Predictors of medication discontinuation by patients with first-episode schizophrenia and schizoaffective disorder

Background: Enhancing medication adherence early in the course of schizophrenia and schizoaffective disorder may substantially improve long-term course. Although extensively studied in multi-episode patients, little data exist on medication adherence by first-episode patients. Method: Medication adherence was assessed during the first year of treatment and following recovery from the first relapse in patients treated by a standardized medication algorithm. Results: During the first year of treatment, patients with poorer premorbid cognitive functioning were more likely to stop antipsychotics (t = -2.54, df= 75, p = 0.01). Parkinsonian side effects increased the likelihood (hazard ratio=41.22; 95% CI= 2.30, 737.89; p=0.01), and better executive function decreased the likelihood (hazard ratio = 0.40; 95% Cl = 0.18, 0.88; p = 0.02) that patients discontinued maintenance medication after a first relapse. Conclusion: Interventions to ameliorate cognitive deficits and Parkinsonian side effects may enhance treatment adherence. (C) 2002 Elsevier Science B.V. All rights reserved.