Early Medication Adherence and Insight Change in First-Episode PsychosisAuthor(s): Martin Lepage , Michael Bodnar , Lisa Buchy , Ridha Joober , Ashok Malla
Objective: Adherence to treatment is a determining factor for symptomatic remission and relapse prevention following a first episode of psychosis (FEP). Risk factors for poor adherence have consistently involved a lack of insight. While insight can improve considerably during the first months of treatment, little is known about the relation between early change in insight and medication adherence. Method: Eighty-eight FEP participants were rated on insight and positive, negative, depressive, and anxious symptoms at baseline and at six months following admission. Insight was measured with the Scale to assess Unawareness of Mental Disorder. FEP participants were categorized as a function of their medication adherence at six months into poor (n=16), partial (n=11) and full-adherence (n=61) groups. Results: No significant group differences in insight emerged at baseline. However, at six months, the poor-adherence group displayed worse insight relative to the partial-adherence group, while the full-adherence group displayed the best insight. At baseline, the partial-adherence group showed significantly higher positive symptoms relative to the other two groups. At month six, positive symptom severity was lowest in the full-adherence group, greatest in the poor-adherence group, with the partial-adherence group falling between the two. Conclusions: These results add to a growing literature showing a significant association between insight and medication adherence. Interestingly, insight improvement following the first six months of treatment was more strongly associated with medication adherence than baseline insight, suggesting a promising window of opportunity to enhance insight.