Evaluation of noncompliance in schizophrenia patients using electronic monitoring (MEMS®) and its relationship to sociodemographic, clinical and psychopathological variables

Background: Noncompliance is common in patients with schizophrenia and can have serious consequences; therefore research of the variables associated with noncompliance is a priority. Although the MEMS device is regarded as the "reference standard" for evaluating compliance, it has been used in very few published studies. Methods: Compliance was evaluated in 102 outpatients diagnosed with schizophrenia according to ICD-10 criteria. Compliance was evaluated with the MEMS device for 3 months in 79 patients who were on oral antipsychotic treatments. Baseline evaluations included sociodemographic, clinical, treatment-related and psychopathological variables. The psychiatrist, patients and relatives also provided compliance estimates. Results: Noncompliant behaviors were observed in 42.3% of patients. Agreement between estimations by the psychiatrist and the MEMS findings was fair, and agreements between those of both patients and relatives and the MEMS findings were slight. Noncompliant patients showed poor insight, conceptual disorganization, stereotyped thinking and poor attention as compared to compliant patients. Conclusions: A large percentage of schizophrenic patients failed to adequately comply with their prescribed treatment. Compliance was overestimated by the psychiatrist, by patients and by relatives. Poorer insight and increased conceptual disorganization were independently associated with noncompliance. Identification of factors associated with noncompliance and strategies to reduce these behaviors would help improve the prognosis of schizophrenia. (C) 2008 Elsevier B.V. All rights reserved.