Pathomechanisms and Signatures in the Longitudinal Course of Psychosis

13.01.2015

2020-05-22

034_ Impact of cognition and education on medication adherence in patients with psychotic and affective disorders

Research Question and Aims

Medication adherence is defined as the extent to which a person's behavior - taking medication, following a diet, and / or executing lifestyle changes, corresponds with agreed recommendation from a healthcare provider (Osterberg & Blaschke, 2005). Core symptoms of many psychiatric disorders are cognitive deficits (Douglas et al., 2018; Fioravanti et al., 2012; Heinrichs & Zakzanis, 1998; Nakagome, 2017). Patterns of cognitive deficits can differ between psychiatric disorders and can be pathognomonic for psychotic and affective disorders (Bora et al., 2016; Brazo et al., 2002; Lewandowski et al., 2011; Taylor & Abrams, 1987). Otherwise, cross-diagnostic cognitive patterns are postulated (Van Rheenen et al., 2016). Many studies point to an association between cognitive deficits and reduced medication adherence (Spiekermann et al., 2011). Both may lead to an exacerbation and chronicity of the disease, especially in schizophrenia and schizoaffective disorder, bipolar disorder, and unipolar depression (Spiekermann et al., 2011). Therefore, there is a need for stable medication adherence to prevent relapse and recurrence. Up to now, little is known about the educational level of non-adherent patients.

This project will investigate whether there is an impact of cognitive performance in different domains (psychomotor processing speed, cognitive flexibility, executive function, short-term memory, and working memory) and educational level on medication adherence in patients with affective and psychotic disorders. The hypothesis is that patients with more severe cognitive impairments and lower levels of education show less adherent behavior. Furthermore, we want to investigate whether specific cognitive subgroups with different patterns of cognitive deficits effect the medication adherence.

Analytic Plan

Hypothesis:
1. We hypothesize that cognitive performance as well as the educational level predict medication adherence.
2. We hypothesize that there are cognitive subgroups which show differences in the medication adherence.

Participants:
Data from clinical participants from PsyCourse who have completed the adherence questionnaire as well as the cognitive tests at visit 1 will be included in this study.

Analytic methods:
The analyses will be performed cross-diagnostically and (if necessary) in the following in diagnostic subgroups: psychotic disorder (schizophrenia, schizoaffective disorder), bipolar disorder and unipolar depression. We will perform correlation analyses and regression analyses (stepwise regression) for investigating the impact of cognition and education on medication adherence. The educational level will be investigated in relation to the internationally comparable categories in accordance with the ISCED 1997 classification (UNESCO). For the second hypothesis, we want to perform a cluster analysis in order to identify cognitive patterns and subgroups relevant for medication adherence. Differences between the cognitive clusters will be tested with variance analytical methods.

Dependent variables: Medication adherence
Independent variables: TMT-A/B, Verbal digit span (forward and backward), Digit-Symbol-Test, Multiple-Choice Vocabulary Intelligence Test (MWT-B), educational parameters, functional level (GAF)
Covariates: age, sex, demographics, current psychopathology, comorbidities, substance abuse, medication, adverse effects, personality traits

Resources needed

v1_id
v1_stat
v1_center
v1_tstlt
v1_interv_date
v1_sex
v1_ageBL
v1_yob
v1_cur_psy_trm
v1_dur_illness
v1_tms_daypat_outpat_trm
v1_cat_daypat_outpat_trm
v1_fam_hist

v1_school
v1_prof_dgr
v1_ed_status
v1_curr_paid
v1_disabl_pens
v1_spec_emp
v1_wrk_abs_pst_5_yrs
v1_cur_work_restr
v1_marital_stat
v1_partner
v1_liv_aln

v1_scid_dsm_dx
v1_scid_dsm_dx_cat
v1_scid_ever_delus
v1_scid_ever_halls
v1_scid_ever_psyc
v1_scid_age_fst_psyc
v1_scid_no_MDE
v1_scid_no_mania
v1_scid_no_hypomania
v1_scid_evr_suic_ide
v1_scid_no_suic_attmpt

v1_med_pst_wk
v1_med_pst_sx_mths

v1_nrpsy_mtv
v1_nrpsy_tmt_A_rt
v1_nrpsy_tmt_A_err
v1_nrpsy_tmt_B_rt
v1_nrpsy_tmt_B_err
v1_nrpsy_dgt_sp_frw
v1_nrpsy_dgt_sp_bck
v1_nrpsy_dg_sym
v1_nrpsy_mwtb

v1_panss_sum_pos
v1_panss_sum_neg
v1_panss_sum_gen
v1_panss_sum_tot
v1_idsc_sum
v1_ymrs_sum
v1_asrm_item1-5
v1_asrm_sum
v1_bdi2_itm1-21
v1_cgi_s
v1_gaf

v1_Antidepressants
v1_Antipsychotics
v1_Mood_Stabilizers
v1_Tranquilizers
v1_Other_psychiatric
v1_adv
v1_medchange

v1_ever_smkd
v1_age_smk
v1_no_cig
v1_alc_pst12_mths
v1_alc_5orm
v1_lftm_alc_dep
v1_evr_ill_drg

v1_waist
v1_bmi
v1_diabetes
v1_stroke
v1_hyperthy
v1_hypothy
v1_autoimm
v1_cancer
v1_kid_fail
v1_epilepsy
v1_migraine
v1_parkinson
v1_liv_cir_inf
v1_tbi

v1_big_five_extra
v1_big_five_neuro
v1_big_five_openn
v1_big_five_consc
v1_big_five_agree