Original Research

Factors associated with dropout at 2 years post-initiation of treatment in the first episode of schizophrenia

Jebril M. Benelmokhtar, Bonginkosi Chiliza, Lebogang Phahladira, Robin Emsley, Laila Asmal
South African Journal of Psychiatry | Vol 27 | a1657 | DOI: https://doi.org/10.4102/sajpsychiatry.v27i0.1657 | © 2021 Jebril M. Benelmokhtar, Bonginkosi Chiliza, Lebogang Phahladira, Robin Emsley, Laila Asmal | This work is licensed under CC Attribution 4.0
Submitted: 12 November 2020 | Published: 09 March 2021

About the author(s)

Jebril M. Benelmokhtar, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Bonginkosi Chiliza, Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
Lebogang Phahladira, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Robin Emsley, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Laila Asmal, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa


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Abstract

Background:Prevention of new episodes during the first 2 years after a first episode of schizophrenia (FES) may delay treatment refractoriness and brain morphological changes over time. However, adherence to treatment is characteristically poor in these patients.

Aim: The aim of this study was to examine clinical and sociodemographic factors associated with patient dropout in patients with FES.

Setting: This study was set at inpatient and outpatient services at a psychiatric hospital in the Western Cape, between 2007 and 2011.

Methods: Data were collected as part of a prospective longitudinal study, which followed up patients with FES treated with flupenthixol decanoate. We examined the relationship between treatment adherence and sociodemographic and clinical factors at baseline and at 24 months. Unadjusted and adjusted logistic regression models were used to determine adherence variables.

Results: A total of 62% of patients completed the 24 months of treatment. Participants with FES and a substance use disorder (dual diagnosis) were at greater risk of dropout (p = 0.01). On univariate analysis, dual diagnosis participants who dropped out were older (p = 0.04) had completed more years of schooling (p = 0.001), older age of onset (p = 0.02) and higher baseline positive symptoms (p = 0.05). On regression analysis, non-completer substance users achieved a higher level of education (odds ratio [OR]: 3.87, confidence interval [CI]: 1.34–11.11, p = 0.01).

Conclusion: Substance use disorder was associated with non-adherence to follow up in a cohort of FES patients treated with flupenthixol decanoate. Interventions that take into account age, education and baseline positive symptoms may afford the opportunity to influence adherence and patient outcome.




Keywords

adherence; schizophrenia; first episode; dual diagnosis; flupenthixol decanoate; long acting injectable; positive and negative syndrome scale

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