Adherence therapy versus routine psychiatric care for people with schizophrenia spectrum disorders: a randomised controlled trial

BACKGROUND: Current practice guidelines for schizophrenia care recommend that antipsychotic medication is essential for patients’ long-term maintenance treatment but their non-adherence to this medication is still a main obstacle to relapse prevention. This study evaluated the effects of a motivational-interviewing-based adherence therapy for people with schizophrenia spectrum disorders. METHODS: This randomised controlled trial was conducted with 134 outpatients with schizophrenia spectrum disorders; 67 of them received a six-session adherence therapy (in addition to usual care) and 67 received usual psychiatric care alone. Participants’ outcome measures included symptom severity, medication adherence, hospitalisation rates, insight into illness/treatment, and functioning. RESULTS: The adherence therapy group reported significantly greater improvements in symptom severity (p < 0.003), insight into illness/treatment (p < 0.001), functioning (p < 0.005), duration of re-hospitalisations (p < 0.005), and medication adherence (p < 0.005) over 18 months follow-up, when compared with usual care alone. CONCLUSIONS: Motivational-interviewing-based adherence therapy can be an effective approach to treatment for people with early stage of schizophrenia who poorly adhere to medication regimen. TRIAL REGISTRATION: ClinicalTrials.gov NCT01780116, registration date January 29, 2013.