Medication Noncompliance and Substance Abuse Among Patients with Schizophrenia

Today's medication adherence related abstract comes from Psychiatry Online. It is from a Veterans Affairs Field Program for Mental Health and was originally published over 10 years ago, however it is still often cited. The results are not that surprising, however it brought to mind alcoholism and how it is related to medication non-adherence and to mental health.

With both schizophrenia and bipolar disorder, the rates of alcoholism are much higher than the average. I have always viewed this alcoholism as self-medicating behavior - thus the patients are adherent to their self prescribed drinking regime. I wonder how side effects came into play as most of the psychiatric medications heighten the effects to alcohol?

OBJECTIVE:
The study examined the effect of medication noncompliance and substance abuse on symptoms of schizophrenia.

METHODS:
Short-term inpatients with a diagnosis of schizophrenia were enrolled in a longitudinal outcomes study and continued to receive standard care after discharge. At baseline and six-month follow-up, Brief Psychiatric Rating Scale (BPRS) scores and data on subjects' reported medication compliance, drug and alcohol abuse, usual living arrangements, and observed side effects were obtained. The number of outpatient contacts during the follow-up period was obtained from medical records. Relationships between the dependent variables-medication noncompliance and follow-up BPRS scores-and the independent variables were analyzed using logistic and linear regression models.

RESULTS:
Medication noncompliance was significantly associated with substance abuse. Subjects who abused substances, had no outpatient contact, and were noncompliant with medication had significantly greater symptom severity than other groups.

CONCLUSIONS:
Substance abuse is strongly associated with medication noncompliance among patients with schizophrenia. The combination of substance abuse, medication noncompliance, and lack of outpatient contact appears to define a particularly high-risk group.

Telenursing Intervention Increases Psychiatric Medication Adherence in Schizophrenia Outpatients

And here is today's medication adherence abstract from Journal of the American Psychiatric Nurses Association:

BACKGROUND:
Promoting medication adherence is a critical issue in optimizing both physical and mental health in persons with schizophrenia. Average antipsychotic medication adherence is only 50%; few studies have examined nonpsychiatric medication adherence. Psychosocial interventions with components of problem solving and motivation have shown promise in improving adherence behaviors.

OBJECTIVES:
This study examines telephone intervention problem solving (TIPS) for outpatients with schizophrenia. TIPS is a weekly, provider-initiated, proactive telenursing intervention designed to help persons with schizophrenia respond to a variety of problems, including adherence problems.

STUDY DESIGN:
The authors completed objective measures of adherence to psychiatric and nonpsychiatric medications in 29 community-dwelling persons with schizophrenia, monthly for 3 months.

STUDY RESULTS:
Persons receiving TIPS had significantly higher objective adherence to psychiatric medications throughout the study period, F(1, 20) = 5.47, p = .0298.

CONCLUSIONS:
Clinicians should consider using TIPS as an adjunct to face-to-face appointments to support adherence in persons at risk. J Am Psychiatr Nurses Assoc, 2008; 14(3), 217–224. DOI: 10.1177/1078390308318750