Monday, December 7, 2015

Hostility Levels May Predict Treatment Discontinuation Among Patients With Schizophrenia

Higher levels of hostility are linked with earlier treatment discontinuation in people with schizophrenia, reports a new study published in European Psychiatry. According to the study authors, the findings highlight the importance of establishing a strong physician-patient relationship while managing symptoms of hostility.

To investigate the effects of hostility on treatment discontinuation as well as predictors and correlates of hostility, the study authors pooled data from two large schizophrenia clinical trials—the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and the European First Episode Schizophrenia Trial (EUFEST)—which provided them with comprehensive medical information from 1,154 patients.

After six months of treatment, more than 60% of patients rated with high hostility had discontinued their medication compared with about 30% of patients with low hostility levels. The greater a patient’s positive symptoms, impaired insight, and/or drug or alcohol consumption, the more likely they were to have heightened hostility. Young age and low adherence to pharmacological treatment also increased risk for higher hostility.

Though the researchers did not identify a mechanism linking hostility and discontinuation, they did note that patients who took olanzapine had the lowest all-cause rates of treatment discontinuation in both the CATIE and EUFEST studies, which might suggest that this medication is the most effective at treating hostility symptoms.

“Alcohol and drug use, impaired insight, low adherence to treatment, and positive symptoms are dynamic, modifiable variables that are associated with hostility in schizophrenia, and might have a causal role in its development and maintenance,” the study authors wrote. “The clinical implications of the results point to the importance of detection and management of hostility, as well as to the treatment of comorbid substance use disorders.”

To read about more recent findings arising from the CATIE study, see the Psychiatric News article “Study Identifies Factors Predictive of Response to Risperidone,” which describes the AJP in Advance article “Differential Response to Risperidone in Schizophrenia Patients by KCNH2 Genotype and Drug Metabolizer Status.”



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