ArticleBMC psychiatry2026
The impact of symptoms and illness insight on treatment adherence in first-episode psychosis: a one-year follow-up study using therapeutic drug monitoring.
Article in BMC psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
backgroundDespite extensive research on adherence in first-episode psychosis (FEP), reliance on self-report or clinician judgment has limited accuracy and obscured nuanced clinical associations.
objectiveThis longitudinal study examined the predictive value of psychopathology, insight, and functioning for objectively measured treatment adherence across a one-year follow-up using therapeutic drug monitoring (TDM).
methodsSeventy-eight FEP patients were assessed at baseline, 2 months, and 12 months. Clinical measures included the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), Social and Occupational Functioning Assessment Scale (SOFAS), and the Schedule for the Assessment of Insight-Expanded version (SAI-E). Adherence was defined by comparing plasma antipsychotic concentrations to prescribed doses according to international consensus guidelines. Generalized linear mixed models (GLMMs) were used to model time-dependent associations.
resultsWhile overall adherence declined, time alone was not a significant predictor. Instead, current positive symptom severity (approximately 4-5% lower odds of adherence per BPRS point) was associated with lower odds of adherence, while prior non-adherence predicted subsequent adherence. In contrast, insight, negative symptoms, and functioning showed no consistent association with adherence. A marginal association between improved functioning and better adherence was observed at 12 months.
conclusionsAdherence in FEP appears to fluctuate in relation to current clinical state rather than follow a stable linear pattern. These findings highlight the value of objective TDM monitoring and early intervention, supporting predictive models that incorporate evolving symptom patterns rather than static baseline measures.
trial registrationClinical trial number: not applicable.
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