Psychoses are among the most common and serious psychiatric disorders. Currently, the most effective treatment for psychosis is symptomatic, and involves the use of antipsychotic or neuroleptic medications. Unfortunately, well-conceived pharmacologic regimens often do not achieve their goals because of poor medication adherence. Depending on study design, measurement method, and other factors, reported rates of adherence to antipsychotic medication range from 11 percent to 80 percent (average rate approximately 50 percent). This is of considerable public health importance as nonadherence with antipsychotic treatment leads to myriad clinical and economic burdens, including psychotic relapse, increased clinic visits, emergency room visits, and rehospitalization. The primary goal of the proposed project is to test the effectiveness of Medication Adherence Therapy (MAT) on improving medication adherence and reducing psychiatric hospitalization. MAT is a fifteen session (60-90 minutes each) multi-interventional program consisting of motivational interviewing, education, social skills and behavior modification. Individual sessions will be held on weeks 1 and 12 and small group sessions will be conducted during weeks 2 through 11. Three monthly booster group sessions will begin on week 16. As secondary goals we will identify risk factors for nonadherence in older psychotic patients and determine whether MAT has benefits that extend beyond adherence and hospitalization. We propose to recruit 240 persons 45 years of age or older with schizophrenia or schizoaffective disorder requiring maintenance treatment with an antipsychotic medication. We will employ a randomized, pre-test, post-test control group design to examine the effects of the experimental intervention (MAT) compared to a support group (Control) which will be time equivalent to the experimental intervention. Research evaluations consisting of comprehensive assessments of demographic and clinical factors (e.g., medication adherence, medication side effects, psychopathology, insight, health beliefs, quality of life, functioning, etc.) will be collected at baseline, and at 3 months (immediately post-intervention), 6 months, and 12 months.
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