Predicting medication noncompliance after hospital discharge among patients with schizophrenia

Objective:The study sought to identify predictors of noncompliance with med ication in a cohort of patients with schizophrenia after discharge from acu te hospitalization. Methods: Adult psychiatric inpatient with schizophrenia or schizoaffective disorder for whom oral antipsychotics were prescribed ( N=213) were evaluated at hospital discharge and three months later to asses s medication compliance. Comparisons were made between patients who reporte d stopping their medications for one week or longer and patients who report ed more continuous medication use. Results: Of the 213 patients, about a fi fth (19.2 percent) met the criterion for noncompliance. Medication noncompl iance was significantly associated with an increased risk of rehospitalizat ion, emergency room visits, homelessness,and symptom exacerbation. Compared with the compliant group, the noncompliant group was significantly more li kely to have a history of medication noncompliance, substance abuse or depe ndence, and difficulty recognizing their own symptoms. Patients who became medication noncompliant were significantly less likely to have formed a goo d therapeutic alliance during hospitalization as measured by inpatient staf f reports and mere more likely to have family members who refused to become involved in their treatment, Conclusions: Patients with schizophrenia at h igh risk for medication noncompliance after acute hospitalization are chara cterized by a history of medication noncompliance, recent substance use, di fficulty recognizing their own symptoms, a weak alliance with inpatient sta ff, and family who refuse to become involved in inpatient treatment.