factors associated with psychotropic medication non-adherence .