Fewer than one in five commercially insured patients who experience first-episode psychosis (FEP) and are prescribed an antipsychotic adhere to it through one year, according to a study published today in JAMA Network Open.Why It’s Relevant
Previous research has found that individuals with FEP who don’t adhere to medication face increased risk of psychosis relapse, psychiatric hospitalization, suicide attempt, and all-cause mortality. While existing studies suggest FEP patients are moderately adherent to antipsychotics, these studies were not based on claims data and were limited by small samples.
By the Numbers
- Using commercial insurance claims data from 2013 through 2021, researchers identified 11,889 individuals ages 15 to 40 years (average age 23) who were diagnosed with FEP in inpatient or outpatient settings and subsequently initiated antipsychotic treatment.
- On average, people with FEP had antipsychotic coverage on just 43% of days during the 12 months after initiation.
- Over the entire 12-month follow-up, only 19% of patients were considered adherent (having medication on hand at least 80% of days) to their antipsychotic; 33% of patients adhered to at least one psychotropic medication.
- There was substantial variation in adherence by diagnosis: 23% for schizophrenia, 17% for mood disorders with psychotic features, and 15% for other psychotic spectrum disorders.
What’s More
Greater adherence was associated with significantly more behavioral health outpatient visits and fewer emergency department visits. However, there was no significant association between adherence to antipsychotics and psychiatric hospitalization.
The Other Side
One limitation of the study was its reliance on prescription-fill data, which represent only an upper limit of adherence because having medication available does not guarantee that it was taken as prescribed. The results may not be generalizable to people covered by public health insurance programs.
Takeaway Message
The low adherence might be related to the younger age of these patients and their concerns over side effects such as weight and sexual dysfunction, the researchers noted. Future studies should further characterize adherence trajectories during early psychosis to identify opportunities for interventions that improve long-term treatment continuity.
Related Information
Source
Emily Chi, et al. Treatment adherence and health care utilization after a first episode of psychosis. JAMA Network Open. Published September 24, 2026. doi:10.1001/jamanetworkopen.2026.35805
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