TELEPHONE MEDICATION MANAGEMENT IN SCHIZOPHRENIA

不遵守典型的精神安定药物是公认的一个主要因素，在复发和再住院的精神分裂症患者。 不依从通常归因于显著的锥体外系副作用和缺乏疗效。非典型抗精神病药物预期对不依从性有一定影响，因为其锥体外系副作用一般较低且疗效较好。 典型抗精神病药物的不依从性已得到充分证实，但没有关于药物不依从性的信息。 虽然非典型抗精神病药物预计会对依从性产生影响，但可能仍然需要额外的依从性诱导策略，因为长效给药和改变对药物态度的尝试尚未证明长期有效。本探索性研究的目的是收集新的抗精神病药物的依从性数据，并测试电话药物管理（TMM）的有效性，对符合人群的精神分裂症和情感障碍。 本研究的具体目的是：1）检查非典型抗精神病药物的依从性是否优于典型抗精神病药物; 2）评估TMM项目中患者将体验更高的生活质量、功能增强和症状减轻的假设; 3）研究TMM项目中患者是否更紧密地遵守药物治疗方案;（4）检验TMM对住院率的影响。 这项探索性研究将采用随机2X2设计，涉及96名诊断为精神分裂症的患者。 研究受试者将被非随机分配至药物组，并被随机分配至TMM状态或"照常治疗"。"那些被分配到TMM条件的人将首先与TMM工作人员会面，讨论用药态度，制定持续用药的策略，并提供有关药物副作用的心理教育。 然后，TMM工作人员将通过每周电话联系进行跟进，他们将询问依从性并进行简短的临床访谈。 TMM工作人员将启动适当的干预措施（即，安排与个人医生的预约），以打击复发和新出现的副作用。

Non-compliance with typical neuroleptic drugs is well established as a major factor in relapse and re-hospitalization of persons with schizophrenia. Non-compliance has typically been attributed to significant extrapyramidal side effects and lack of efficacy. Atypical antipsychotic drugs are expected to have some impact on non-compliance because of generally lower extrapyramidal side effects and better efficacy. Non-compliance with typical antipsychotics is well established, but no information is available on non-compliance with atypicals. While atypical antipsychotic agents are expected to have an impact on compliance, there will likely remain a need for additional compliance-inducing strategies, as depot administrations and attempts to change attitudes toward medications have not proven effective in the long-term. The purpose of this exploratory study is to collect data on compliance with new antipsychotic medications and to test the effectiveness of telephone medication management (TMM) on compliance with a population of persons with schizophrenia and schizoaffective disorders. The specific aims of this study are: 1) Examine whether compliance with atypical antipsychotic drugs will be better than that with typical neuroleptics; 2) Evaluate the hypothesis that patients in the TMM program will experience superior quality of life, enhanced functioning, and decreased symptoms; 3) Study whether patients in the TMM program will adhere more closely to medication regimens; and 4) Examine the impact of TMM on hospitalization rates. This exploratory study will utilize a randomized 2X2 design involving 96 persons diagnosed with schizophrenia. Research participants will be non-randomized to medication and randomized to the TMM condition or "treatment as usual." Those assigned to the TMM condition will initially meet with a TMM staffperson and discuss medication attitudes, develop strageies for taking medications on a consistent basis, and provide psychoeducation about medication side effects. The TMM staffperson will then follow this up with weekly telephone contacts in which they will inquire about compliance and conduct a brief clinical interview. The TMM staffperson will initiate appropriate interventions (i.e., schedule an appointment with the persons physician) to combat relapse and emerging side effects.