Electronic Letters to:

PAPERS:
RICHARD GRAY, MORVEN LEESE, JONATHAN BINDMAN, THOMAS BECKER, LORENZO BURTI, ANTHONY DAVID, KEVIN GOURNAY, MARTIJN KIKKERT, MAARTEN KOETER, BERND PUSCHNER, AART SCHENE, GRAHAM THORNICROFT, and MICHELE TANSELLA
Adherence therapy for people with schizophrenia: European multicentre randomised controlled trial
The British Journal of Psychiatry 2006; 189: 508-514 [Abstract] [Full text] [PDF]
*eLetters: Submit a response to this article

Electronic letters published:

[Read eLetter] Adherence therapy in schizophrenia
Subodh Bhagyalakshmi Nanjayya   (6 June 2007)

Adherence therapy in schizophrenia 6 June 2007
Top
Subodh Bhagyalakshmi Nanjayya,
Senior resident
PGIMER, Chandigarh , India

Send letter to journal:
Re: Adherence therapy in schizophrenia

drsubodhbn2002{at}yahoo.co.in Subodh Bhagyalakshmi Nanjayya

Respected Sir,

Gray et al’s study of adherence therapy for patients with schizophrenia is significant because of the high rates of non-adherence and several adverse consequences of this phenomenon e.g. increasing relapses, rehospitalisation, increased risk of suicide and aggression etc. (Raphael et al 2005). The study was unique in being a multinational RCT, which focused on the effectiveness of a clearly described, structured intervention. The large sample size and well validated assessment instruments were its other strengths. However, certain aspects were still unclear. Firstly, why was quality of life (QOL), which is at best an indirect measure of the adherence, used as a primary outcome variable? Others have failed to find an association between subjective QOL and adherence (Puschner et al 2007). It would have been helpful if data on several potential mediating variables such as global functioning, duration of the illness, depressive cognitions, type of drugs and side effects of the drugs were included. The lack of evidence for adherence therapy as shown by this study should not immediately lead to its dismissal. Thus further trials with longer follow-up, more careful and comprehensive assessment of adherence, and controlling for possible confounds, are still required.

References Puschner, B., Born, A., Anne, G., et al (2006) Adherence to medication and quality of life in people with schizophrenia: Results of a European multicenter study. J Nerv Ment Dis, 194, 746-752 Raphael, L.J., Kuldip, J. & Yogesh, D.B. (2005) Non adherence with psychopharmacological treatment among psychiatric patients. Primary psychiatry, 12, 33-39

Subodh B. N., M.D. Senior Resident** Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh – 160012, India