Compliance therapy: a randomised controlled trial in schizophrenia

doi:10.1136/bmj.327.7419.834

BMJ 2003;327:834 (11 October), doi:10.1136/bmj.327.7419.834

Paper

Compliance therapy: a randomised controlled trial in schizophrenia

Colin O'Donnell, registrar¹, Gary Donohoe, clinical psychologist¹, Louise Sharkey, registrar¹, Nicholas Owens, registrar¹, Maria Migone, registrar¹, Raewynn Harries, clinical nurse specialist¹, Anthony Kinsella, statistician², Conall Larkin, consultant³, Eadbhard O'Callaghan, professor⁴

¹ Stanley Research Unit, Department of Adult Psychiatry, Cluain Mhuire Service, Newtownpark Avenue, Dublin, Republic of Ireland, ² Dublin Institute of Technology, Kevin Street, Dublin, ³ Saint John of God Hospital, Stillorgan, County Dublin, ⁴ Department of Psychiatry, University College Dublin, St Vincent's University Hospital, Elm Park, Dublin

Correspondence to: E O'Callaghan eadbhard{at}iol.ie

Objective To evaluate the efficacy of "compliance therapy" forimproving adherence to prescribed drug treatment among patientswith schizophrenia.

Design Randomised controlled trial.

Setting Urban catchment area psychiatric service.

Participants 94 consecutive admissions of patients with schizophrenia,56 agreed to participate.

Intervention Compliance therapy and non-specific counselling,each consisting of 5 sessions lasting 30-60 minutes.

Main outcome measures Compliance with drug treatment at oneyear; attitudes to treatment, symptomatology, insight, and qualityof life at one year; length of "survival" in the community,bed days, and rehospitalisation rates at two years.

Results Compliance therapy did not confer a major advantageover non-specific therapy in improving compliance at one year(43% (12/28) v 54% (15/28), difference -11% (95% confidenceinterval -37% to 15%) or in any of the secondary outcome measures—symptomatology,attitudes to treatment, insight, global assessment of functioning,and quality of life.

Conclusion Compliance therapy may not be of benefit to patientswith schizophrenia. Attitudes to treatment at baseline predictedadherence one year later and may be a clinically useful tool.

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Rapid Responses:

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Compliance therapy for schizophrenia: lack of compliance with study methodology: Gregory M Peterson, et al.
bmj.com, 13 Oct 2003 [Full text]
compliance?: susanne mccabe
bmj.com, 16 Oct 2003 [Full text]
The use of the atypical antipsychotics,& good doctor patient relationship might improve compliance.: AK. Al-Sheikhli
bmj.com, 16 Oct 2003 [Full text]
Don't write off compliance therapy: Paul J Whelan
bmj.com, 21 Oct 2003 [Full text]
Compliance therapy ........ or not?: Philip W Timms
bmj.com, 22 Oct 2003 [Full text]
Compliance Therapy works: Anthony S David, et al.
bmj.com, 27 Oct 2003 [Full text]
Collaboration in Treatment Decisions is Fundamental: Steve Moorhead, et al.
bmj.com, 28 Oct 2003 [Full text]
Treatment choice affects compliance: Allan H Young
bmj.com, 30 Oct 2003 [Full text]
Title: Addressing possible reasons for no significant differences and the need to adjust for antipsychotic type: Mariam K. Hassan, et al.
bmj.com, 5 Nov 2003 [Full text]
Compliance therapy in schizophrenia: Thomas R. E. Barnes, et al.
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Efficacy of compliance therapy in schizophrenia: Richard John Gray, et al.
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