Patient perception of medication benefit and early treatment discontinuation in a 1-year study of patients with schizophrenia

OBJECTIVE The objective of this study was to examine the relationship between patient beliefs about medication use and their likelihood of discontinuing treatment prematurely. Associations of patient beliefs about medication with clinical psychopathology and their life satisfaction were also assessed. METHODS This post-hoc analysis used data from a randomized, open label, 1-year trial of antipsychotics in the treatment of patients with schizophrenia or schizoaffective disorders (N = 664). Medication management including dosage adjustment and medication switching was at doctors' discretion, reflecting naturalistic treatment in usual clinical care settings. Early treatment discontinuation was defined as all-cause study drop out. Patient-reported beliefs about medication were assessed by Rating of Medication Influences (ROMI), degree of clinical psychopathology was measured by Positive and Negative Syndrome Scale (PANSS), and patient quality of life was measured by Lehman Quality of Life Interview (LQLI). RESULTS Patient perception of medication benefit was the only strong predictor of treatment duration among the 5 underlying dimensions of medication influence. Higher level of perceived beneficial effect of medication was associated with reduced risk of early treatment discontinuation (Hazard ratio = 0.56, 95% Confidence Interval [0.40, 0.79], p = 0.001). Patients with greater beliefs in the beneficial effect of treatment also had better clinical psychopathology outcome and were more satisfied with their quality of life and well-being. CONCLUSION Understanding the predictors of early treatment discontinuation in the care of schizophrenia patients is important for the development of interventions to improve treatment outcome. Current findings suggest that patient perception of beneficial effect of medication may be a critical factor in achieving treatment persistence and a satisfactory treatment outcome.