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.
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.
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.
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