Factors influencing the adherence of antipsychotic medication (Aripiprazole) in first-episode psychosis: findings from a grounded theory study

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  Antipsychotic medication is integral to the treatment of patients with first-episode psychosis. Non adherence is a common barrier to treatment. It is a well-recognized but poorly understood problem. This qualitative study aimed to gain a greater understanding of patients’ medication-taking practices.
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  In-depth, semi-structured interviews were conducted with 12 patients between the age of 18 and 35 years who were treated with Aripiprazole under an Early Intervention Service in the south of England. A grounded theory approach was used for data collection and analysis. Sample size was determined by theoretical saturation.
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  The findings indicated that patients varied their medication-taking practices according to the effects of psychosis as well as the antipsychotics on their life. Three inter-related thematic categories emerged from the data analysis. These are quality of life, health status and discernment. They are inter-related with a cyclical outcome. Quality of life is identified as the core category. This theoretical element has a centralizing influence on antipsychotic adherence and is able to account for all other categories and sub-categories.
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  Patients see the side effects of medication and symptoms of illness in similar terms as they both affect their quality of life. When patients have gaps in understanding or struggling with conflicting pieces of information, their approach to the actual medication-taking practice is affected. The findings contribute to the understanding and theoretical insight of the medication-taking practices of patients with first-episode psychosis and have implications for prescribing practice and strategies to enhance antipsychotic adherence.

Antipsychotic medication is central to the treatment of patients with first-episode psychosis (FEP). Although non-adherence with the antipsychotic medication regime is a common barrier to the effective treatment of FEP, knowledge is limited about how patients make decisions about adhering to antipsychotic treatment. This qualitative study aimed to gain a greater understanding of patients’ medication-taking practices, and their subjective experiences with antipsychotic treatment. In-depth, semi-structured interviews were conducted with patients between the ages of 18 and 35 years who were treated with Aripiprazole under an Early Intervention Service in the south of England. A grounded theory approach was used for data collection and analysis. Twelve participants were included in the study. The findings indicated that patients taking antipsychotic medication for treatment of FEP varied their medication-taking practices according to the effects of the illness or antipsychotic treatment on their lives. A conceptual model was developed and this consists of three thematic categories: quality of life, discernment and health status. The three main themes are interrelated with a cyclical outcome. The findings contribute to the understanding of the medication-taking practices of patients with FEP and have implications for prescribing practice and strategies to enhance antipsychotic adherence.