Patterson Thomas L, Lacro Jonathan, McKibbin Christine L, Moscona Sherry, Hughs Troy, Jeste Dilip V
Department of Psychiatry, University of California, San Diego, CA 92093-0680, USA.
J Clin Psychopharmacol. 2002 Feb;22(1):11-9. doi: 10.1097/00004714-200202000-00003.
Patients with schizophrenia who adhere to physicians' recommended use of medications are less likely to relapse than those who do not. Self-report measures of adherence have been criticized on a number of grounds. Here we describe a performance-based measure of medication management, the Medication Management Ability Assessment (MMAA), which represents a modification of the Medication Management Test used in individuals with HIV infection. Subjects were 104 patients older than 45 years with diagnoses of schizophrenia or schizoaffective disorder, and 33 normal comparison subjects (NCs). Subjects participated in a role-play task (MMAA) that simulated a prescribed medication regimen similar in complexity to one that an older person is likely to be exposed to. The total number of pills over that prescribed, total number of pills under that prescribed, and total number of correct responses were calculated. Self-report and prescription record data on adherence as well as data on measures of psychopathology, global cognitive status, and other clinical measures were also gathered. MMAA role-plays required 15 minutes, and its 1-week test-retest reliability was excellent (intraclass correlation coefficient, 0.96). Patients committed significantly more errors in medication management compared with NCs. Significantly more patients were classified as being nonadherent (i.e., taking +/-5%, 10%, 15%, or 20% of prescribed pills) compared with NCs. Patients with more severe cognitive deficits performed worse on the MMAA. MMAA performance was significantly related to prescription refill records, performance-based measures of everyday functioning, and self-reported quality of life. The MMAA is a useful instrument for observing ability to manage medications in patients with schizophrenia. The measure was related to severity of cognitive impairment, suggesting that adherence may improve with psychotropic and psychosocial interventions that target these deficits.
坚持按照医生建议用药的精神分裂症患者比不坚持的患者复发的可能性更小。自我报告的依从性测量方法受到了多方面的批评。在此，我们描述一种基于表现的药物管理测量方法，即药物管理能力评估（MMAA），它是对用于HIV感染个体的药物管理测试的一种改进。研究对象为104名年龄超过45岁、被诊断为精神分裂症或分裂情感性障碍的患者，以及33名正常对照对象（NCs）。研究对象参与了一项角色扮演任务（MMAA），该任务模拟了一种规定的用药方案，其复杂性与老年人可能面临的方案相似。计算出超过规定剂量的药丸总数、低于规定剂量的药丸总数以及正确反应的总数。还收集了关于依从性的自我报告和处方记录数据，以及精神病理学测量、整体认知状态和其他临床测量的数据。MMAA角色扮演需要15分钟，其1周的重测信度极佳（组内相关系数为0.96）。与NCs相比，患者在药物管理方面犯的错误明显更多。与NCs相比，被归类为不依从（即服用规定药丸的+/-5%、10%、15%或20%）的患者明显更多。认知缺陷更严重的患者在MMAA上的表现更差。MMAA表现与处方 refill记录、基于表现的日常功能测量以及自我报告的生活质量显著相关。MMAA是观察精神分裂症患者药物管理能力的一种有用工具。该测量方法与认知障碍的严重程度相关，这表明针对这些缺陷的精神药物和心理社会干预可能会提高依从性。
