medwireNews: Prospective memory (PM) is a strong determinant of medication management in patients with schizophrenia, Chinese researchers have found.
They suggest that strategies to improve PM may therefore be useful for improving medication adherence, particularly for patients who unintentionally fail to take their pills.
Eric Cheung (Castle Peak Hospital, Tuen Mun, Hong Kong) and colleagues hypothesized that PM - the ability to remember to carry out an intended action in the future - is associated with patients' ability to manage their medication.
They recruited 82 patients with clinically stable schizophrenia and monitored their medication adherence in a simulation task at baseline and subsequently over a 3-month period.
Older age and more severe negative symptoms were significantly associated with a lower score on the Medication Management Ability Assessment (MMAA) task, while more years in education was associated with a higher MMAA score.
Furthermore, MMAA score positively correlated with all measures of PM, and the combination of time- and event-based PM explained a remarkable 72.3% of variance in MMAA scores.
Factors such as demographics, clinical symptoms, and other neuropsychologic functions had a much smaller influence on MMAA, note the researchers in Schizophrenia Research. They suggest that PM "taps into the crucial cognitive components that are essential for an individual's ability to manage medication regimens."
Poor medication adherence over the 3-month period was associated with greater impairment of PM as well as with more severe symptoms, less disease insight, and worse ability to manage medications. In multivariate analysis, insight and symptom severity emerged as significant independent predictors of medication non-adherence.
Cheung et al say that PM appears to be closely related to patients' ability to manage their medications but is less closely associated with actual medication adherence, which they note "is conceptually a much more complex construct."
They write: "Instead our findings suggest that PM plays an important role in influencing medication adherence in the context of its interplay with other factors such as awareness of illness, attitudinal issues and symptom severity."
The team concludes: "Clinicians should be vigilant in identifying possible PM impairments and to explore carefully patients' patterns of medication taking, as to whether they habitually use time- or event-based cues. Simple behavioral modifications may be useful in enhancing medication adherence."
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