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Psychiatr Prax 2005; 32(2): 62-67
DOI: 10.1055/s-2004-828332
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Compliance-Interventionen in der medikamentösen Behandlung Schizophrenieerkrankter

Befunde aktueller ÜbersichtsarbeitenEffects of Interventions to Improve Compliance with Antipsychotic Medication in People Suffering from SchizophreniaResults of Recent ReviewsBernd  Puschner1 , Anja  Born2 , Anne  Gießler2 , Hedda  Helm2 , Thomas  Becker1 , Matthias  C.  Angermeyer2
  • 1Universität Ulm, Abteilung Psychiatrie II, Bezirkskrankenhaus Günzburg
  • 2Universitätsklinikum Leipzig, Klinik und Poliklinik für Psychiatrie
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Publication History

Publication Date:
15 February 2005 (online)

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Zusammenfassung

Hintergrund: Non-Compliance (oder Non-Adherence) mit antipsychotischer Pharmakotherapie kommt häufig vor und stellt ein Risiko für psychotische Rückfälle dar, das wissenschaftlich sehr gut belegt ist. Compliance ist von großer Bedeutung für den Verlauf und die Behandlung schizophrener Psychosen. Ein Schwerpunkt der Forschung gilt der Compliance mit antipsychotischer Pharmakotherapie. Methode: Die Arbeit gibt eine Übersicht der Ergebnisse aus Metaanalysen. Literaturreviews der internationalen psychiatrischen Literatur seit 1990 zu Effekten von Interventionen, die zum Ziel haben, die Medikamentencompliance bei Schizophreniekranken zu erhöhen, werden zusammenfassend referiert. Ergebnisse: Es fanden sich acht aktuelle Übersichtsarbeiten zur Effektivität compliancesteigernder Maßnahmen bei Schizophreniepatienten. Interventionen zur Besserung non-complianten Verhaltens zeigten bislang wenig (Psychoedukation) bis mittelstarke (kognitiv-behaviorale und multimodale Interventionen) Effekte. Weitere relevante Befunde werden zusammenfassend berichtet und kritisch diskutiert.

Abstract

Background: Non-compliance (or non-adherence) with antipsychotic pharmacotherapy occurs frequently. In addition, there is overwhelming evidence that it constitutes a major risk factor for psychotic relapse. Compliance substantially affects course and treatment of schizophrenia. During the last decades, a large body of research on compliance with antipsychotic medication has been accumulated. Method: The authors provide an overview of meta-analyses. Reviews published since 1990 on effects of interventions aiming at increasing compliance with medication in people suffering from schizophrenia are summarized. Results: We found eight reviews which reported empirical findings on the efficacy and effectiveness of interventions with the goal of improving compliance. Interventions have shown limited (psychoeducation) to moderate (cognitive-behavioral and combined interventions) effects. Other relevant findings are summarized and discussed.

