Antipsychotic treatment dosing profile in patients with schizophrenia evaluated with electronic monitoring (MEMS®)

• Published in: Schizophrenia research 2013-05, Vol.146 (1), p.196-200
• Main Authors: Acosta, Francisco J, Ramallo-Fariña, Yolanda, Bosch, Esperanza, Mayans, Teresa, Rodríguez, Carlos J, Caravaca, Ana
• Format: Article
• Language: English
• Subjects: Adherence; Adult; Adult and adolescent clinical studies; Aged; Antipsychotic Agents - therapeutic use; Biological and medical sciences; Dose-Response Relationship, Drug; Dosing profile; Drug Monitoring; Electronic monitoring; Electronics - methods; Female; Follow-Up Studies; Humans; Male; Medical sciences; Medication Event Monitoring System; Middle Aged; Neuropharmacology; Nonadherence; Outcome Assessment (Health Care); Outpatients; Patient Compliance; Pharmacology. Drug treatments; Psychiatric Status Rating Scales; Psychiatry; Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Psychoses; Schizophrenia; Schizophrenia - drug therapy; Statistics, Nonparametric; Young Adult
• ISSN: 0920-9964; 1573-2509
• DOI: 10.1016/j.schres.2013.02.016

Abstract Background Although the Medication Event Monitoring System (MEMS®) device offers accurate information on treatment dosing profile, such profile has never been studied in patients with schizophrenia. Enhancing our knowledge on this issue would help in developing intervention strategies to improve adherence to antipsychotic treatment in these patients. Methods 74 outpatients with schizophrenia were monitored with the MEMS device for a 3-month period, for evaluation of antipsychotic treatment dosing profile, possible influence of medication schedule-related variables, adherence to treatment – considering dose intake within prescribed timeframes – and possible Hawthorne's effect of using the MEMS device. Results Dose-omission gaps occurred in 18.7% of monitoring days, most frequently during weekends, almost significantly. Almost one-third of prescribed doses were taken out of prescribed time. Neither the prescribed number of daily doses nor the indicated time of the day for dose intake (breakfast, dinner), were associated with correct antipsychotic dosing. Excess-dose was rare in general, and more frequent out of prescribed dose timeframe. No Hawthorne's effect was found for the MEMS device. Adherence reached only 35% according to a definition that included dose intake within prescribed timeframes. Conclusions Antipsychotic treatment dosing was considerably irregular among patients with schizophrenia. Strategies to reduce dose-omission gaps and increase dosing within prescribed timeframes seem to be necessary. Gaining knowledge on precise oral antipsychotic dosing profiles or the influence of schedule-related variables may be useful to design strategies towards enhancing adherence. There appears to be no Hawthorne's effect associated with the use of MEMS devices in outpatients with schizophrenia.