Objective:
Poor adherence to antipsychotic medications is strongly associated with psychotic relapses and hospitalizations. This may hinder patients’ ability to function, particularly in a first episode of psychosis (FEP). Poor adherence to treatment may be due to poor insight that can alter the capacity to consent to care, including pharmacotherapy. When patients are judged legally lacking the capacity to consent to care, treatment can be mandated through community treatment orders (CTOs). This naturalistic study examines the effects of CTOs in FEP patients.

Method:
This study examines 38 FEP patients legally deemed unable to consent to care during their follow-up. Using a naturalistic mirror-image approach, we compare clinical (Scale for the Assessment of Positive Symptoms [SAPS], Scale for the Assessment of Negative Symptoms [SANS]), functional (Global Assessment of Functioning Scale [GAF], Social and Occupational Functioning Assessment Scale [SOFAS]), and service use (number of emergency room visits, length of hospitalizations) indicators before and after CTO.

Results:
After the CTO, 37 of 38 patients complied with treatment. Statistically significant improvements in clinical (▵SAPS = –6.3; 95% CI, 4.5 to 8.1 and ▵SANS = –2.2; 95% CI, 0.9 to 3.4, P < 0.01) and functional (▵GAF = +15.0; 95% CI, 8.4 to 21.6, ▵SOFAS = +18.6; 95% CI, 12.8 to 24.4, P < 0.01) outcomes were observed. Significant reduction in emergency room visits (P = 0.016) and days of hospitalization per month in acute care units (P < 0.05) were identified with no difference in hospital days per month in short-stay units. Moreover, encounters with case managers (P = 0.008) and attendance of cognitive therapy sessions (P = 0.031) were significantly higher. However, patients’ weight significantly increased after CTO (▵weight = +8.0 kg, P < 0.01).

Conclusions:
In FEP patients, CTOs improve compliance to treatment, which contributes to reducing positive and negative symptoms, shortening hospital stays, and improving functioning.

Emmanuelle Levy, MD, FRCPC, Sally Mustafa, PhD, Kanza Naveed, BA, Ridha Joober, MD, PhD

The Canadian Journal of Psychiatry, August 5, 2018

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