Compliance with maintenance medication in first-episode schizophrenia

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Objective: The history of obstetric complications (OCS) could potentially shed some light on the heterogeneity in the etiology and course of schizophrenia. We investigated the effect of OCs on treatment response during the first episode of schizophrenia using patients from the Prospective Study of Psychobiology in Schizophrenia at Hillside Hospital. Method: Histories of OCS were collected on 58 patients (33 males and 2S females) in their first episode of schizophrenia. Histories were based on mother's recall alone in 43% of the patients and supplemented with birth records in the rest of the sample. The McNeil-SjOstrOmScale for OCs was the assessment instrument used. Patients were grouped according to whether or not they had a history of any Level 5 (potentially greatly harmful) OC. The effect of a history of Level SOC on treatment response during the first episode of schizophrenia was estimated using Cox proportional hazards regression analysis . Results: Eleven of the 58 patients (19%) had positive histories of LevelS OCs . The percentage of patients with positive histories was greater among women (28%) than among men (12%) . The group with positive histories of OC exhibited lower rates of treatment response compared to those with negative histories (hazard ratio controlling for gender = 0.26; 95% confidence interval=O.ll, 0.59) . This effect held when positive symptoms at baseline were controlled for. Conclusion: Positive history of potentially greatly harmful obstetric complications was a strong predictor of lower response to treatment in the first episode of schizophrenia. Because this large effect was based on a small sample of 58 patients, replication of our results are necessary before definitive conclusions can be made regarding obstetric complications and the course of schizophrenia.

$i1) COMPLIANCE WITH MAINTENANCE MEDICATION IN FIRST-EPISODE SCHIZOPHRENIA T.R.E. Barnes,M.A. McPhillips, R. Hillier,B.K. Purl, Eileen Joyce

DepartmentofPsychiatry. Charing Cross and Westminster MedicalSchool. St Dunstan's Road. London W68RF, UK In the context of a multi-centre study of first-episode schizophrenia in West London, we examined the role of several factors reported to be associated with poor compliance with maintenance antipsychotic medication. Thirty-five patients were assessed with regard to attitudes to medication (Rating of Medication Influences scale: ROMI), insight (Birchwood Scale) and compliance with maintenance medication six months after first presentation to psychiatric services. Substance misuse was assessed by a combination of questionnaire and hair analysis. 43% of the sample were overtly non-compliant with prescribed maintenance medication while 6% reported that they were covertly noncompliant. Compared with the compliant patients, these noncompliers had significantly higher scores for negative attitudes to medication on the ROMI scale. The two groups did not d iffer significantly on the insight scale ratings overall. However, the

noncompliant subjects exhibited a greater tendency to attribute their symptoms to mental illness while strongly disagreeing with the need for further treatment. Self-report of past or current substance misuse did not predict compliance with maintenance medication. These results suggest that lack of insight is an inadequate explanation for noncompliance in this context. The ROMI may help to identify subjects with a high risk of noncompliance.

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SATISFACTION WITH TREATMENT OUTCOME AND NONCOMPLIANCE IN SCHIZOPHRENIA Crystal R. Blylerand WayneS. Fenton Chestnut Lodge Research Institute. 500 JV, Montgomery Ave.• Rockville MD 20850 Although new medications are increasingly effective in treating schizophrenia, patient noncompliance with medication regimes remains a significant barrier to maximizing pharmacologic efficacy. The factors contributing to medication noncompliance, therefore, warrant intensive study. We studied self-reported medication compliance among 89 pat ients with serious mental illness six months following an acute descompensation that resulted in hospital or crisis care. 57"10 of patients reported missing medication at least once in the six months following acute care, and 15% reported skipping daily dosages more than once per week. Non-compliance rates among patients with schizophrenia and schizoaffective disorder did not differ significantly from those of patients with other diagnoses. Among 49 schizophrenic and schizoaffective patients, noncompliance was associated with elevated positive symptoms but an increased ability to work . Patient satisfaction with treatment and other aspects of their lives was strongly associated with medication adherence. Consistent with anecdotal reports from the literature, the data suggest that antipsychotic medications may disrupt some patients' ability to work, leading them not to adhere to medication regimes, despite a resulting increase in psychotic symptoms. Patients' goals for treatment may differ from those of their physicians, and the patients' subjective satisfaction with the results of treatment may be the strongest predictor of medication compliance .

sn.METHYLPHENIDATE TREATMENT OF NEGATIVE SYMPTOMS IN SCHIZOPHRENIA DebraW. Brescan, George E. Jaskiw, P. EricKonicki VA MedicalCenter and Department ofPsychiatry, CWRU, Cleveland, OH 44/41 Although the pathophysiology of negative symptoms remains to be defined, some data implicate reduced frontal lobe dopa-