***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : The objective of this study was to examine the relationship between patient beliefs about medication use and their likelihood of discontinuing treatment prematurely . Associations of patient beliefs about medication with clinical psychopathology and their life satisfaction were also assessed . Methods : This post-hoc analysis used data from a r and omized , open label , 1-year trial of  antipsychotics in the treatment of patients with schizophrenia or schizoaffective disorders ( N = 664 ) .  Medication management including dosage adjustment and medication switching was at doctors ’ discretion , reflecting naturalistic treatment in usual clinical care setting s. Early treatment discontinuation was defined as all-cause study drop out . Patient-reported beliefs about medication were assessed by Rating of Medication Influences ( ROMI ) , degree of clinical psychopathology was measured by Positive and Negative Syndrome Scale ( PANSS ) , and patient quality of life was measured by Lehman Quality of Life Interview ( LQLI ) . Results : Patient perception of medication benefit was the only strong predictor of treatment duration among the 5 underlying dimensions of medication influence . Higher level of perceived beneficial effect of medication was associated with reduced risk of early treatment discontinuation ( Hazard ratio = 0.56 , 95 % Confidence Interval [ 0.40 , 0.79 ] , p = 0.001 ) . Patients with greater beliefs in the beneficial effect of treatment also had better clinical psychopathology outcome and were more satisfied with their quality of life and well-being . Conclusion : Underst and ing the predictors of early treatment discontinuation in the care of schizophrenia patients is important for the development of interventions to improve treatment outcome . Current findings suggest that patient perception of beneficial effect of medication may be a critical factor in achieving treatment persistence and a satisfactory treatment outcome INTRODUCTION This study aim ed to identify factors associated with  medication adherence  in bipolar disorder ( BPD ) patients . METHODS EMBLEM is a 2-year , prospect i ve , observational study on the outcomes of BPD patients initiating or changing treatment for a manic/mixed episode . Data were collected at baseline , during the first 12 weeks of treatment ( acute phase ) and up to 24 months of follow-up ( maintenance phase ) .  Adherence was assessed by investigators at every visit . Repeated measures logistic regression analyses identified variables associated with adherence . RESULTS Of 1,831 patients included in the analysis , 76.6 % were adherent and 23.4 % were non-adherent with their BPD medication during the maintenance phase . Patients were more likely to be adherent if they had insight into their illness at week 12 . Patients were less likely to be adherent if they had cannabis abuse/dependence during the acute phase , work impairment or higher CGI hallucinations/delusions at baseline DISCUSSION Psychotic symptoms , poor insight , cannabis abuse/dependence and work impairment are negatively related to medication adherence during maintenance therapy of bipolar disorder . Patients with these characteristics may need a different therapeutic approach OBJECTIVE Since sustained treatment-adherence is often problematic and may limit clinical outcomes among bipolar disorder ( BPD ) patients , we sought risk factors to guide clinical prediction of nonadherence . METHODS Data were from a 2005 US national sample providing question naire responses by 131 r and omly selected prescribing psychiatrists and their adult BPD patients . We contrasted demographic and clinical factors in treatment-adherent versus nonadherent patients ( strictly defined as missing > or = 1 dose within 10 days ) in univariate analyses followed by multivariate logistic-regression modeling . RESULTS Of 429 DSM-IV BPD patients ( 79 % type-I ; 62 % women ; 17 % minorities ) , 34 % reported missing > or = 1 dose of  psychotropic medication within 10 days , 20 % missed entire daily doses at least once , and only 2.5 % missed all doses for 10 days . However , their prescribing psychiatrists considered only 6 % as treatment-nonadherent . Factors significantly associated with nonadherence in multivariate modeling ranked : alcohol-dependence > youth > greater affective morbidity > various side effects > or = comorbid obsessive-compulsive disorder > or = recovering from mania-hypomania . Unrelated were sex , diagnostic subtype , and other comorbidities . Since most patients received > or = 2 psychotropics , potential relationships between treatment-complexity and adherence were obscured . CONCLUSIONS Prevalent treatment-nonadherence among American BPD patients , and striking underestimation of the problem by prescribing clinicians may encourage increasingly complex treatment-regimens of untested value , but added expense , risk of adverse effects , and uncertain impact on treatment-adherence