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Adherence therapy for people with schizophrenia: European multicentre randomised controlled trial

  • Richard Gray (a1), Morven Leese (a1), Jonathan Bindman (a1), Thomas Becker (a2), Lorenzo Burti (a3), Anthony David (a4), Kevin Gournay (a1), Martijn Kikkert (a5), Maarten Koeter (a5), Bernd Puschner (a2), Aart Schene (a5), Graham Thornicroft (a1) and Michele Tansella (a6)...
Abstract
Background

There is equivocal evidence of the effectiveness of adherence therapy in improving treatment adherence and clinical outcomes for people with schizophrenia.

Aims

To evaluate the effectiveness of adherence therapy in improving quality of life for people with schizophrenia.

Method

A 52-week, single-blind, multicentre randomised controlled trial of the effectiveness of adherence therapy. Participants were individually randomised to receive eight sessions of adherence therapy or health education. Assessments were undertaken at baseline and at 52-week follow-up.

Results

Adherence therapy was no more effective than health education in improving quality of life.

Conclusions

This effectiveness trial provides evidence for the lack of effect of adherence therapy in people with schizophrenia with recent clinical instability, treated in ordinary clinical settings.

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Copyright
Corresponding author
Dr Richard Gray, Health Services Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. Tel.: +44 (0)20 7848 0139; fax: +44(0)20 7848 0458; email: R.Gray@iop.kcl.ac.uk
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Declaration of interest

None. Funding detailed in Acknowledgements.

Footnotes
References
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  • ISSN: 0007-1250
  • EISSN: 1472-1465
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Adherence therapy for people with schizophrenia: European multicentre randomised controlled trial

  • Richard Gray (a1), Morven Leese (a1), Jonathan Bindman (a1), Thomas Becker (a2), Lorenzo Burti (a3), Anthony David (a4), Kevin Gournay (a1), Martijn Kikkert (a5), Maarten Koeter (a5), Bernd Puschner (a2), Aart Schene (a5), Graham Thornicroft (a1) and Michele Tansella (a6)...
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eLetters

Adherence therapy in schizophrenia

Subodh Bhagyalakshmi Nanjayya, Senior resident
06 June 2007

Respected Sir,

Gray et al’s study of adherence therapy for patients with schizophrenia is significant because of the high rates of non-adherence and several adverse consequences of this phenomenon e.g. increasing relapses, rehospitalisation, increased risk of suicide and aggression etc.(Raphael et al 2005). The study was unique in being a multinational RCT, which focused on the effectiveness of a clearly described, structured intervention. The large sample size and well validated assessment instruments were its other strengths.However, certain aspects were still unclear. Firstly, why was quality of life (QOL), which is at best an indirect measure of the adherence, used asa primary outcome variable? Others have failed to find an association between subjective QOL and adherence (Puschner et al 2007). It would have been helpful if data on several potential mediating variables such as global functioning, duration of the illness, depressive cognitions, type of drugs and side effects of the drugs were included. The lack of evidencefor adherence therapy as shown by this study should not immediately lead to its dismissal. Thus further trials with longer follow-up, more carefuland comprehensive assessment of adherence, and controlling for possible confounds, are still required.

References Puschner, B., Born, A., Anne, G., et al (2006) Adherence to medication andquality of life in people with schizophrenia: Results of a European multicenter study. J Nerv Ment Dis, 194, 746-752 Raphael, L.J., Kuldip, J. & Yogesh, D.B. (2005) Non adherence with psychopharmacological treatment among psychiatric patients. Primary psychiatry, 12, 33-39

Subodh B. N., M.D. Senior Resident**Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh – 160012, India
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