effects of an acceptance-based medication adherence therapy for recent-onset psychosis

Conditions: Early Psychosis; Psychotic Disorders

Summary: this randomized controlled trial aimed to examine the effectiveness of a 10-session acceptance-based, insight-inducing medication adherence therapy (aim-at) program for recent-onset psychosis (in addition to usual care) over a 12-month follow-up (i.e., at immediate, 6-month, and 12-month post-intervention).

objectives: to evaluate the effectiveness of an acceptance-based, insight-inducing medication adherence therapy (aim_ at) for recent-onset psychosis on patient outcomes over 12-month follow-up, when compared with a standardized psychoeducation group and routine care only. focus-group interviews will be performed on purposively selected participants to examine perceived benefits, satisfaction and limitations of the aim_ at. hypotheses: compared with psychoeducation group and routine care only, the aim_at participants will indicate significantly greater improvements in patients' adherence to anti-psychotic medication and illness/treatment insight and other secondary outcomes (symptom severity, drug attitude, progress of recovery, psychosocial functioning, satisfaction with service, and re-hospitalization rate) at immediate post-intervention, and/or greater improvements in the above outcomes at 6- and 12-month follow-ups. design: a multi-center rct with repeated-measures, three-arm design. subjects: 126 chinese patients with recent-onset psychosis ( \</= 5 years) randomly selected from four integrated community centers for mental wellness and randomly assigned into three study groups. instruments/outcome measures: frequency, length of re-hospitalizations, and total number of patients being hospitalized from clinic records over 5-6 months; valid questionnaires (ars, itaq, dai, qpr, panss, slof, csq-8) for medication adherence, illness/treatment insight, drug attitude, recovery, symptom severity, functioning, and service satisfaction accordingly. focus group interviews will collect views on benefits and weaknesses of the aim_at. data analysis: comparing the mean value changes of outcomes between groups across time on intention-to-treat basis, using mixed modeling/gee-test; and content analysis of data from focus-group interviews and intervention sessions will be conducted. expected results: the findings can provide evidence of the effectiveness of aim_ at for early-stage psychosis in community mental healthcare on improving patients' medication adherence, mental condition and recovery, functioning, and service satisfaction.

Eligibility criteria:
inclusion criteria: * primarily diagnosed with psychosis (termed recent-onset), including brief, first-episode and other psychotic disorders according to the criteria of the dsm-v (american psychiatric association, 2013); * had the mental illness ≤5 years (defined as recent-onset psychosis in recent literature) * hong kong chinese residents, aged 18-64 years; * global assessment of functioning scores ≥51, indicating mild to moderate symptoms and difficulties in psychosocial/occupational functioning (american psychiatric association, 2013), thus being mentally stable to comprehend aim_at and/or psychoeducation training; * unsatisfactory medication adherence as indicated by the adherence rating scale of \<2 (hayward et al.,1995) during screening; and * able to read/understand cantonese/mandarin. exclusion criteria: * participated in/have recently been receiving other psychotherapies; * having comorbidity of another mental illness (learning disability, cognitive or personality disorder) and/or clinically significant medical disease; and * having communication and/or visual/hearing difficulty.

Keywords: recent-onset psychosis randomized controlled trial insight into illness acceptance psychotic symptoms rehospitalization medication adherence service satisfaction