TY - JOUR
T1 - Insight and medication adherence in schizophrenia
T2 - An analysis of the CATIE trial
AU - Kim, Julia
AU - Ozzoude, Miracle
AU - Nakajima, Shinichiro
AU - Shah, Parita
AU - Caravaggio, Fernando
AU - Iwata, Yusuke
AU - De Luca, Vincenzo
AU - Graff-Guerrero, Ariel
AU - Gerretsen, Philip
N1 - Funding Information:
This work was supported by the Centre for Addiction and Mental Health Discovery Fund (J.K.), the Ontario Mental Health Foundation grant (P.G.), and the Canadian Institutes of Health Research (PJT-159807 to P.G.).J.K. has received funding from the Centre for Addiction and Mental Health Foundation and the Ontario Graduate Scholarship (OGS). S.N. has received fellowship grants from the Canadian Institutes of Health Research, Japan Society for the Promotion of Science, Japan Agency for Medical Research and Development, Japan Research Foundation for Clinical Pharmacology, Naito Foundation, Takeda Science Foundation, Uehara Memorial Foundation, and Daiichi Sankyo Scholarship Donation Program within the past 3 years. He has also received research support, manuscript fees, or speaker's honoraria from Dainippon Sumitomo Pharma, Meiji-Seika Pharma, Otsuka Pharmaceutical, Shionogi, and Yoshitomi Yakuhin within the past 3 years. F.C. has received funding from CIHR, the Ontario Mental Health Post-Doctoral Fellowship Award, CAMH Foundation, the Brain & Behavior Research Foundation (Formerly NARSAD), and the Vancouver Coastal Health Research Institute. Y.I. has received fellowship grants from Keio University Medical Science Foundation, Mitsukoshi Foundation, Japan Foundation for Aging and Health, and manuscript fees from Dainippon Sumitomo Pharma. A.G.-G. has received support from the United States National Institute of Health, CIHR, Ontario Mental Health Foundation (OMHF), Consejo Nacional de Ciencia y Tecnología, the Instituto de Ciencia y Tecnología del DF, the Brain & Behavior Research Foundation (Formerly NARSAD), the Ontario Ministry of Health and Long-Term Care, the Ontario Ministry of Research and Innovation Early Research Award, and Janssen. P.G. reports receiving research support from CIHR, Ontario Ministry of Health and Long-Term Care, Ontario Mental Health Foundation (OMHF), and CAMH. All other authors have declared that there are no conflicts of interest in relation to the subject of this study.Data used for this paper was obtained from the limited access dataset (version 1) distributed from the NIH-supported “Clinical Antipsychotic Trials of Intervention Effectiveness in Schizophrenia” (NIMH Contract #N01MH90001). We would like to thank all the participating investigators and study personnel who carried out the trial and provided invaluable data.
Funding Information:
This work was supported by the Centre for Addiction and Mental Health Discovery Fund (J.K.), the Ontario Mental Health Foundation grant (P.G.), and the Canadian Institutes of Health Research (PJT-159807 to P.G.).J.K. has received funding from the Centre for Addiction and Mental Health Foundation and the Ontario Graduate Scholarship (OGS). S.N. has received fellowship grants from the Canadian Institutes of Health Research, Japan Society for the Promotion of Science, Japan Agency for Medical Research and Development, Japan Research Foundation for Clinical Pharmacology, Naito Foundation, Takeda Science Foundation, Uehara Memorial Foundation, and Daiichi Sankyo Scholarship Donation Program within the past 3 years. He has also received research support, manuscript fees, or speaker's honoraria from Dainippon Sumitomo Pharma, Meiji-Seika Pharma, Otsuka Pharmaceutical, Shionogi, and Yoshitomi Yakuhin within the past 3 years. F.C. has received funding from CIHR, the Ontario Mental Health Post-Doctoral Fellowship Award, CAMH Foundation, the Brain & Behavior Research Foundation (Formerly NARSAD), and the Vancouver Coastal Health Research Institute. Y.I. has received fellowship grants from Keio University Medical Science Foundation, Mitsukoshi Foundation, Japan Foundation for Aging and Health, and manuscript fees from Dainippon Sumitomo Pharma. A.G.-G. has received support from the United States National Institute of Health, CIHR, Ontario Mental Health Foundation (OMHF), Consejo Nacional de Ciencia y Tecnolog?a, the Instituto de Ciencia y Tecnolog?a del DF, the Brain & Behavior Research Foundation (Formerly NARSAD), the Ontario Ministry of Health and Long-Term Care, the Ontario Ministry of Research and Innovation Early Research Award, and Janssen. P.G. reports receiving research support from CIHR, Ontario Ministry of Health and Long-Term Care, Ontario Mental Health Foundation (OMHF), and CAMH. All other authors have declared that there are no conflicts of interest in relation to the subject of this study.Data used for this paper was obtained from the limited access dataset (version 1) distributed from the NIH-supported ?Clinical Antipsychotic Trials of Intervention Effectiveness in Schizophrenia? (NIMH Contract #N01MH90001). We would like to thank all the participating investigators and study personnel who carried out the trial and provided invaluable data.
