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Case Manager- and Patient-Rated Alliance as a Predictor of Medication Adherence in First-Episode Psychosis

Montreuil, Tina C. MA*†‡; Cassidy, Clifford M. MSc*‡§; Rabinovitch, Mark MD; Pawliuk, Nicole MSc*; Schmitz, Norbert PhD‡§; Joober, Ridha MD, PhD*‡§; Malla, Ashok K. MD, FRCPC

Journal of Clinical Psychopharmacology: August 2012 - Volume 32 - Issue 4 - p 465–469
doi: 10.1097/JCP.0b013e31825d3763
Original Contributions

Objective The objective of this study was to evaluate the association between adherence to antipsychotic medication and working alliance (WA) ratings as reported separately by case manager (CM) and patient in first-episode psychosis (FEP) and to identify whether other factors previously related to adherence influence this relationship.

Methods Adherence was evaluated every month in 81 participants who met criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, psychotic disorder (affective or nonaffective) and were treated in a specialized early intervention program. Adherence was measured, taking into account information from patient and clinician reports and pill counting. The WA, as assessed by both CM and patient, was assessed using the Working Alliance Inventory.

Results The WA was stable during the course of the study as rated by both patient and CM. The “task” domain of WA was the subdomain most significantly correlated to adherence in cross-sectional analysis. The WA as measured by CM at study baseline was a significant predictor of the number of subsequent months with “good” adherence independently of other variables, including adherence at treatment onset (β = 0.011; P = 0.020; 95% confidence interval, 0.002–0.020). However, the WA as measured by patients was not similarly predictive of subsequent adherence (β = 0.003; P = 0.31; 95% confidence interval, −0.003 to 0.010).

Conclusions The CM-rated WA is a significant predictor of future medication adherence in FEP, suggesting that good alliance can improve adherence in this population.

From the *Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute; †Department of Psychology, University of Québec in Montréal; ‡Douglas Research Centre, Douglas Mental Health University Institute; and §Department of Psychiatry, McGill University, Montreal, Quebec, Canada.

Received March 16, 2011; accepted after revision December 14, 2011.

Reprints: Ashok K. Malla, MD, FRCPC, Canada Research Chair in Early Psychosis, c/o Tina C. Montreuil, MA, Douglas Mental Health University Institute-FBC1, 6875 LaSalle Blvd, Room F-1131, Verdun, Quebec, Canada H4H 1R3 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.