Compliance Therapy: A Randomized Controlled Trial in Schizophrenia

Schizophrenia is a chronic, severe, and disabling brain disease. People with schizophrenia may have perceptions of reality that are strikingly different from the reality seen and shared by others around them. Living in a world distorted by hallucinations and delusions, individuals with this disease may feel frightened, anxious and confused. Although hallucinations can occur in any sensory form such as: auditory (sound), visual, tactile (touch), gustatory (taste), and olfactory (smell)-hearing voices that other people do not hear are the most common hallucination. Since there is no known single cause of schizophrenia, researchers are using all the tools of modern biomedical research to search for genes, critical moments in the brain, and other factors that may lead to this illness.

This research evaluates compliance therapy with drug treatment to Schizophrenia patients. Ninety-four people between the ages of eighteen and sixty five who had been admitted to St. John of God Hospital in Dublin whose IQ was greater than 80 and spoke fluent English participated in this research. Out of the ninety-four patients six were ineligible and thirty-two declined leaving a remainder of fifty-six people to participate in the research. The fifty six patients were randomly allocated to two types of treatment. The two types of treatment were compliance therapy and control groups.

Compliance therapy is a cognitive behavior intervention with techniques adapted from motivational interviewing and other cognitive therapies as well as psychoeducation. The therapy consists of five sessions, each lasting thirty to sixty minutes, and covered the patientís illness history. The control group patients received non-specific counseling, which also consisted of five sessions each lasting thirty to sixty minutes long and were told to discuss matters relating to medications of their treatment to their teammates. Even though the methodology is not stated in this case, I believe it could either be case study or experimental. This study confirmed that the patients treated in the compliance therapy were not significantly different from the control patients at one year of follow-up. But the study prospectively confirmed that measuring a patientís attitudes to drug treatment predicts adherence one year later. This study also showed that there was no difference in compliance therapy and control therapy. However the finding did suggest that, although non-compliance may be increasingly identifiable and predictable, schizophrenia still remains hard to solve.

After reading the research I donít think the researchers took a broad enough approach on studying this topic. All the patients where from the same area and same hospital and were given only five sessions of thirty to sixty minutes observation therapy. Even though they started out with ninety-four patients between the ages of eighteen and sixty-five they only ended up with fifty-six patients. How do fifty-six patients make up the population of all the patients diagnosed with schizophrenia? Also the research stated the age range but we are not sure what percentage was female or male and we do not know their ethnic background. Also the researchers came back a year later to see if any changes had occurred. How do they know what took place within that year? I think in order to do a good research on this topic the researchers should have taken this study to several different hospitals and different states. They also should have observed them off an on within that year instead of a year later. As with compliance therapy they do not specify what actually took place except they observed them.

What I learned about this research was not much that I didnít already know. I did find that compliance therapy failed to replicate previous findings and there was no advantage over non-specific therapy in terms of patientís adherence. Also patients are able to function socially & survive in the community with the right medications and there are many strategies that patients, doctors and families can use to improve adherence and prevent the illness from becoming worse.

March 20, 2004

Human Growth & Development

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