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Prescribing preferred medications improves adherence in people with severe mental illness

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What is the effect of psychiatric advance directives on type of medications prescribed and adherence to prescribed medications?


Adults (aged 18–65 years) with schizophrenia or schizoaffective disorder (63%), bipolar disorder (25%) or major depressive disorder with psychotic features (12%), participating in a randomised controlled trial comparing the effects of preparing a psychiatric advanced directive (PAD) with giving general information about PAD. Of the 239 participants randomised to preparing a PAD, only 123 participants completing both a PAD plus a follow-up interview at 12 months were included in this study.


Outpatients from county-based programmes, North Carolina, USA; time period studied October 2004 to September 2006.

Prognostic factors

Medication preferences described in the PAD: participants identified medications they would either request for treatment or refuse to take during a psychiatric crisis. Forward-selected stepwise logistic regression was used to identify factors associated with medication adherence at 12 months. Possible predictor variables included diagnosis, age, sex, race and history of hospitalisation in the past 12 months, Brief Psychiatric Rating Scale score, positive score on …

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  • Sources of funding National Institutes of Health grants 5-R01-MH-063949, T32-MH019117 and K02-MH67864; John D and Catherine T MacArthur Foundation.


  • Competing interests None.

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