Literatur

  • 1 Thornley B, Rathbone J, Adams C E, Awad G. Chlorpromazine versus placebo for schizophrenia (Cochrane review). Chichester, U. K.; John Wiley u. Sons 2003
    Google Scholar
  • 2 Hunter R H, Joy C B, Kennedy E, Gilbody S M, Song F. Risperidone versus typical antipsychotic medication for schizophrenia (Cochrane review). Chichester, U. K.; John Wiley u. Sons 2003
    Google Scholar
  • 3 Wahlbeck K, Cheine M, Essali M A. Clozapine versus typical neuroleptic medication for schizophrenia (Cochrane review). Chichester, U. K.; John Wiley u. Sons 2003
    Google Scholar
  • 4 Hornung W P, Franzen U, Lemke R, Wiesemann C, Buchkremer G. Kann Psychoedukation bei chronisch schizophrenen Patienten kurzfristig medikationsbezogene Einstellungen und Verhaltensweisen beeinflussen?.  Psychiat Prax. 1993;  20 152-154
    PubMedGoogle Scholar
  • 5 Haynes R B. Introduction. In: Haynes RB, Taylor DW, Sacket DL (eds) Compliance in Health Care. Baltimore; John Hopkins Press 1979: 1-10
    Google Scholar
  • 6 Stimson G V. Obeying doctors' orders: A view from the other side.  Social Science and Medicine. 1974;  8 97-194
    CrossrefPubMedGoogle Scholar
  • 7 Holm S. What is wrong with compliance?.  Journal of Medical Ethics. 1993;  19 108-110
    PubMedGoogle Scholar
  • 8 Bebbington P. The content and context of compliance.  International Clinical Psychopharmacology. 1995;  9 (5) 41-50
    PubMedGoogle Scholar
  • 9 Lingam R, Scott J. Treatment non-adherence in affective disorders.  Acta Psychiatrica Scandinavia. 2002;  105 164-172
    PubMedGoogle Scholar
  • 10 Dodds F, Rebair-Brown A, Parsons S. A systematic review of randomized controlled trials that attempt to identify interventions that improve patient compliance with prescribed antipsychotic medication.  Clinical Effectiveness in Nursing. 2000;  4 47-53
    CrossrefPubMedGoogle Scholar
  • 11 Gray R, Wykes T, Gournay K. From compliance to concordance: A review of the literature on interventions to enhance compliance with antipsychotic medication.  Journal of Psychiatric and Mental Health Nursing. 2002;  9 (3) 277-284
    CrossrefPubMedGoogle Scholar
  • 12 Lacro J P, Dunn L B, Dolder C R, Leckband S G, Jeste D V. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: A comprehensive review of recent literature.  J Clin Psychiatry. 2002;  63 (10) 892-909
    CrossrefPubMedGoogle Scholar
  • 13 Fenton W S, Blyler C R, Hummer M. Determinants of medication compliance in schizophrenia: Empirical and clinical findings.  Schizophrenia Bulletin. 1997;  23 (4) 637-651
    Google Scholar
  • 14 Haynes R B, McKibbon K A, Kanani R. Systematic review of randomized trials of interventions to assist patients to follow prescriptions for medications.  The Lancet. 1996;  348 383-386
    CrossrefPubMedGoogle Scholar
  • 15 Oehl M, Hummer M, Fleischhacker W W. Compliance with antipsychotic treatment.  Acta Psychiatrica Scandinavia. 2000;  102 83-86
    PubMedGoogle Scholar
  • 16 Helgason L. Twenty years' follow-up of first psychiatric presentation for schizophrenia: what could have been prevented?.  Acta Psychiatrica Scandinavia. 1990;  81 231-235
    CrossrefPubMedGoogle Scholar
  • 17 Green J H. Frequent rehospitalization and noncompliance with treatment.  Hosp Community Psychiatry. 1988;  39 (9) 963-966
    PubMedGoogle Scholar
  • 18 Haywood T W, Kravitz H M, Grossman L S, Cavanaugh jr J L, Davis J M, Lewis D A. Predicting the „revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders.  Am J Psychiatry. 1995;  152 (6) 856-861
    CrossrefPubMedGoogle Scholar
  • 19 Curson D A, Barnes T R, Bamber R W, Platt S D, Hirsch S R, Duffy J C. Long-term depot maintenance of chronic schizophrenic out-patients: The seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems, side-effects, neurotic symptoms and depression.  British Journal of Psychiatry. 1985;  146 469-474
    PubMedGoogle Scholar
  • 20 Coldham E L, Addington J, Addington D. Medication adherence of individuals with a first episode of psychosis.  Acta Psychiatrica Scandinavia. 2002;  106 (4) 286-290
    CrossrefPubMedGoogle Scholar
  • 21 Kemp R, Hayward P, David A. Compliance therapy manual. London; The Bethlem and Maudsley NHS Trust 1997
    Google Scholar
  • 22 Zygmunt A, Olfson M, Boyer C A, Mechanic D. Interventions to improve medication adherence in schizophrenia.  American Journal of Psychiatry. 2002;  59 1653-1664
    PubMedGoogle Scholar
  • 23 Kampman O, Lethinen K. Compliance in psychosis.  Acta Psychiatrica Scandinavia. 1999;  100 167-175
    PubMedGoogle Scholar
  • 24 Dolder C, Lacro J, Leckband S, Jeste D. Interventions to improve antipsychotic medication adherence: Review of recent literature.  Journal of Clinical Pharmacology. 2003;  23 (4) 389-399
    PubMedGoogle Scholar
  • 25 Nose M, Barbui C, Gray R, Tansella M. Clinical interventions for treatment non-adherence in psychosis: Meta-analysis.  British Journal of Psychiatry. 2003;  183 197-206
    CrossrefPubMedGoogle Scholar
  • 26 Kemp R, Kirov G, Everitt B, Hayward P, David A. Randomised controlled trial of compliance therapy: 18-month follow-up.  British Journal of Psychiatry. 1998;  172 413-419
    CrossrefPubMedGoogle Scholar
  • 27 Kemp R, Hayward P, Applewhaite G, Everitt B, David A. Compliance therapy in psychotic patients: Randomised controlled trial.  BMJ. 1996;  312 345-349
    PubMedGoogle Scholar
  • 28 Becker M H. Understanding patient compliance: The contribution of attitudes and other psychosocial factors. In: Cohen SJ (ed) New Directions in patient compliance. Lexington, MA; D. C. Heath and Co 1979: 1-31
    Google Scholar
  • 29 Awad A G, Hogan T P, Voruganti L N, Heslegrave R J. Patients' subjective experiences on antipsychotic medications: Implications for outcome and quality of life.  International Clinical Psychopharmacology. 1995;  10, Suppl 3 123-132
    PubMedGoogle Scholar
  • 30 Löffler W, Kilian R, Toumi M, Angermeyer M. Schizophrenic patients' subjective reasons for compliance and noncompliance with neuroleptic treatment.  Pharmacopsychiatry. 2003;  36 (3) 105-112
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Geddes J. Generating evidence to inform policy and practice: The example of the second generation „atypical” antipsychotics.  Schizophrenia Bulletin. 2003;  29 (1) 105-114
    PubMedGoogle Scholar
  • 32 McDonald H, Garg A, Haynes R. Interventions to enhance patient adherence to medication prescriptions.  Journal of the American Medical Association. 2002;  288 (22) 2867-2879
    PubMedGoogle Scholar
  • 33 O'Donnell C, Donohoe G, Sharkey L, Owens N, Migone M, Harries R. et al . Compliance therapy: A randomised controlled trial in schizophrenia.  BMJ. 2003;  327 (7419) 834-840
    CrossrefPubMedGoogle Scholar
  • 34 Roter D L, Hall J A, Merisca R, Nordstrom B, Cretin D, Svarstad B. Effectiveness of interventions to improve patient compliance: A meta-analysis.  Med Care. 1998;  36 1138-1161
    CrossrefPubMedGoogle Scholar

1 Ausschließlich der besseren Lesbarkeit wegen wird die männliche Form verwendet. Natürlich sind mit Patienten auch Patientinnen, mit Ärzten auch Ärztinnen usw. gemeint.

Dr. Bernd Puschner

Abteilung Psychiatrie II der Universität Ulm · Bezirkskrankenhaus Günzburg

Ludwig-Heilmeyer-Straße 2

89312 Günzburg

Email: bernd.puschner@bkh-guenzburg.de

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