El-Missiry Ahmed, Elbatrawy Amira, El Missiry Marwa, Moneim Dalia Abdel, Ali Ramy, Essawy Heba
Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt.
Institute of Psychiatry, The WHO Collaborating Center for Mental Health Research & Training, Ain Shams University, Department of Neuropsychiatry, Abbasseyia, Ramses Street Extension, P.O. Box: 11657 Dair Al-Malak, Cairo, Egypt.
J Psychiatr Res. 2015 Nov;70:106-12. doi: 10.1016/j.jpsychires.2015.09.006. Epub 2015 Sep 14.
Medication non-adherence presents a considerable problem in patients with schizophrenia. Cognitive and executive functions can affect adherence. The association between medication non-adherence and cognitive impairment in schizophrenia is under investigated with limited and conflicting research data.
To prospectively assess the rate of drug adherence among a sample of patients with schizophrenia and to compare the cognitive and executive functions between adherent and non-adherent patients.
109 patients with schizophrenia diagnosed according to the DSM-IV classification were initially assessed by the Wechsler Adult Intelligence Scale (WAIS), Wechsler Memory Scale-Revised (WMS-R) and Wisconsin Card Sorting Test (WCST) and six months later by the Brief Adherence Rating Scale (BARS).
68.8% were non-adherent to their antipsychotic medication. Adherent patients (31.2%) had significantly higher mean scores for the total, verbal and performance IQ. They had significantly higher mean scores in most of WMS subtests (orientation, information, verbal paired association, digit span, visual memory span), and higher mean scores for; total correct, conceptual level response, percentage and categories completed on the WSCT subscales (P < 0.0001). Whereas the non-adherent group had higher mean scores in; trials administered, total errors, perseverative responses, and perseverative errors (P < 0.0001). In a step regression analysis, digit span, conceptualization, total and percentage of errors were putative predictors of non-adherence.
Cognitive deficits, especially verbal memory and executive functions were the strongest patients' related factors associated with non adherence to medication. Psychiatrists ought to consider possible cognitive factors influencing adherence to enable offering proper interventions.
药物治疗不依从在精神分裂症患者中是一个相当严重的问题。认知和执行功能会影响依从性。精神分裂症患者药物治疗不依从与认知障碍之间的关联正在研究中，相关研究数据有限且相互矛盾。
前瞻性评估一组精神分裂症患者的药物依从率，并比较依从和不依从患者的认知与执行功能。
109例根据《精神疾病诊断与统计手册》第四版（DSM-IV）分类诊断的精神分裂症患者，最初通过韦氏成人智力量表（WAIS）、韦氏记忆量表修订版（WMS-R）和威斯康星卡片分类测验（WCST）进行评估，六个月后通过简易依从性评定量表（BARS）进行评估。
68.8%的患者未坚持服用抗精神病药物。依从患者（31.2%）在总智商、言语智商和操作智商方面的平均得分显著更高。他们在大多数WMS子测验（定向、信息、言语配对联想、数字广度、视觉记忆广度）中的平均得分显著更高，在WCST子量表上的总正确数、概念水平反应、百分比和完成的类别方面平均得分也更高（P < 0.0001）。而不依从组在施测的试验次数、总错误数、持续性反应和持续性错误方面的平均得分更高（P < 0.0001）。在逐步回归分析中，数字广度、概念化、错误总数和错误百分比是不依从的推定预测因素。
认知缺陷，尤其是言语记忆和执行功能是与药物治疗不依从相关的最强患者相关因素。精神科医生应考虑可能影响依从性的认知因素，以便进行适当干预。
