Research often focuses upon developing new treatments for medical disorders.  Although better treatments are always desirable, an important contributor to poor outcomes for almost all chronic illness is poor adherence to currently available treatments.  For example, as many as 80% of patients with schizophrenia are at least partially non-adherent with their medication regimen.  Treatment nonadherence by patients with psychotic disorders may be the result of many factors including:  more severe symptomatology, lack of awareness of the illness, comorbid substance abuse, presence of medication side effects, an absence of social supports from family or friends, and practical barriers such as inability to afford medications.  Factors associated with nonadherence may also vary with the phase of the illness.  For example, factors associated with nonadherence may differ between young patients and patients with more established illness.    In an analysis (Robinson et al. 2002) of data from a Zucker Hillside first episode study, we found that Parkinsonian side effects and poorer cognitive ability, particularly executive function deficits,  increased the likelihood of medication discontinuation.  These data suggest that efforts to minimize side effects, as well as efforts to improve cognitive deficits or teach patients strategies to improve their functioning despite deficits may enhance adherence.

Given the multiple potential causes of medication discontinuation, a variety of strategies may be effective for improving adherence.  Based upon the association of executive function deficits and nonadherence, our group has investigated the use of assistive devices such as pagers to help remind patients to adhere to their medication regimes.  A long-term interest of the Center has been the use of long-acting injectable antipsychotics to assist with treatment adherence.  For the RAISE study, we will compare medication adherence with an integrated medication and psychosocial approach versus usual care at community setting around the country.

Select Publications:

Robinson DG, Woerner MG, Alvir JMaJ, Bilder RM, Hinrichsen GA, Lieberman JA.  Predictors of medication discontinuation by patients with first episode schizophrenia and schizoaffective disorder. Schizophrenia Research 57: 209-219, 2002.

Kane JM, Conley RR, Keith SJ, Nasrallah HA, Turner M: Guidelines for the use of long-acting injectable atypical antipsychotics; J Clin Psych; 65: 120-131; 2004.

Keith SJ. Kane JM. Turner M. Conley RR. Nasrallah HA. Academic highlights: guidelines for the use of long-acting injectable atypical antipsychotics.  Journal of  Clinical Psychiatry. 65(1):120-31, 2004.

Lasser RA, Bossie CA, Gharabawi GM, Kane JM. Remission in Schizophrenia: results from a 1-year study of long-acting risperidone. Schizophrenia Research  77: 215-227, 2005.

Kane JM. Review of treatments that can ameliorate nonadherence in patients with schizophrenia. J Clin Psychiatry 67[suppl] 5:9-14, 2006.

Lasser RA, Bossie CA, Locklear JC, Zhu Y, Kane JM. Long-acting risperidone in young adults with early schizophrenia or schizoaffective illness. Annals of Clin  Psychiatry. 19(2):65-71, 2007.

Kane JM. Treatment adherence and long-term outcomes. CNS Spectrums. 12(10 Suppl 17):21-26, 2007.

Dankert ME, Brensinger CM, Metzger KL, Han C, Gonzalez-Pinto A, Mosquera F, Gayares JG, Li C, Severus WE, Langosch JM, Tateno M, Mihai A, Johnstone  EC, MacIntyre DJ, Lallart X, Lallart E, Hoeft F, Wiguna T, Farooq S, Koleva SG, Radoeva PD, Mesen A, Laprade B, Nair SRN, Babb SM, Adler C, Habibpoor E,  Belmaker R, Rybakowsi J, Owe-Larsson B, Young A, Malhotra S, Sivakumar, Kane JM, Swanson C, Rush AJ, Siegel SJ. Attitudes towards implantable  psychiatric medication in a worldwide sample of patients.  Schizophrenia Research. 105(1-3):279-86, 2008.

Masand P, Roca M, Turner M, Kane JM. Partial adherence impacts the course of illness in patients with schizophrenia. Primary Care Companion to the Journal of Clinical Psychiatry. 11(4):147-54, 2009.
 
Kane JM, Naber D, Detke JC, Gopalan S, Lin DY, Bergstrom RF, McDonnell D. Olanzapine long-acting injection: A  24-week randomized double-blind trial of  maintenance treatment in patients with schizophrenia. Am J Psych (In Press).

Kane JM, Garcia-Ribera C. Clinical guideline recommendations for antipsychotic long-acting injections. In press BJP Nov 2009.