Lacro Jonathan P, Dunn Laura B, Dolder Christian R, Leckband Susan G, Jeste Dilip V
Department of Psychiatry, University of California, and Veterans Affairs San Diego Healthcare System, 92161, USA.
J Clin Psychiatry. 2002 Oct;63(10):892-909. doi: 10.4088/jcp.v63n1007.
Nonadherence to prescribed antipsychotic medications places patients with schizophrenia at a greatly increased risk of illness exacerbation and rehospitalization. Identification of risk factors for nonadherence is an initial step toward designing effective interventions. This article reviews recent literature on the prevalence of and risk factors for medication nonadherence in patients with schizophrenia.
We searched the MEDLINE/HealthSTAR and PsycINFO databases using combinations of the keywords risk factor(s), adherence, compliance, antipsychotic, neuroleptic, schizophrenia, and psychosis for articles published since 1980 that identified risk factors for medication nonadherence in schizophrenia patients. We included reports that (1) were published in English and (2) specifically examined risk factors for medication nonadherence. Thirty-nine articles met our selection criteria.
Among the 10 reports that met a strict set of study inclusion criteria, we found a mean rate of nonadherence of 41.2%; the 5 reports that met a stricter set of inclusion criteria had a mean nonadherence rate of 49.5%. In the 39 articles reviewed, factors most consistently associated with nonadherence included poor insight, negative attitude or subjective response toward medication, previous nonadherence, substance abuse, shorter illness duration, inadequate discharge planning or aftercare environment, and poorer therapeutic alliance. Findings regarding an association between adherence and medication type were inconclusive, although few studies explored this relationship. Other factors such as age, gender, ethnicity, marital status, education level, neurocognitive impairment, severity of psychotic symptoms, severity of medication side effects, higher antipsychotic dose, presence of mood symptoms, route of medication administration, and family involvement were not found to be consistent predictors of nonadherence. Limitations of the published literature are discussed.
Efforts to improve medication adherence in patients with schizophrenia should target relevant risk factors.
不遵医嘱服用抗精神病药物会使精神分裂症患者病情加重和再次住院的风险大幅增加。识别不遵医嘱的风险因素是设计有效干预措施的第一步。本文综述了近期关于精神分裂症患者药物不依从性的患病率及风险因素的文献。
我们使用关键词“风险因素”“依从性”“顺应性”“抗精神病药”“神经阻滞剂”“精神分裂症”和“精神病”的组合，在MEDLINE/HealthSTAR和PsycINFO数据库中搜索自1980年以来发表的确定精神分裂症患者药物不依从性风险因素的文章。我们纳入了（1）以英文发表的报告以及（2）专门研究药物不依从性风险因素的报告。39篇文章符合我们的选择标准。
在符合一组严格研究纳入标准的10篇报告中，我们发现不依从的平均发生率为41.2%；符合更严格纳入标准的5篇报告的平均不依从率为49.5%。在综述的39篇文章中，与不依从最一致相关的因素包括洞察力差、对药物的消极态度或主观反应、既往不依从、药物滥用、病程较短、出院计划或后续护理环境不足以及治疗联盟较差。尽管很少有研究探讨这种关系，但关于依从性与药物类型之间关联的研究结果尚无定论。未发现年龄、性别、种族、婚姻状况、教育水平、神经认知障碍、精神病症状严重程度、药物副作用严重程度、较高的抗精神病药物剂量、情绪症状的存在、给药途径和家庭参与等其他因素是不依从的一致预测因素。讨论了已发表文献的局限性。
改善精神分裂症患者药物依从性的努力应针对相关风险因素。
