‘Targeted’ motivational interviewing may improve antipsychotic adherence

By Eleanor McDermid, Senior medwireNews Reporter

Motivational interviewing may help specific subgroups of patients with schizophrenia to adhere to their antipsychotic medication, a study suggests.

Previous studies of the technique have produced mixed results, and the current randomized trial found no overall differences in adherence between 45 patients who completed up to eight sessions (average 6.4) of motivational interviewing and 51 who received health education sessions (average 6.6).

But Emile Barkhof (Academic Medical Centre, Amsterdam, the Netherlands) and co-workers “hypothesized that the heterogeneity of the investigated patient groups” could account for the conflicting results, so a secondary aim of their study was to assess the benefits of motivational interviewing in patient subgroups.

They found that, at 6 months of follow-up, patients using depot rather than oral medication were significantly more adherent if they had received motivational interviewing and that there was a trend for younger patients (<35 years old) to be more adherent if they received this intervention.

The researchers also found that some subgroups were significantly less likely to be hospitalized if assigned to receive motivational interviewing rather than health education, suggesting that they may have been more adherent, despite not having significantly improved adherence measures.

Barkhof et al call this “remarkable because adherence is strongly associated with relapse rates,” and suggest that the adherence measures used (Medication Adherence Questionnaire, Drug Attitude Inventory, and adherence score on the Life Chart Schedule) may have been insufficiently reliable or sensitive.

The subgroups that appeared to benefit were patients aged 35 years or younger, with a hospitalization rate of 14% with motivational interviewing versus 50% without; women, at 9% versus 63%; patients who did not use cannabis, at 20% versus 53%; and patients with schizophrenia duration of less than 6 years, at 14% versus 42%.

The researchers therefore suggest that “targeted use of [motivational interviewing] may be of benefit for improving medication adherence in certain groups of patients, although this needs further examination.”

They conclude in Schizophrenia Bulletin: “[O]ur findings underscore the need to focus on specific targets that lead to nonadherence and to apply an individualized approach for each patient of this challenging group.”

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