GOALS Neuroleptic noncompliance is a major barrier to treatment efficacy in schizophrenia. Noncompliance prolongs psychosis, causes unnecessary relapse, and limits the generalizability of treatment studies. One year post-hospital noncompliance rates are at least 50%, yet little systematic attention has been focused on developing models for its causation, management or prevention. In particular, there is evidence that extrapyramidal syndromes (EPS) and neuroleptic dysphoria may be important predictors of compliance. A series of 3 related studies will focus on developing new measures and models for the prediction of noncompliance. These studies will have the methodological advantages of using multiple assessments and a prospective design generally lacking in prior research. Epidemiologic and treatment issues in noncompliance will be carefully evaluated with an emphasis on extrapyramidal symptoms. METHODS Study 1 Two criterion groups of 30 schizophrenic outpatients who are clinically defined as compliant and noncompliant will undergo blind noncompliance evaluations including patient and family report, pill counts and serum prolactin and neuroleptic levels. From this, a brief and externally validated clinical assessment for a comprehensive measurement of noncompliance will be developed. Study 2 Another sample of two hundred acutely psychotic schizophrenic inpatients will be evaluated for noncompliance, EPS and EPS-related distress, dysphoria, beliefs about their illness and treatment, and psychiatric symptoms during standardized open fluphenazine treatment. The relationship between illness, treatment, personal, and family variables as factors promoting noncompliance during hospitalization will be investigated. Study 3 The same cohort as Study 2 will be followed at the PWC schizophrenia clinic for a 1 year longitudinal assessment of noncompliance with instruments developed in Study 1 under controlled treatment conditions. SIGNIFICANT Neuroleptic noncompliance is both a significant research and public health problem. These studies will contribute to 1) standardizing the methodology of assessing neuroleptic noncompliance, 2) evaluating the natural history for noncompliance from an index cohort, 3) understanding the factors that promote noncompliance, especially those readily amenable to pharmacologic interventions.