itself INTRODUCTION The goal of this study is to assess , prospect ively , the relative contribution of baseline variables to long-term medication adherence in patients with a first episode of schizophrenia . METHODS Consecutively admitted patients suffering from a first episode of schizophrenia or related disorders were investigated . Subjective experience , attitudes towards treatment , insight , interaction with members of staff , involuntary admission , substance abuse , and severity of psychopathology were independently assessed at first admission and related to medication adherence during five year follow up . RESULTS St and ard multiple regression analysis revealed that hostility and uncooperativeness ( p=0.007 ) and involuntary admission ( p=0.02 ) were associated with the level of adherence during 5 year follow-up after admission . DISCUSSION In first episode schizophrenia and related disorders , the initial interaction with staff and involuntary admission partly predicts long-term adherence to antipsychotic medication .  Ameliorating these initial interactions might have long-term consequences on medication adherence . Involuntary admitted patients need intensive outpatient care OBJECTIVE Interventions improving adherence to antipsychotic medication are needed . The present study examined the effects on medication adherence of 2 years of integrated treatment for patients with schizophrenia . METHOD Adherence to medication was examined in a r and omized controlled trial of 2 years of integrated treatment versus st and ard treatment . The 50 included patients were consecutively referred to a specialized psychiatric team for treatment of psychosis and were diagnosed with DSM-IV schizophrenia or schizoaffective or schizophreniform disorder . The patients were clinical ly stable and had less than 2 years ' duration of illness .  Integrated treatment consisted of assertive outreach community treatment , family psychoeducation and involvement , and social skills training . Good adherence was defined as less than 1 month without medication . Outcomes were compared over 12-month and 24-month follow-up periods . The study was conducted from February 1992 to October 1999 . RESULTS No difference in adherence between the integrated treatment group and the st and ard treatment group ( chi(2 ) = 0.06 , NS ) was found . Men were more nonadherent than women ( OR 6.11 [ CI 1.25 to 29.74 ] , p = .025 ) . Patients living in families with low expressed emotion were less adherent than patients living in families with high expressed emotion ( OR 6.04 [ CI 1.07 to 34.13 ] , p = .042 ) . CONCLUSION No effects of integrated treatment on medication adherence were found . CLINICAL TRIALS REGISTRATION Clinical Trials.gov identifier NCT00184509 BACKGROUND Relatively little is known about the relationships between medication adherence and long-term functional outcomes in the treatment of schizophrenia . To extend previous research , we prospect ively examined the relationships between adherence with any antipsychotic medication and functional outcomes among schizophrenia patients treated over a 3-year period , assessed the stability of adherence over time , and examined whether adherence in the first year predicts changes in functional outcomes over the following 2 years . METHOD Analyses included 1906 participants with DSM-IV diagnoses of schizophrenia or schizoaffective or schizophreniform disorder in a multi-site , 3-year , prospect i ve , naturalistic study conducted in the United States between July 1997 and September 2003 . Outcome measures were assessed at 6-month intervals using systematic medical record abstract ion and structured interview of patients . Adherence with antipsychotic regimen was assessed using patient-reported adherence and the medication possession ratio ( percent days with prescription for any antipsychotic ) , dichotomized into adherence and non-adherence . Analyses employed generalized estimating equations and mixed models with repeated measures . RESULTS Nonadherence was associated with poorer functional outcomes , including greater risks of psychiatric hospitalizations , use of emergency psychiatric services , arrests , violence , victimizations , poorer mental functioning , poorer life satisfaction , greater substance use , and more alcohol-related problems ( all p < .001 ) . Adherence was relatively stable , with 77.3 % of patients maintaining the same adherence status from the first year to the second year . Nonadherence in the first year predicted significantly poorer outcomes in the following 2 years . CONCLUSIONS Findings highlight the importance of adherence with antipsychotic medication in the long-term treatment of schizophrenia and its potential beneficial impact on the mental health and criminal justice delivery systems RATIONALE Most first-episode schizophrenia patients will stop their medication after their acute symptoms improve . Underst and ing the salient motivations and attitudes that drive adherence -- as well as nonadherence -- is an important part of developing strategies to prevent or delay nonadherence during the early phases of the illness . METHODS Self-reported reasons for adherence and nonadherence among first-episode and multi-episode patients with schizophrenia were obtained from cross-sectional adherence interviews from two prospect i ve adherence studies : one composed of a first-episode sample ( n=33 ) and the other with recently relapsing multi-episode patients ( n=16 ) . Both groups received the Rating of Medication Influences ( ROMI ) Scale at approximately 16 to 20 weeks after an acute psychotic episode . The specific ROMI items were ranked in order of percentage ( % ) strong , and were compared both within each patient group for rank order of importance , and also compared between groups to determine the differences in specific adherence and nonadherence influences . RESULTS The  doctor-patient relationship was more likely to be endorsed as a strong adherence influence in the first-episode sample ( 74 % ) than in the multi-episode sample ( 13 % , X²=18.07 , p<.01 ) . Change in physical appearance attributed to medication was a more commonly endorsed nonadherence influence for the multi-episode sample ( 25 % ) relative to the first-episode sample ( 0 % , X²=9.2 , p<.01 ) . CONCLUSIONS The doctor-patient relationship st and s out as being the major reason for ongoing adherence for first-episode schizophrenia patients . Our post hoc interpretation is that lack of prior experience with medication and treatment elevates the importance of the relationship with the treating clinician for first-episode patients To assess baseline predictors and consequences of antipsychotic adherence during the long-term treatment of schizophrenia out patients , data were taken from the 3-year , prospect i ve , observational , European Schizophrenia Out patients Health Outcomes ( SOHO ) study , in which out patients  starting  or  changing antipsychotics were assessed every 6 months . Physician-rated adherence was dichotomized as adherence/non-adherence . Regression models tested for predictors of adherence during follow-up , and associations between adherence and outcome measures . Of the 6731 patients analysed , 71.2 % were adherent and 28.8 % were non-adherent over 3 years . The strongest predictor of adherence was adherence in the month before baseline assessment . Other baseline predictors of adherence included initial treatment for schizophrenia and greater social activities . Baseline predictors of non-adherence were alcohol dependence and substance abuse in the previous month , hospitalization in the previous 6 months , independent housing and the presence of hostility . Non-adherence was significantly associated with an increased risk of relapse , hospitalization and suicide attempts . In conclusion , non-adherence is common but can partly be predicted . This may allow strategies to improve adherence to be targeted to high-risk patients . Also , reversal of some risk factors may improve adherence . Non-adherence is associated with a range of poorer long-term outcomes , with clinical and economic implication OBJECTIVES This study aim ed to prospect ively identify the best single predictor and the best set of predictors of risk for nonadherence with anti-psychotic medication in the treatment of patients with schizophrenia . METHOD We used data from 1579 patients in a 3-year , prospect i ve , naturalistic , nonr and omized , multisite study of schizophrenia patients conducted from July 1997 to September 2003 ( U.S. Schizophrenia Care and Assessment Program ) . Adherence with any oral antipsychotic medication was assessed using  patient-reported medication adherence and an indirect adherence measure  based on medical record prescription information . Patients who reported poor medication adherence or had a medication possession ratio < or = 80 % ( percentage of days with prescriptions for any oral antipsychotic ) during the first year after enrollment were defined as nonadherent ( N = 296 , 18.8 % ) . 
    Output:
    
A key reason directly associated with intentional nonadherence was a negative attitude toward medication , a mediator of effects of insight and therapeutic alliance .
Substance abuse was the only reason consistently associated with unintentional nonadherence , regardless of type and stage of SMI .
Discussion Although adherence research is inherently biased because of numerous method ological limitations and specific reasons under investigation , reasons for nonadherence consistently identified as significant across studies likely reflect valid existing associations with important clinical implication s. Conclusion This systematic review suggests that a negative attitude toward medication and substance abuse are consistent reasons for nonadherence to antipsychotic medication among people with SMI .
Adherence enhancement approaches that specifically target these reasons may improve adherence in a high-risk group .