Medication Adherence in a Transdiagnostic First-Episode Psychosis Sample.

Medication adherence is an important component of treatment and has the potential to influence illness trajectory in individuals with first-episode psychosis (FEP). We sought to examine time to medication non-adherence as well as factors related to non-adherence in a real-world FEP clinic. We conducted a survival analysis to examine time to medication non-adherence using data extracted from medical records of patients admitted to a FEP clinic at an academic psychiatric hospital between May 2012 and October 2017 (n = 219). The risk pool included patients who were adherent during the first 6 months in the clinic (n = 122). Data were extracted for the entire length of participants' time in the clinic, up to 66 months. Pre-selected clinical and demographic variables of interest were extracted and entered into a Cox proportional hazards model. Of the risk pool of 122 patients, 37 (30%) had documented non-adherence events. The risk of non-adherence was 0.35 (95% CI, 0.25-0.46) and 0.49 (95% CI, 0.37-0.63) at the 24- and 36-month time points, respectively, and plateaued after 36 months. Non-White race (adjusted HR = 3.69;  = .003; 95% CI, 1.57-8.70), lack of insight in the prior 6 months (adjusted HR = 3.24;  = .005; 95% CI, 1.43-7.35), and substance use in the prior 6 months (adjusted HR = 2.58;  = .022; 95% CI, 1.15-5.81) were significant predictors of non-adherence. Clinicians should consider efforts to strengthen therapeutic alliance with non-White patients, improve insight, and help patients reduce or cease substance use when supporting medication adherence in the FEP population.