Funding Information:
J.K. has received funding from the Centre for Addiction and Mental Health Foundation and the Ontario Graduate Scholarship (OGS) . S.N. has received fellowship grants from the Canadian Institutes of Health Research , Japan Society for the Promotion of Science , Japan Agency for Medical Research and Development , Japan Research Foundation for Clinical Pharmacology , Naito Foundation, Takeda Science Foundation , Uehara Memorial Foundation , and Daiichi Sankyo Scholarship Donation Program within the past 3 years. He has also received research support, manuscript fees, or speaker's honoraria from Dainippon Sumitomo Pharma, Meiji-Seika Pharma, Otsuka Pharmaceutical, Shionogi, and Yoshitomi Yakuhin within the past 3 years. F.C. has received funding from CIHR , the Ontario Mental Health Post-Doctoral Fellowship Award , CAMH Foundation, the Brain & Behavior Research Foundation (Formerly NARSAD) , and the Vancouver Coastal Health Research Institute . Y.I. has received fellowship grants from Keio University Medical Science Foundation , Mitsukoshi Foundation , Japan Foundation for Aging and Health , and manuscript fees from Dainippon Sumitomo Pharma. A.G.-G. has received support from the United States National Institute of Health , CIHR , Ontario Mental Health Foundation (OMHF) , Consejo Nacional de Ciencia y Tecnología , the Instituto de Ciencia y Tecnología del DF , the Brain & Behavior Research Foundation (Formerly NARSAD) , the Ontario Ministry of Health and Long-Term Care , the Ontario Ministry of Research and Innovation Early Research Award , and Janssen. P.G. reports receiving research support from CIHR, Ontario Ministry of Health and Long-Term Care , Ontario Mental Health Foundation (OMHF) , and CAMH . All other authors have declared that there are no conflicts of interest in relation to the subject of this study.
Funding Information:
This work was supported by the Centre for Addiction and Mental Health Discovery Fund (J.K.), the Ontario Mental Health Foundation grant (P.G.), and the Canadian Institutes of Health Research ( PJT-159807 to P.G.).
Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2020/5/15
Y1 - 2020/5/15
N2 - Adherence to antipsychotic medication is critical for the treatment of patients with schizophrenia. Impaired insight into illness is one of the principal drivers of medication nonadherence, which contributes to negative clinical outcomes. The aims of this study were to examine the relationships between impaired insight and (1) rates of antipsychotic medication nonadherence, and (2) time to medication nonadherence using data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. Insight was assessed using the Positive and Negative Syndrome Scale (PANSS) item G12 (lack of judgment and insight). Patients were divided into 3 groups based on their degree of insight impairment, i.e. no impairment (PANSS G12 = 1), minimal impairment (PANSS G12 = 2–3), and moderate-to-severe insight impairment (PANSS G12 ≥ 4). Medication nonadherence was defined as taking less than 80% of monthly pill counts. Kaplan-Meier survival and Cox regression analyses were performed to examine differences in time to medication nonadherence between insight groups. There were significant differences between insight groups in the percentage of nonadherent patients at 6 months (χ2(2) = 8.80, p = 0.012) and 18 months (χ2(2) = 10.04, p = 0.007) after study initiation. Moderate-to-severe insight impairment was associated with earlier nonadherence compared to minimal (χ2 = 4.70, p = 0.030) or no impairment (χ2 = 11.92, p = 0.001). The association remained significant after adjustment for illness severity, substance use, attitudes toward medication, cognition, level of hostility, and depression. The results of this study indicate a strong link between impaired insight and antipsychotic medication nonadherence. Interventions to enhance insight early during treatment may help improve medication adherence, and in turn, long-term clinical and functional outcomes in patients with schizophrenia. This article is part of the issue entitled ‘Special Issue on Antipsychotics’.
AB - Adherence to antipsychotic medication is critical for the treatment of patients with schizophrenia. Impaired insight into illness is one of the principal drivers of medication nonadherence, which contributes to negative clinical outcomes. The aims of this study were to examine the relationships between impaired insight and (1) rates of antipsychotic medication nonadherence, and (2) time to medication nonadherence using data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. Insight was assessed using the Positive and Negative Syndrome Scale (PANSS) item G12 (lack of judgment and insight). Patients were divided into 3 groups based on their degree of insight impairment, i.e. no impairment (PANSS G12 = 1), minimal impairment (PANSS G12 = 2–3), and moderate-to-severe insight impairment (PANSS G12 ≥ 4). Medication nonadherence was defined as taking less than 80% of monthly pill counts. Kaplan-Meier survival and Cox regression analyses were performed to examine differences in time to medication nonadherence between insight groups. There were significant differences between insight groups in the percentage of nonadherent patients at 6 months (χ2(2) = 8.80, p = 0.012) and 18 months (χ2(2) = 10.04, p = 0.007) after study initiation. Moderate-to-severe insight impairment was associated with earlier nonadherence compared to minimal (χ2 = 4.70, p = 0.030) or no impairment (χ2 = 11.92, p = 0.001). The association remained significant after adjustment for illness severity, substance use, attitudes toward medication, cognition, level of hostility, and depression. The results of this study indicate a strong link between impaired insight and antipsychotic medication nonadherence. Interventions to enhance insight early during treatment may help improve medication adherence, and in turn, long-term clinical and functional outcomes in patients with schizophrenia. This article is part of the issue entitled ‘Special Issue on Antipsychotics’.
KW - Antipsychotic
KW - Illness awareness
KW - Insight
KW - Medication adherence
KW - Schizophrenia
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U2 - 10.1016/j.neuropharm.2019.05.011
DO - 10.1016/j.neuropharm.2019.05.011
M3 - Article
C2 - 31077729
AN - SCOPUS:85067640551
SN - 0028-3908
VL - 168
JO - Neuropharmacology
JF - Neuropharmacology
M1 - 107634
ER -