Determination of Adherence Profiles in Schizophrenia Using Self-Reported Adherence
David Misdrahi
(1, 2, 3)
,
Arnaud Tessier
(1, 2, 3)
,
Joel Swendsen
(1, 2)
,
Fabrice Berna
(3, 4, 5, 6)
,
Lore Brunel
(3, 7, 8)
,
Delphine Capdevielle
(3, 9, 10)
,
Isabelle Chéreau
(3, 11)
,
Jean-Marie Danion
(3, 4, 5, 6)
,
Marie de Pradier
(3, 12, 13)
,
Jean-Michel Dorey
(3, 14, 15)
,
Caroline Dubertret
(3, 12, 13)
,
Julien Dubreucq
(3, 16)
,
Catherine Faget
(3, 17)
,
Franck Gabayet
(3, 16)
,
Romain Rey
(3, 14, 15)
,
Raphaëlle Richieri
(3, 17)
,
Christine Passerieux
(3, 18, 19)
,
Aurélie Schandrin
(3, 9, 10)
,
Franck Schürhoff
(3, 7, 8)
,
Anne Marie Tronche
(3, 11)
,
Mathieu Urbach
(3, 18, 19)
,
Pierre Michel Llorca
(3, 11)
,
Guillaume Fond
(3, 7, 8)
,
Face-Sz (fondamental Academic Centers of Expertise For Schizophrenia) Group
1
Centre hospitalier Charles Perrens [Bordeaux]
2 INCIA - Institut de Neurosciences cognitives et intégratives d'Aquitaine
3 Fondation FondaMental [Créteil]
4 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
5 NCPS - Neuropsychologie Cognitive et Physiopathologie de la Schizophrénie
6 FMTS - Fédération de Médecine Translationnelle de Strasbourg
7 Pôle de Psychiatrie [Hôpital Henri Mondor]
8 IMRB - Institut Mondor de Recherche Biomédicale
9 Département de Psychiatrie adulte [Hôpital de la Colombière - CHU Montpellier]
10 PSNREC - Neuropsychiatrie : recherche épidémiologique et clinique
11 NPsy-Sydo - Neuro-Psycho Pharmacologie des Systèmes Dopaminergiques sous-corticaux
12 Hôpital Louis Mourier - AP-HP [Colombes]
13 U894 - Centre de Psychiatrie et Neurosciences
14 Centre Hospitalier le Vinatier [Bron]
15 UCBL - Université Claude Bernard Lyon 1
16 CH Alpes Isere - Centre Hospitalier Alpes Isère [Grenoble, France]
17 Hôpitaux Sud - Département Universitaire de Psychiatrie - [Hôpital Sainte Marguerite - APHM]
18 CHV - Centre Hospitalier de Versailles André Mignot
19 UVSQ Santé - UFR Sciences de la santé Simone Veil
2 INCIA - Institut de Neurosciences cognitives et intégratives d'Aquitaine
3 Fondation FondaMental [Créteil]
4 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
5 NCPS - Neuropsychologie Cognitive et Physiopathologie de la Schizophrénie
6 FMTS - Fédération de Médecine Translationnelle de Strasbourg
7 Pôle de Psychiatrie [Hôpital Henri Mondor]
8 IMRB - Institut Mondor de Recherche Biomédicale
9 Département de Psychiatrie adulte [Hôpital de la Colombière - CHU Montpellier]
10 PSNREC - Neuropsychiatrie : recherche épidémiologique et clinique
11 NPsy-Sydo - Neuro-Psycho Pharmacologie des Systèmes Dopaminergiques sous-corticaux
12 Hôpital Louis Mourier - AP-HP [Colombes]
13 U894 - Centre de Psychiatrie et Neurosciences
14 Centre Hospitalier le Vinatier [Bron]
15 UCBL - Université Claude Bernard Lyon 1
16 CH Alpes Isere - Centre Hospitalier Alpes Isère [Grenoble, France]
17 Hôpitaux Sud - Département Universitaire de Psychiatrie - [Hôpital Sainte Marguerite - APHM]
18 CHV - Centre Hospitalier de Versailles André Mignot
19 UVSQ Santé - UFR Sciences de la santé Simone Veil
David Misdrahi
- Fonction : Auteur
- PersonId : 1033225
- ORCID : 0000-0003-1146-3206
- IdRef : 091552125
Arnaud Tessier
- Fonction : Auteur
- PersonId : 11532
- IdHAL : arnaud-tessier
- ORCID : 0000-0001-5758-5693
- IdRef : 189477520
Fabrice Berna
- Fonction : Auteur
- PersonId : 1247289
- ORCID : 0000-0002-6118-0629
- IdRef : 113479174
Delphine Capdevielle
- Fonction : Auteur
- PersonId : 1416394
- ORCID : 0000-0002-7146-8554
- IdRef : 069470251
Jean-Michel Dorey
- Fonction : Auteur
- PersonId : 921864
Julien Dubreucq
- Fonction : Auteur
- PersonId : 765988
- ORCID : 0000-0003-4079-4194
Christine Passerieux
- Fonction : Auteur
- PersonId : 1234382
- ORCID : 0000-0003-4130-1590
Pierre Michel Llorca
- Fonction : Auteur
- PersonId : 781416
- ORCID : 0000-0001-7438-8990
- IdRef : 05967797X
Guillaume Fond
- Fonction : Auteur
- PersonId : 767238
- ORCID : 0000-0003-3249-2030
- IdRef : 15207127X
Résumé
OBJECTIVE:
Medication nonadherence is one of the most important, and potentially modifiable, prognostic factors in the outcome of patients with schizophrenia. The aim of this article is to propose a new classification of adherence profiles according to the Medication Adherence Rating Scale (MARS) in a large community-dwelling sample of French patients with schizophrenia to provide a new tool to help clinicians in daily practice.
METHODS:
319 community-dwelling patients from a national network of 10 Schizophrenia Expert Centers were interviewed between January 2009 and January 2014. Assessments were conducted with a dedicated electronic medical record including the Structured Clinical Interview for DSM-IV Disorders. A cluster analysis was performed to explore clinical variables associated with poor adherence.
RESULTS:
Two distinct groups of patients were identified relative to their main adherence style. Items about medications' subjective negative effects constituted the greatest discriminating factor between the 2 clusters. Patients with poor adherence (n = 117) were significantly younger (adjusted OR [aOR] = 1.036; 95% CI, 1.004-1.069) and had higher levels of current depression (aOR = 0.894; 95% CI, 0.829-0.964) and lower insight (aOR = 0.820; 95% CI, 0.693-0.970).
CONCLUSIONS:
The MARS provides a useful tool for clinicians and can also aid in the evaluation of adherence styles and their determinants in patients with schizophrenia. The element providing the greatest discriminative power between the 2 clusters was a subjective negative attitude toward medication. The findings also suggest that depression is more frequent in schizophrenia patients with poor adherence and that improving insight into illness might be suggested as a first-line intervention to improve adherence in this population.