Medication Adherence in Schizophrenia: Development of a CBT-Based Intervention

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00980252
Recruitment Status : Completed
First Posted : September 21, 2009
Last Update Posted : June 16, 2014
National Institute of Mental Health (NIMH)
Information provided by (Responsible Party):
Peter Weiden, University of Illinois at Chicago

Brief Summary:
This is a randomized pilot study of an intervention based on principles of Cognitive Behavioral Therapy (CBT). This intervention is the Health Dialogue Intervention (HDI) and will be compared to a traditional medical model of psychoeducation known as Team Solutions (TS) for first-episode schizophrenia patients. Outcomes include the acceptance of HDI and TS, compare adherence attitudes at the end of the treatment intervention, and to compare the time until the first episode of nonadherence.

Condition or disease Intervention/treatment Phase
Schizophrenia Psychotic Disorders Behavioral: Cognitive Behavioral Therapy Not Applicable

Detailed Description:

Overview: Many people recovering from first-episode schizophrenia typically respond very well to their initial course of antipsychotic medications; however, studies indicate that nonadherence rates soar as high as 90% in the first year and do not improve over time. To date, there is no effective psychosocial intervention that improves adherence or reduces the adverse consequences of nonadherence after it occurs. Thus, it is imperative to develop a new intervention to improve medication adherence and improve clinical outcomes in patients recovering from first-episode schizophrenia.

This study is to pilot an intervention specifically suited for patients with first-episode schizophrenia based on the principles of Cognitive Behavioral Therapy (CBT). This is to focus on adherence from the perspective of the patient.

Methods: This study compares the effectiveness of a standard psychoeducation program [Team Solutions (TS)] to a CBT approach known as the Health Dialogue Intervention (HDI). Consenting patients will receive a 4 week stabilization assessment period and then be randomized to a prospective, random-assignment study comparing the effectiveness of TS to HDI to improve medication adherence of patients recovering from first-episode schizophrenia.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 34 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Official Title: Medication Adherence in Schizophrenia: Development of a CBT-Based Intervention
Study Start Date : November 2009
Actual Primary Completion Date : December 2012
Actual Study Completion Date : March 2013

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Schizophrenia

Arm Intervention/treatment
Experimental: CBT
UK-based intervention
Behavioral: Cognitive Behavioral Therapy
Brief intervention of Cognitive Behavioral Therapy sessions compared to Team Solutions

Primary Outcome Measures :
  1. 1. Acceptance of therapeutic intervention as measured by number of sessions attended. 2. Difference in adherence behavior as measured by duration of antipsychotic treatment during follow up (ASV). 3. Differences in adherence attitudes (ROMI). [ Time Frame: Completion of Study ]

Secondary Outcome Measures :
  1. 1. Compare the course of symptoms and relapse of patients in HDI to those in the TS. [ Time Frame: Completion of Study ]

Information from the National Library of Medicine

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Ages Eligible for Study:   16 Years to 45 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

There is a 2 step inclusion/exclusion criteria, the first being for assessing overall eligibility to enter the study, and then, for continued outpatient treatment for schizophrenia, schizophreniform disorder, or schizoaffective disorder.

Inclusion criteria for entry into the Evaluation Phase:

  1. Between 16-45 years of age
  2. A provisional clinical diagnosis of schizophreniform disorder, schizophrenia, or schizoaffective disorder in last 6 months
  3. Discharge from inpatient unit for treatment of psychotic symptoms must have occurred in the last 6 months, or, if never hospitalized, initial treatment started in the last 6 months
  4. Able to fully participate in the informed consent process
  5. The patient is judged to be an appropriate candidate for ongoing outpatient follow-up at the First-episode Treatment Program at the Psychotic Disorders Program at UIC

Exclusion criteria for the Evaluation Phase:

