Graham Danzer, David Sugarbaker, Adriano Zanello, Sam Barkin, Doug Cort
{"title":"Is there a relationship between psychiatrist's clinical assessment of medication non-adherence and treatment outcomes? Implications for practice.","authors":"Graham Danzer, David Sugarbaker, Adriano Zanello, Sam Barkin, Doug Cort","doi":"10.1186/s12888-024-06298-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There is considerable research on the ramifications of medication non-adherence for adults with psychotic illnesses. Much of which has tightly controlled designs and strict inclusion/exclusion procedures (i.e., it is less \"ecologically valid,\" or consistent with real-world challenges in care). The authors sought to determine predictive relationships between psychiatrists' clinical assessments of non-adherence and treatment outcomes, via a design that would be more applicable to practice.</p><p><strong>Method: </strong>Multiple regression analyses were conducted on non-adherence, symptom severity upon admission, number of recent hospitalizations, and length of hospital stay. The sample consisted of 182 inpatients with psychotic spectrum disorders and significant risk and vulnerability factors. Non-adherence was measured via the psychiatrists' diagnosis of V15.81. Symptom severity was measured via the 24-item Brief Psychiatric Rating Scale (BPRS-E).</p><p><strong>Results: </strong>There were null findings on non-adherence and BPRS-E pretest score ( <math><mi>χ</mi></math> <sup>2</sup>= 2, p = 0.16), recent hospitalizations ( <math><mi>χ</mi></math> <sup>2</sup>= 1.2, p = 0.27), and length of stay (β = 0.003, p = 0.97). Higher symptom severity predicted a modestly longer length of stay ( <math><mi>χ</mi></math> <sup>2</sup>= .20, p = 0.007), though Bonferroni correction nullified this finding. White/Caucasian participants were far more likely to be non-adherent than black/African-American participants (t = -8.66; p > .00001).</p><p><strong>Conclusions: </strong>Null findings suggest the psychiatrist's initial, quick-form assessment of non-adherence may not necessarily presume a poor prognosis. Perhaps, because individuals with severe and chronic psychotic disorders may have greater coping, adaptive, and survival skills than is often assumed. In severely under-resourced hospitals, such second thoughts and more reliable information about adherence and contributing factors may improve treatment outcomes.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"24 1","pages":"925"},"PeriodicalIF":3.4000,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Psychiatry","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12888-024-06298-7","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PSYCHIATRY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: There is considerable research on the ramifications of medication non-adherence for adults with psychotic illnesses. Much of which has tightly controlled designs and strict inclusion/exclusion procedures (i.e., it is less "ecologically valid," or consistent with real-world challenges in care). The authors sought to determine predictive relationships between psychiatrists' clinical assessments of non-adherence and treatment outcomes, via a design that would be more applicable to practice.
Method: Multiple regression analyses were conducted on non-adherence, symptom severity upon admission, number of recent hospitalizations, and length of hospital stay. The sample consisted of 182 inpatients with psychotic spectrum disorders and significant risk and vulnerability factors. Non-adherence was measured via the psychiatrists' diagnosis of V15.81. Symptom severity was measured via the 24-item Brief Psychiatric Rating Scale (BPRS-E).
Results: There were null findings on non-adherence and BPRS-E pretest score ( 2= 2, p = 0.16), recent hospitalizations ( 2= 1.2, p = 0.27), and length of stay (β = 0.003, p = 0.97). Higher symptom severity predicted a modestly longer length of stay ( 2= .20, p = 0.007), though Bonferroni correction nullified this finding. White/Caucasian participants were far more likely to be non-adherent than black/African-American participants (t = -8.66; p > .00001).
Conclusions: Null findings suggest the psychiatrist's initial, quick-form assessment of non-adherence may not necessarily presume a poor prognosis. Perhaps, because individuals with severe and chronic psychotic disorders may have greater coping, adaptive, and survival skills than is often assumed. In severely under-resourced hospitals, such second thoughts and more reliable information about adherence and contributing factors may improve treatment outcomes.
期刊介绍:
BMC Psychiatry is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of psychiatric disorders, as well as related molecular genetics, pathophysiology, and epidemiology.