Indicators of medication compliance in first-episode psychosis

Compliance behaviour is a multi-factorial phenomenon. In psychotic patients, it includes patient-related, medication-related, and environmental components. Compliance is a crucial factor in relation to outcome. The aim of this study was to explore indicators of compliance in a sample of 59 patients with a first-onset psychosis during their initial phase of treatment. Dependent variables in the logistic regression analysis included predictions made by the patients about their compliance in the initial phase and the observed compliance during the first 3 months according to patient record data. Explanatory variables comprised age, sex, living situation, education and social activities, Positive and Negative Syndrome Scale (PANSS) score, Hamilton Depression Scale score, Global Assessment of Functioning Scale score, Strauss-Carpenter Outcome Scale score, self-rated side effects, and insight and treatment-related variables. Predictions made by the patients about their compliance were determined by their self-rated attitude and insight measures. Determinants of observed non-compliance included experienced harmful side effects, male sex, lack of social activities, low score on PANSS positive symptoms, high PANSS total score and young age. The duration of untreated psychosis was not associated with compliance. Indicators of compliance in first-episode psychosis resemble those in the overall psychotic population. During the acute phase of psychosis, insight and attitudes toward treatment are the sole determinants of the patients' prediction of compliance.