Medication non-adherence in schizophrenia (SZ), estimated to be as high as 89%, has serious, costly and potentially dangerous consequences including poorer illness course as well as increased risk for relapse, re-hospitalization and longer length of inpatient stay. Medication nonadherence is multidetermined, however neurocognitive (NC) deficits, prevalent in schizophrenia, appear to play a significant role in this disease. NC deficits are significant predictors of medication adherence and medication management skill learning and are robust predictors of functional disability, independent of psychopathology. Over the past three years, this applicant has (supported by a NARSAD Young Investigator Award) been developing a pager-based intervention to help psychiatric patients improve their level of independent functioning. The intervention is an adaptation of an approach originally designed for, and having demonstrated efficacy in, helping brain injured patients compensate for NC deficits by improving independent functioning. Results of our pilot study in patients with SZ support the efficacy of this intervention for improving psychosocial treatment adherence. The proposed study extends this line of investigation to target medication adherence to improve psychopathology, community tenure, disability, and quality of life in SZ patients. Phase 1 will test the feasibility of Electronically Assisted Medication Adherence (EAMA) (N=20), and will inform a detailed revision of the current Beta version of the intervention manual and refinement of the study protocol for Phase 2, a randomized controlled trial (30 treatment as usual, 30 TAU+EAMA) which will provide preliminary efficacy data. In each phase, consenting schizophrenia inpatients are enrolled and followed for 6 months after discharge and complete assessments (psychopathology, medication attitudes, disability, service utilization, quality of life) at multiple timepoints. Medication adherence will be assessed using the medication event monitoring system (MEMS), pill counts and self report ratings. Results of this R34 intervention development project will provide a blueprint for the optimal design of future fully powered efficacy and effectiveness trials
