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Factors associated with poor satisfaction with treatment and trial discontinuation in chronic schizophrenia

Published online by Cambridge University Press:  05 June 2018

Joep H. Schoemaker Open the ORCID record for Joep H. Schoemaker [Opens in a new window] ,
Ad J.J.M. Vingerhoets  and
Robin A. Emsley
Joep H. Schoemaker*
Affiliation:
Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
Ad J.J.M. Vingerhoets
Affiliation:
Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
Robin A. Emsley
Affiliation:
Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Republic of South Africa
*
*Address for correspondence: Joep Schoemaker, Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands. (Email: [email protected])
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Abstract

Introduction

Despite consistently high discontinuation rates due to withdrawal of consent (WOC) and insufficient therapeutic effect (ITE) in schizophrenia trials, insight into the underlying factors contributing to poor satisfaction with treatment and dropout is limited. A better understanding of these factors could help to improve trial design and completion rates.

Methods

Using data from 1,136 trial participants with schizophrenia or schizoaffective disorder, we explored associations between predictor variables with (1) dropout due to WOC and ITE and (2) satisfaction with treatment among patients and investigators by means of hierarchic multiple regression analyses.

Results

ITE was associated with poor clinical improvement, poor investigator satisfaction with treatment, and poor patient insight into their own disease, whereas WOC only showed a meaningful association with poor patient satisfaction with treatment. Investigator satisfaction with treatment appeared most strongly associated with Positive and Negative Syndrome Scale (PANSS) positive factor endpoint scores, whereas patient satisfaction with treatment was best predicted by the endpoint score on the PANSS emotional distress factor. The occurrence of severe side effects showed no meaningful association to satisfaction with treatment among investigators and patients, and neither did a patient’s experienced psychopathology, nor their self-rating of functional impairment.

Conclusions

Whereas trial discontinuation due to ITE is associated with poor treatment effectiveness, a patient’s decision to withdraw from an antipsychotic trial remains unpredictable and may occur even when the investigator observes a global clinical improvement and is satisfied with the treatment.

Keywords

Schizophreniadropoutsatisfaction with treatmentpredictorsrandomized controlled trial
Type
Original Research
Information
CNS Spectrums , Volume 24 , Issue 4 , August 2019 , pp. 380 - 389
Copyright
© Cambridge University Press 2018 

