Adherence to treatment and antipsychotic levels in saliva in patients with a first psychotic episode

Abstract

Introduction. Adherence plays a key role in promptly achieving and maintaining remission in Schizophrenia. Thus, monitoring adherence is of utmost importance to optimize treatments, and evidence suggests that this can be done by measuring salivary levels of antipsychotics, which could have several advantages over the traditional plasma level monitoring. Aims. We aim to study the relationship between adherence, salivary levels of antipsychotics and clinical outcomes after a first episode psychosis. Material and methods. This multicentre study includes 223 patients diagnosed of first episode of psychosis (FEP) in remission in the moment of recruitment. We compared salivary levels of antipsychotics, EEAG and PANSS scores in the adherent versus the non-adherent group. Results. Adherence increased from baseline (49%) to three (52%) and six months (60%). All antipsychotics could be measured in saliva, and there was a positive correlation between saliva and blood levels of Aripiprazole. Adherent patients had a significative decrease in score in PANSS Negative scale (F =4.779, p= 0.010) and a tendency to this in PANSS Global scale. PANSS Positive scale and EEAG did not show different outcomes between the two adherence groups. Conclusions. There is a positive correlation between plasma and salivary levels for Aripiprazole, and such levels are related with dose in adherent patients. Levels of non- adherence are high, almost 50% in first psychotic episode patients., and are associated with higher negative symptoms in follow-up. Further studies should be made to better establish the relationship between salivary and blood levels and between salivary levels and dose.