Research That Matters (January 17 - 20, 2008)

Background and Purpose: Primary psychotic disorders and mood disorders with psychotic features (PD/MDPF) are serious and persistent mental health disorders that are increasingly being diagnosed in children and adolescents. Children and adolescents with a PD/MDPF experience a chronic episodic course characterized by relapses, poor educational functioning, and impaired social adjustment and functioning. Treatment adherence is the key predictor of relapse. Treatment and Medication non-adherence in patients experiencing a psychotic disorder ranges from 33% to 75%. Research has found that adults with schizophrenia are six times more likely to be readmitted to hospital, due to poor adherence. While treatment adherence in adult psychiatric conditions has received intense scientific scrutiny, very little attention has been given to children and adolescents. This study examined predictors associated with adherence to medication of youth following their first-episode of a PD/MDPF, for which they were treated in an inpatient psychiatric hospital unit. Key variables explored were chosen following a biopsychosocial model, as well as the inclusion of treatment variables.

Methods: A total of 65 children and adolescents, 59% males and 41% females, age 15.35 + 2.08 years who had participated in a longitudinal cohort study examining relapse following first hospitalization for episode of psychosis were included in this study. All youth were discharged on one of three atypical antipsychotics (risperidone, quetiapine, or olanzapine) between January 1999 and October 2004. Time 1 data were collected retrospectively from medical charts across 6 hospitals using a standardized questionnaire; time 2 data were obtained using questionnaires mailed to participants' parents a minimum of two years post discharge, mean 3.9 + 1.3 years. The following eight variables were considered for inclusion in the multivariate analysis: age at admission, gender, decreased social support, length of untreated illness, diagnostic group, family history of depression, presence of MDD, and participant discharged on atypical neuroleptic with or without medication for affective symptoms.

Results: In this study, Seventy-five percent (75%) of adolescents remained adherent to medication across the study. Predictors of medication adherence included discharge on pharmacologic agent for mood symptoms in addition to atypical antipsychotic, OR = 10.5 (95% confidence interval (CI) 2.06 – 53.19) and shorter length of time untreated prior to hospital admission OR = 0.98 (95% CI 0.95 – 1.01).

Conclusions and Implications: In this research, the multivariable model's strongest predictor of adherence to medication following discharge was having been discharged on both an atypical antipsychotic agent and another medication for mood symptoms, either an antidepressant or a mood stabilizing agent. The second predictor variable, duration of untreated illness, also impacted adherence rates in youth. The impact and implications of treatment adherence for children and adolescents following their first-episode of psychosis, and duration of untreated illness will be explored. Also, clinical, policy, and research implications of study results will be discussed in relation to social work practice.