Intervention Review

Compliance therapy for schizophrenia

  1. Andrew McIntosh1,*,
  2. Louise Conlon2,
  3. Stephen Lawrie3,
  4. Andrew C Stanfield4

Editorial Group: Cochrane Schizophrenia Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 23 MAR 2006

DOI: 10.1002/14651858.CD003442.pub2

Database Title

Additional Information

How to Cite

McIntosh A, Conlon L, Lawrie S, Stanfield AC. Compliance therapy for schizophrenia. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD003442. DOI: 10.1002/14651858.CD003442.pub2.

Author Information

  1. 1

    University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK

  2. 2

    National University of Ireland, Department of Psychiatry, Clinical Sciences Institute, University College Hospital, Galway, Ireland

  3. 3

    University of Edinburgh, Department of Psychiatry, Edinburgh, Scotland, UK

  4. 4

    University of Edinburgh, Division of Psychiatry, Edinburgh, Lothian, UK

*Andrew McIntosh, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK. andrew.mcintosh@ed.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Schizophrenia is a severe mental illness characterised by delusions and hallucinations. Antipsychotic drugs does reduce these symptoms, but at least half of people given these drugs do not comply with the treatment regimen prescribed.

Objectives

To assess the effects of compliance therapy on antipsychotic medication adherence for people with schizophrenia.

Search methods

Cochrane Schizophrenia Group Trials Register (June 2005).

Selection criteria

We included all randomised controlled trials of 'compliance therapy' for people with schizophrenia or related severe mental disorders.

Data collection and analysis

We independently extracted data and, for dichotomous data, calculated the relative risk (RR), its 95% confidence interval (CI) on an intention to treat basis. We present continuous data using the weighted mean difference statistic.

Main results

We included one trial with relevant and available data (n=56, duration 2 years) comparing compliance therapy with non-specific counseling. The primary outcome 'non-compliance with treatment' showed no significant difference between compliance therapy and non-specific counseling (n=56, RR 1.23 CI 0.74 to 2.05). The compliance therapy did not substantially effect attitudes to treatment (n=50, WMD DAI score -2.10 CI -6.11 to 1.91). Very few people (˜10%) left the study by one year (n=56, RR 0.5 CI 0.1 to 2.51). Mental state seemed unaffected by the therapy (n=50, WMD PANSS score 6.1 CI -4.54 to 16.74) as was insight (n=50, WMD SAI -0.5 CI -2.43 to 1.43), global functioning (n=50, WMD GAF -4.20 CI -16.42 to 8.02) and quality of life (n=50, WMD QLS -3.40 CI -16.25 to 9.45). At both one and two years the average number of days in hospital was non-significantly reduced for those allocated to the compliance therapy.

Authors' conclusions

There is no clear evidence to suggest that compliance therapy is beneficial for people with schizophrenia and related syndromes but more randomised studies are justified and needed in order for this intervention to be fully examined.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Compliance therapy for schizophrenia

Relapse in people with schizophrenia is common and in many cases attributable to poor compliance with antipsychotic medication. Compliance therapy was developed to specifically address non-compliance with antipsychotic medication. We only found one reasonably good but small trial. It did not show that compliance therapy really effected compliance with medication, psychotic symptoms, or quality of life but it was always too small really to show this for certain. The study did, however, suggest that the compliance therapy may help people spend shorter times in hospital across a two year period, when compared with standard care. There is a need for more studies and we have proposed a design that could be conducted within the confines of routine care for outcomes of interest to everyone involved.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

精神分裂症的順從治療

精神分裂症是一種嚴重的精神疾病，特徵是妄想與幻覺。抗精神病藥物可以減少這些症狀，但至少有一半接受這些藥物的患者並沒有遵循醫囑服藥。

目標

評估順從治療對於精神分裂症患者服用抗精神病藥物的順從度之效果。

搜尋策略

Cochrane Schizophrenia Group Trials Register(至2005年6月)。

選擇標準

我們納入所有對精神分裂症或相關的嚴重精神疾患進行“順從治療”的隨機對照試驗。

資料收集與分析

我們獨立地擷取資料，對於二分變項的資料，以治療意向計算其相對危險(RR)與它的95%信賴區間(CI)。我們以加權的平均差異(WMD)統計值來呈現連續變項。

主要結論

我們納入一個有相關資料的試驗，比較順從治療與非特定的諮商的效果(56個參與者，為期2年)。主要的結果變項是對治療的不順從，研究顯示順從治療與非特定的諮商的效果並沒有統計上顯著的差異(56個參與者, RR 1.23 CI 0.74 至 2.05)。順從治療並沒有實質地影響對治療的態度(50個參與者, WMD DAI 分數 −2.10 CI −6.11 至 1.91)。在一年期間退出研究的人很少(∼10%)(56個參與者, RR 0.5 CI 0.1 至 2.51)。治療似乎並沒有影響精神狀態(50個參與者, WMD PANSS 分數 6.1 CI −4.54 至 16.74)與病識感(50個參與者, WMD SAI −0.5 CI −2.43 至 1.43)、整體功能(50個參與者, WMD GAF −4.20 CI −16.42 至 8.02)、生活品質(50個參與者, WMD QLS −3.40 CI −16.25 至 9.45)。在一年與兩年期間，這些接受順從治療的患者住院的平均日數降低，但並未達統計上的顯著差異。

作者結論

並沒有清楚的證據支持順從治療對於精神分裂症與相關症候群的患者有益，需要更多隨機試驗來為此提供證明，對這個治療有更完整的檢驗。

翻譯人

本摘要由彰化基督教醫院陳美雀翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

精神分裂症患者常有復發的情形，常見的原因是對抗精神病藥物的順從性不佳。順從治療是特定用來處理對抗精神病藥物的服從性不佳問題。我們只發現一個品質好但樣本數少的試驗。結果顯示順從治療並沒有真的影響對藥物的順從度、精神症狀或生活品質。然而，這個研究發現與標準照護相比，順從治療可能可以協助患者減少在兩年期間的住院時間。還需要更多的研究，我們也提出了一個在例行照護下執行的研究設計，針對每個納入的人來探討有興趣的預後。

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