Medication Adherence Predictors in Patients With Severe Psychiatric Disorders

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As antipsychotic medications are vital to the effective management of severe psychiatric disorders, investigators sought to examine reasons for medication nonadherence in patients with schizophrenia, bipolar disorders, and other psychotic disorders.

Medication adherence among patients with severe psychiatric disorders is strongly determined by employment, high global functioning, and social support, according to research published in BMC Psychiatry.

Because nonadherence is a serious problem, especially as antipsychotic medications are necessary for the effective management of schizophrenia and bipolar disorder, researchers sought to examine determinants of nonadherence.

Researchers gathered baseline data from the Post Stationary Telemedical Care of Patients With Severe Psychiatric Disorders (Tecla) study and assessed medication usage with the Medications Adherence Report Scale German version (MARS-D). A total of 127 participants were included in the study (73 men, mean age 42 years). Logistic regression was calculated using age, sex, education, employment status, level of global functioning, social support, and intake of typical and atypical antipsychotics as predictors.

Older age, employment, high level of global functioning, social support, and intake of typical antipsychotics were all positive predictors of medication adherence. Female sex was a negative predictor. No significant relationship was seen between higher education and medication adherence.

Some level of nonadherence was reported by 54% of participants, as reflected by a MARS-D score <25; forgetting to take medication was the most common reason stated. A prevalence of <20% was seen for active deviation from the prescribed medication regimen.

MARS-D scores were self-reported and likely resulted in an underestimate of nonadherence, especially in the long term. The researchers noted that current methods of assessing nonadherence are costly, require increased effort, and pertain only to specific drugs. “Due to the importance of non-adherent behavior, a simple tool is needed that can easily be implemented in various study settings,” the researchers wrote.

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Adherence is a complex issue, but these findings suggest that employment, functioning, and social support can facilitate adherence among patients with schizophrenia and bipolar disorder.

The researchers concluded that “these results can specifically be used for the development of adherence-promoting interventions.”


Stentzel U, van den Berg N, Schulze LN, et al. Predictors of medication adherence among patients with severe psychiatric disorders: findings from the baseline assessment of a randomized controlled trial (Tecla) [published online May 29, 2018]. BMC Psychiatry. doi:10.1186%2Fs12888-018-1737-4