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References

Wahlbeck, K, Tuunainen, A, Ahokas, A, Leucht, S. Dropout rates in randomised antipsychotic drug trials. Psychopharmacology. 2001; 155(3): 230–233.CrossRefGoogle ScholarPubMed
Lieberman, JA, Stroup, TS, McEvoy, JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005; 353(12): 1209–1223.CrossRefGoogle ScholarPubMed
Kahn, RS, Fleischhacker, WW, Boter, H, et al. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet. 2008; 371(9618): 1085–1097.CrossRefGoogle ScholarPubMed
Liu-Seifert, H, Adams, DH, Kinon, BJ. Discontinuation of treatment of schizophrenic patients is driven by poor symptom response: a pooled post-hoc analysis of four atypical antipsychotic drugs. BMC Med. 2005; 3(1): 1–10.CrossRefGoogle ScholarPubMed
McEvoy, JP, Lieberman, JA, Perkins, DO, et al. Efficacy and tolerability of olanzapine, quetiapine, and risperidone in the treatment of early psychosis: a randomized, double-blind 52-week comparison. Am J Psychiatry. 2007; 164: 1050–1060.CrossRefGoogle ScholarPubMed
Mert, DG, Turgut, NH, Kelleci, M, Semiz, M. Perspectives on reasons of medication nonadherence in psychiatric patients. Patient Prefer Adherence. 2015; 9: 87–93.CrossRefGoogle ScholarPubMed
Young, JL, Zonana, HV, Shepler, L. Medication noncompliance in schizophrenia: codification and update. Bull Am Acad Psychiatry Law. 1986; 14(2): 105–122.Google ScholarPubMed
Fenton, WS, Blyler, CR, Heinssen, RK. Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophr Bull. 1997; 23(4): 637–651.CrossRefGoogle ScholarPubMed
Cramer, JA, Rosenheck, R. Compliance with medication regimens for mental and physical disorders. Psychiatr Serv. 1998; 49(2): 196–201.CrossRefGoogle ScholarPubMed
Lacro, JP, Dunn, LB, Dolder, CR, Jeste, DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry. 2002; 63(10): 892–909.CrossRefGoogle ScholarPubMed
Higashi, K, Medic, G, Littlewood, KJ, Diez, T, Granström, O, De Hert, M. Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Ther Adv Psychopharmacol. 2013; 3(4): 200–218.CrossRefGoogle ScholarPubMed
Cabeza, IG, Amador, MS, López, CA, de Chávez, MG. Subjective response to antipsychotics in schizophrenic patients: clinical implications and related factors. Schizophr Res. 2000; 41(2): 349–355.CrossRefGoogle ScholarPubMed
Marder, S. Subjective experiences on antipsychotic medications: synthesis and conclusions. Acta Psychiatr Scand. 2005; 111(427): 43–46.CrossRefGoogle Scholar
Karow, A, Czekalla, J, Dittmann, RW, et al. Association of subjective well-being, symptoms, and side effects with compliance after 12 months of treatment in schizophrenia. J Clin Psychiatry. 2007; 68(1): 75–80.CrossRefGoogle Scholar
Lambert, M, Schimmelmann, BG, Naber, D, et al. Prediction of remission as a combination of symptomatic and functional remission and adequate subjective well-being in 2960 patients with schizophrenia. J Clin Psychiatry. 2006; 67(11): 1690–1697.CrossRefGoogle ScholarPubMed
Haro, JM, Suarez, D, Novick, D, et al. Three-year antipsychotic effectiveness in the outpatient care of schizophrenia: observational versus randomized studies results. Eur Neuropsychopharmacol. 2007; 17(4): 235–244.CrossRefGoogle ScholarPubMed
Chue, P. The relationship between patient satisfaction and treatment outcomes in schizophrenia. J Psychopharmacol. 2006; 20(6 Suppl): 38–56.CrossRefGoogle Scholar
Kuhnigk, O, Slawik, L, Meyer, J, Naber, D, Reimer, J. Valuation and attainment of treatment goals in schizophrenia: perspectives of patients, relatives, physicians, and payers. J Psychiatr Pract. 2012; 18(5): 321–328.CrossRefGoogle ScholarPubMed
Shumway, M, Saunders, T, Shern, D, et al. Preferences for schizophrenia treatment outcomes among public policy makers, consumers, families, and providers. Psychiatr Serv. 2003; 54(8): 1124–1128.CrossRefGoogle ScholarPubMed
Hofer, A, Rettenbacher, MA, Widschwendter, CG, Kemmler, G, Hummer, M, Fleischhacker, WW. Correlates of subjective and functional outcomes in outpatient clinic attendees with schizophrenia and schizoaffective disorder. Eur Arch Psychiatry Clin Neurosci. 2006; 256(4): 246–255.CrossRefGoogle ScholarPubMed
Kim, JH, Ann, JH, Kim, MJ. Relationship between improvements of subjective well-being and depressive symptoms during acute treatment of schizophrenia with atypical antipsychotics. J Clin Pharm Ther. 2011; 36(2): 172–178.CrossRefGoogle ScholarPubMed
Narvaez, JM, Twamley, EW, McKibbin, CL, Heaton, RK, Patterson, TL. Subjective and objective quality of life in schizophrenia. Schizophr Res. 2008; 98(1–3): 201–208.CrossRefGoogle Scholar
