Leclerc Emilie, Noto Cristiano, Bressan Rodrigo A, Brietzke Elisa
Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Braz J Psychiatry. 2015 Apr-Jun;37(2):168-76. doi: 10.1590/1516-4446-2014-1539. Epub 2015 May 1.
To conduct a comprehensive review of current evidence on factors for nonadherence to treatment in individuals with first-episode psychosis (FEP).
MEDLINE, LILACS, PsycINFO, and SciELO databases were searched with the keywords first episode psychosis, factor, adherence, nonadherence, engagement, disengagement, compliance, and intervention. References of selected studies were consulted for relevant articles.
A total of 157 articles were screened, of which 33 articles were retained for full review. The factors related to nonadherence were: a) patient-related (e.g., lower education level, persistent substance use, forensic history, unemployment, history of physical abuse); b) environment-related (e.g., no family involved in treatment, social adjustment difficulties); c) medication-related (e.g., rapid remission of negative symptoms when starting treatment, therapeutic alliance); and d) illness-related (e.g., more positive symptoms, more relapses). Treatment factors that improve adherence include a good therapeutic alliance and a voluntary first admission when hospitalization occurs.
The results of this review suggest that nonadherence to treatment in FEP is multifactorial. Many of these factors are modifiable and can be specifically targeted in early intervention programs. Very few studies have assessed strategies to raise adherence in FEP.
对目前关于首发精神病（FEP）患者治疗不依从因素的证据进行全面综述。
使用关键词“首发精神病”“因素”“依从性”“不依从性”“参与”“脱离”“依从”和“干预”检索MEDLINE、LILACS、PsycINFO和SciELO数据库。查阅所选研究的参考文献以获取相关文章。
共筛选出157篇文章，其中33篇文章被保留进行全面审查。与不依从相关的因素有：a）患者相关因素（如教育水平较低、持续使用物质、有法医史、失业、身体虐待史）；b）环境相关因素（如无家人参与治疗、社会适应困难）；c）药物相关因素（如开始治疗时阴性症状快速缓解、治疗联盟）；d）疾病相关因素（如阳性症状较多、复发较多）。改善依从性的治疗因素包括良好的治疗联盟以及住院时自愿首次入院。
本综述结果表明，FEP患者治疗不依从是多因素的。这些因素中的许多是可改变的，可在早期干预项目中针对性处理。很少有研究评估提高FEP患者依从性的策略。
