Cannabis use and involuntary admission may mediate long-term adherence in first-episode psychosis patients: a prospective longitudinal study.
Barbeito et al.·BMC PsychiatryImpact 4.0
MixedGRADEVery low38 citations
Samplen = 98 Pat.
Duration8 years
EndpointTreatment adherence
Blindingn.a.
DesignProspektive Longitudinalstudie (8 Jahre)
”Key finding
Involuntary first admission and cannabis abstinence are associated with improved long-term treatment adherence in FEP, however adherence remains persistently poor in a large proportion.
Summary
8-year longitudinal study (N=98 FEP patients); 52% cannabis use at baseline, 74,4% poor treatment adherence. Cannabis abstinence during follow-up was associated with improved adherence in 38,9% of patients; involuntary first admission as a further predictor (p<0,001). Continued cannabis use (persistent CUD) associated with persistently poor treatment adherence over 8 years — intervention target for FEP treatment.
P
PopulationPatients with first-episode psychosis (FEP), n=98, follow-up over 8 years
I
InterventionNaturalistic treatment with assessment of cannabis use trajectory (continued use, stopped, never used) and type of first admission (voluntary vs. involuntary)
O
OutcomeGood treatment adherence over 8 years: involuntary first admission and cessation of cannabis use significantly associated with improved adherence (p<0.001 and logistic regression, respectively); 25% improved from poor to good adherence, of these 95,7% with involuntary first admission and 38,9% with cannabis abstinence
Confidence in the evidence
Very lowLowModerateHigh
Very low
The lowest GRADE level, the effect estimate remains uncertain.
Downgraded for
Imprecision
Quality profile
Sample size★★★★★
Blinding—
Effect sizeMixed
Citations / year★★★★★
Authors
Barbeito S, Vega P, Ruiz de Azúa S, Saenz M, Martinez-Cengotitabengoa M, González-Ortega I, Bermudez C, Hernanz M, Corres BF, González-Pinto A.
<h4>Background</h4>This study aimed to examine factors associated with treatment adherence in first-episode psychosis (FEP) patients followed up over 8 years, especially involuntary first admission and stopping cannabis use.<h4>Methods</h4>This prospective, longitudinal study of FEP patients collected data on symptoms, adherence, functioning, and substance use. Adherence to treatment was the main outcome variable and was categorized as 'good' or 'bad'. Cannabis use during follow-up was stratified as continued use, stopped use, and never used. Bivariate and logistic regression models identified factors significantly associated with adherence and changes in adherence over the 8-year follow-up period.<h4>Results</h4>Of the 98 FEP patients analyzed at baseline, 57.1% had involuntary first admission, 74.4% bad adherence, and 52% cannabis use. Good adherence at baseline was associated with Global Assessment of Functioning score (p = 0.019), Hamilton Depression Rating Scale score (p = 0.017) and voluntary admission (p < 0.001). Adherence patterns over 8 years included: 43.4% patients always bad, 26.1% always good, 25% improved from bad to good. Among the improved adherence group, 95.7% had involuntary first admission and 38.9% stopped cannabis use. In the subgroup of patients with bad adherence at baseline, involuntary first admission and quitting cannabis use during follow up were associated with improved adherence.<h4>Conclusions</h4>The long-term association between treatment adherence and type of first admission and cannabis use in FEP patients suggest targets for intervention to improve clinical outcomes.