Karow, A, Moritz, S, Lambert, M, Schoder, S, Krausz, M. PANSS syndromes and quality of life in schizophrenia. Psychopathology. 2005; 38(6): 320–326.CrossRefGoogle Scholar
Fitzgerald, PB, de Castella, AR, Filia, K, et al. A longitudinal study of patient- and observer-rated quality of life in schizophrenia. Psychiatry Res. 2003; 119(1–2): 55–62.CrossRefGoogle Scholar
Hellewell, JS. Patients’ subjective experiences of antipsychotics: clinical relevance. CNS Drugs. 2002; 16(7): 457–471.CrossRefGoogle ScholarPubMed
Fakhoury, WK, Wright, D, Wallace, M. Prevalence and extent of distress of adverse effects of antipsychotics among callers to a United Kingdom National Mental Health Helpline. Int Clin Psychopharmacol. 2001; 16(3): 153–162.CrossRefGoogle ScholarPubMed
Kohler, S, Unger, T, Hoffmann, S, Steinacher, B, Fydrich, T. Patient satisfaction with inpatient psychiatric treatment and its relation to treatment outcome in unipolar depression and schizophrenia. Int J Psychiatry Clin Pract. 2015; 19(2): 119–123.CrossRefGoogle Scholar
Schoemaker, J, Naber, D, Vrijland, P, Panagides, J, Emsley, R. Long-term assessment of asenapine vs. olanzapine in patients with schizophrenia or schizoaffective disorder. Pharmacopsychiatry. 2010; 43(4): 138–146.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision Washington, DC: American Psychiatric Association; 2000.Google Scholar
Guy, W. Clinical Global Impression Scale: The ECDEU Assessment Manual for Psychopharmacology–Revised. Rockville, MD: U.S. Department of Health, Education, and Welfare Public Health Service; 1976.Google Scholar
Kay, SR, Flszbein, A, Opfer, LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987; 13(2): 261–276.CrossRefGoogle Scholar
Kelley, ME, White, L, Compton, MT, Harvey, PD. Subscale structure for the Positive and Negative Syndrome Scale (PANSS): a proposed solution focused on clinical validity. Psychiatry Res. 2013; 205(1): 137–142.CrossRefGoogle ScholarPubMed
Naber, D, Moritz, S, Lambert, M, et al. Improvement of schizophrenic patients’ subjective well-being under atypical antipsychotic drugs. Schizophr Res. 2001; 50(1): 79–88.CrossRefGoogle ScholarPubMed
Ware, J Jr, Kosinski, M, Keller, SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3): 220–233.CrossRefGoogle ScholarPubMed
Leucht, S, Kane, JM, Kissling, W, Hamann, J, Etschel, E, Engel, RR. What does the PANSS mean? Schizophr Res. 2005; 79(2): 231–238.CrossRefGoogle ScholarPubMed
Dassa, D, Boyer, L, Benoit, M, Bourcet, S, Raymondet, P, Bottai, T. Factors associated with medication non-adherence in patients suffering from schizophrenia: a cross-sectional study in a universal coverage health-care system. Aust N Z J Psychiatry. 2010; 44(10): 921–928.CrossRefGoogle Scholar
Ascher-Svanum, H, Faries, DE, Zhu, B, Ernst, FR, Swanson, JW. Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. J Clin Psychiatry. 2006; 67(3): 453–460.CrossRefGoogle ScholarPubMed
Olivares, JM, Alptekin, K, Azorin, JM, et al. Psychiatrists’ awareness of adherence to antipsychotic medication in patients with schizophrenia: results from a survey conducted across Europe, the Middle East, and Africa. Patient Prefer Adherence. 2013; 7: 121–132.CrossRefGoogle ScholarPubMed
Lambert, M, Conus, P, Eide, P, et al. Impact of present and past antipsychotic side effects on attitude toward typical antipsychotic treatment and adherence. Eur Psychiatry. 2004; 19(7): 415–422.CrossRefGoogle ScholarPubMed
Perkins, DO, Gu, H, Weiden, PJ, et al. Predictors of treatment discontinuation and medication nonadherence in patients recovering from a first episode of schizophrenia, schizophreniform disorder, or schizoaffective disorder: a randomized, double-blind, flexible-dose, multicenter study. J Clin Psychiatry. 2008; 69(1): 106–113.CrossRefGoogle ScholarPubMed
Fervaha, G, Takeuchi, H, Agid, O, Lee, J, Foussias, G, Remington, G. Determinants of patient-rated and clinician-rated illness severity in schizophrenia. J Clin Psychiatry. 2015; 76(7): 924–930.CrossRefGoogle Scholar
Fervaha, G, Agid, O, Takeuchi, H, Lee, J, Foussias, G, Remington, G. Relationship between symptomatic improvement and overall illness severity in patients with schizophrenia. J Clin Psychopharmacol. 2015; 35(2): 128–133.CrossRefGoogle ScholarPubMed
Vanelli, M, Burstein, P, Cramer, J. Refill patterns of atypical and conventional antipsychotic medications at a national retail pharmacy chain. Psychiatr Serv. 2001; 52(9): 1248–1250.CrossRefGoogle Scholar
Perkins, DO. Predictors of noncompliance in patients with schizophrenia. J Clin Psychiatry. 2002; 63(12): 1121–1128.CrossRefGoogle ScholarPubMed