  1. Unable to understand informed consent process
  2. A history of nonresponse to prior antipsychotic trials such that long-term inpatient treatment or clozapine will be recommended
  3. Prior treatment with clozapine
  4. Discharge from inpatient treatment for psychotic symptoms, initial treatment, or provisional diagnosis of schizophrenia, schizoaffective disorder, or schizophreniform occurred more than 6 months from enrollment into the evaluation phase
  5. Pregnancy or stated goal to become pregnant
  6. Will not be living close enough to the medical center to return for follow-up visits or assessments
  7. History of geographic instability such that it is judged unlikely that patient will reside in the area
  8. Currently under arrest for a felony, or an arrest is deemed likely in the near future
  9. Currently receiving medication over objection by court order
  10. Currently receiving treatment in another research protocol

Inclusion Criteria for the Treatment Intervention Phase:

  1. Willingness to transition to receive evaluation and future pharmacologic treatment at the Psychotic Disorders Program at UIC
  2. Has capacity to understand the risks and benefits of participating in a randomized psychosocial trial
  3. Willingness to sign informed consent to go into the Treatment Intervention Phase
  4. Is able to complete a post-test for understanding the nature of the study and what it entails, and the potential risks and benefits of study participation
  5. Is willing to have therapy sessions recorded for fidelity assessments
  6. Is willing to receive follow-up independent assessments of adherence status, including separate interviews with trained independent raters, and our contacting the outpatient pharmacy for pharmacy refill records

Exclusion criteria for Treatment Intervention Phase:

  1. Diagnosis or inpatient treatment for psychotic symptoms occurred more than 6 months from date of enrollment into evaluation phase
  2. Acutely psychotic individuals may not participate because therapy will not benefit if symptoms are too severe
  3. Has dropped out of the treatment program and cannot be located for follow-up appointments
  4. Stated refusal to come for to at least one clinical evaluation appointment at the PDP, or has been a "no show" for at least three consecutive appointments
  5. Judged to be at significant and imminent risk of harm to self or others*
  6. Ongoing active substance or alcohol use that is not controlled during the Evaluation Phase, along with refusal of referral to a "dual diagnosis" treatment program for substance abuse problems
  7. Remains enrolled in another research protocol at UIC*
  8. Unwilling to consider any additional psychotherapeutic intervention above and beyond coming in to the service for medication management appointment
  9. Baseline PANSS total score ≥ 90, or has a individual PANSS item of conceptual disorganization (item P2), excitement (P4), or hostility (P7) that is ≥ 5 (moderately severe)*
  10. Judged to require additional concrete case management services to support medication adherence*
  11. Receives antipsychotics under coercive conditions (e.g. inpatient or outpatient commitment)*

Note: The exclusion criteria (*) may be present during some parts of the Evaluation Phase and would need to be resolved within the 4 week time period permitted for the Evaluation Phase prior to the Treatment Intervention Phase of study entry.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00980252

United States, Illinois
University of Illinois at Chicago
Chicago, Illinois, United States, 60612
Sponsors and Collaborators
University of Illinois at Chicago
National Institute of Mental Health (NIMH)
Principal Investigator: Peter J. Weiden, M.D. University of Illinois at Chicago

Responsible Party: Peter Weiden, Professor, University of Illinois at Chicago Identifier: NCT00980252     History of Changes
Other Study ID Numbers: R34MH080978 ( U.S. NIH Grant/Contract )
R34MH080978 ( U.S. NIH Grant/Contract )
R34MH080978-01A2 ( U.S. NIH Grant/Contract )
First Posted: September 21, 2009    Key Record Dates
Last Update Posted: June 16, 2014
Last Verified: June 2014

Keywords provided by Peter Weiden, University of Illinois at Chicago:
Cognitive Behavioral Therapy
Medication Adherence
Psychotic Disorders
Mental Disorders
Adherence Attitudes
Schizophrenia and Disorders with Psychotic Features

Additional relevant MeSH terms:
Mental Disorders
Psychotic Disorders
Schizophrenia Spectrum and Other Psychotic Disorders