St. John of God Adult Psychiatric Service, Cluain Mhuire Family Centre, Dublin, Ireland.
Psychiatr Serv. 2010 Feb;61(2):189-92. doi: 10.1176/ps.2010.61.2.189.
This study examined concurrent associations and predictors at first indication of nonadherence to antipsychotic medication four years after a first episode of psychosis.
A prospective cohort of 171 patients in urban Ireland with a first episode of psychosis was followed up four years after inception (follow-up primary analysis, N=84; secondary analysis, N=104).
At the four-year follow-up 76% were adherent and 24% were not. Nonadherence was concurrently associated with substance misuse (p<.01), increased symptomatology (p<.01), less insight (p=.01), lower global functioning (p<.01), and negative attitudes toward medication (p<.01). Compared with other patients, those who were nonadherent had more readmissions (p=.01). Predictors of future nonadherence were substance misuse (p=.02) and duration of untreated psychosis (p=.04).
This prospective investigation confirms previous cross-sectional studies. The association between longer duration of untreated psychosis and nonadherence warrants further research because it could be interpreted as further evidence of the importance of early intervention.
本研究在首发精神分裂症四年后首次发现非抗精神病药物依从性时，同时考察了相关因素和预测因素。
对爱尔兰城市中 171 名首发精神分裂症患者进行前瞻性队列研究，在发病四年后进行随访（主要分析时的随访人数为 84 人，次要分析时的随访人数为 104 人）。
在四年的随访中，76%的患者是依从的，24%的患者不依从。不依从与物质滥用（p<.01）、症状加重（p<.01）、洞察力不足（p=.01）、总体功能下降（p<.01）和对药物的负面态度（p<.01）同时相关。与其他患者相比，不依从的患者再入院率更高（p=.01）。未来不依从的预测因素是物质滥用（p=.02）和未治疗精神病的持续时间（p=.04）。
这项前瞻性研究证实了之前的横断面研究。未治疗精神病持续时间较长与不依从之间的关联需要进一步研究，因为这可以进一步证明早期干预的重要性。
