Grant: Pfizer Operating Grant in Disease Prevention and Management

Antipsychotic medication is critical to the effective treatment of schizophrenia, with evidence that outcome is worse in those who are not on these medications. Antipsychotic nonadherence is common in schizophrenia, although it is not an all-or-none process. Electronic monitoring systems represent the gold standard in assessing medication adherence, and we have experience using the Medication Event Monitoring System (MEMS) in schizophrenia. We shall employ this strategy to examine patterns of nonadherence (e.g. individual missed doses, blocks of time off antipsychotic). We predict that individuals stabilized on their antipsychotics can miss a few days (perhaps as long as a week) without necessarily getting worse. However, longer gaps will be associated with an increased risk of poorer response. We shall recruit 150 individuals with schizophrenia who are on an antipsychotic and classified as either good or poor responders (75 each), monitoring medication adherence/nonadherence with MEMS while looking at different risk factors and outcome measures over a 3-month interval. Why is this work important and clinically relevant? We have recently learned that people responding to their medication may not need to take it daily to maintain response. Taking it less often could reduce side effects and possibly even increase its effect over time. Thus, it is critical that the medication be taken regularly to get the best response but this does not necessarily mean daily. We are trying to find out when the length of medication gap becomes risky to the individual's best response. Reducing exposure to medication without compromising response can have many benefits, for example decreased side effects and drug costs. Along similar lines, if we know more clearly at what point a gap in taking antipsychotic medication increases risk of doing poorly, we can better inform clinicians and those who take these medications in order to minimize risk of clinical deterioration