T114. IMPROVING THERAPEUTIC ADHERENCE IN SCHIZOPHRENIA SPECTRUM DISORDERS - FROM NURSING APPROACHES TO NEW TECHNOLOGIES

Abstract

Background: Treatment adherence in patients with psychotic disorders is an important challenge for physicians and caregivers, and various methods have been suggested in order to improve this parameter. Therapeutic adherence is defined as the extent to which the patient's behavior corresponds to the agreement between him or her and the prescribing physician. Monitoring this parameter is essential, because of its implications for the patient's prognosis, evolution, risk of relapse, quality of life, and overall functioning. A large number of factors have been associated with the ability to influence therapeutic adherence, e.g. frequency of administration and number of daily medications, adverse events related to antipsychotics, lack of insight or partial insight. Finding new ways to improve therapeutic adherence may be of considerable help for clinicians and may improve patients' functional prognosis. Methods: Main electronic databases (PubMed, CINAHL, PsychInfo, Cochrane, EMBASE, Thomson Reuters/Web of Science) were searched using as keywords “therapeutic adherence”, “treatment adherence”, combined with “schizophrenia”, “schizoaffective disorder”, and “psychotic disorders”. All papers published between 1988 and 2018 were included in the review. RCTs, as well as meta-analyses, systematic reviews and narrative reviews, case reports, case series, and letters to the editor were included. Papers without specified diagnoses of psychotic disorders, which included poorly specified interventions, or which included patients under 18 years old were excluded from this review. Results: A number of 288 papers were found after the primary search, and 41 remained after filtering out the rest of studies based on inclusion and exclusion criteria. Adherence therapy based on motivational interview, and psycho-educational approaches were the most reported psychological interventions. Adherence therapy was associated with lower duration of rehospitalization, improvements in severity of the main symptoms, and better functioning. Good-quality data about the efficacy of nursing techniques for improving therapeutic adherence are not available. Assertive community treatment is useful in patients with schizophrenia, because it improved the general psychopathology, functioning, quality of life, and decreased the re-hospitalization rates. Long-acting injectable atypical antipsychotics were also evaluated for patients with low adherence and this formulation decreased the number of re-hospitalization and treatment discontinuation rate. Aripiprazole tablets with sensor represent the newest addition in the clinician's toolkit for improving therapeutic adherence, but data derived from independent trials about the effects of this formulation over patients' rate of re-hospitalization and antipsychotic discontinuation rate are still lacking. Discussion: Psychological and pharmacological interventions focused on treatment adherence augmentation have impact over patients' functionality, several aspects of the general psychopathology, re-hospitalization and treatment discontinuation rates. Data about superiority of one therapeutic adherence- focused intervention over another are not available, so the decision about what method should be used depends mostly on the clinician's judgment.