A trial of compliance therapy in outpatients with schizophrenia or schizoaffective disorder

Objective: To evaluate the efficacy of compliance therapy when delivered to outpatients with schizophrenia or schizoaffective disorder. Method: Thirty patients with schizophrenia or schizoaffective disorder (DSM-IV criteria) were recruited from urban psychiatric outpatient clinics in an open trial of compliance therapy. Compliance therapy is a cognitive/psychoeducational approach consisting of 4 to 6 sessions lasting 30 to 60 minutes each. The primary outcome was electronically measured antipsychotic medication adherence. Adherence data were analyzed for effects during an initial treatment period (month -1 to month +1) and a subsequent 5-month follow-up period. Secondary outcome measures included clinician and patient ratings of adherence, symptoms, insight, and attitudes to medication treatment. Data were collected from August 2001 to January 2004. Results: Compliance therapy was not associated with improvements in antipsychotic medication adherence. Patient ratings of adherence improved during the month -1 to month +1 period, but not in the subsequent 5-month follow-up. A diagnosis of schizoaffective disorder was associated with poorer adherence than was a diagnosis of schizophrenia during the month -1 to month +1 period. A higher degree of insight at baseline (end of month -1) was associated with greater adherence in the 5-month follow-up period. Symptoms, insight, and attitudes to medication treatment did not change significantly during the study. Conclusion: In this uncontrolled trial, outpatients with schizophrenia or schizoaffective disorder did not benefit from compliance therapy.