According to available evidence, prospective memory (PM) is important in daily
functioning but is impaired in schizophrenia. However, there were hardly any Indian
studies on this topic. Medication adherence is one of the challenges which clinicians
often face during treatment. Our study aims to enhance medication adherence and
prospective memory using a cue-based intervention.
Aims:
To assess the improvement in prospective memory using cue-based intervention to enhance
medication adherence and basic functional skills.
Objective:
To correlate prospective memory and medication adherence with executive function and
cognitive insight.
To correlate the medication adherence with basic functional skills
Hypotheses to be tested:
Statistically significant difference between prospective memory improvement with
intervention in the intervention group and treatment as usual group.
A Statistically significant correlation between prospective memory score and
medication adherence score.
A Statistically significant correlation between medication adherence and basic
functional skills.
The study will have two arms with two arms (n=52 in each group) the intervention arm and
the TAU arm. Participants in both arms will receive standard medical care as advised by
the treating psychiatrist. The treating psychiatrist will be blinded about which group
the patient belongs to and they will be encouraged to prescribe stable medication
throughout the study process unless it would affect the treatment outcome or prognosis of
the patient. The intervention arm will receive the cues in the form of daily repeating
reminders for a time period of 30 days. The reminders will be set on participants' mobile
phone to receive at least 1 hour prior to the prescribed oral antipsychotic medication.
The same reminder will be repeated after 10minutes duration to ensure that participant
does not miss the cue and the uniformity of the cue will be ensured by setting the same
emoji or the same phrase on the participants own mobile phone. The participants will also
be encouraged to close their eyes for 5-7 seconds and imagine themselves to be taking the
medication at the prescribed time when they see the reminder. The family members or the
caretaker of the patient will be provided with a adherence chart which will be reviewed
during the follow up visits. During the baseline assessment Independent Living Skills
Survey (ILSS) questionnaire will be administered to obtain a baseline score of living
skills and the domain with least score will be addressed by individual based intervention
using similar cue-based intervention by repeated reminders will be done to improve that
domain and during the follow up visit the improvement will be assessed by comparing the
follow up scores of (ILSS) with baseline scores. Subsequently on first follow up the
medication adherence will be assessed using Brief Adherence Rating Scale (BARS) and
prospective memory will be assessed using Memory for Intentions Screening Test (MIST) and
the score will be briefed to the patients and patients will be motivated to comply with
study process till the second follow up. The second follow up assessment will be done
after 90 days from baseline assessment. During the time period between first and second
follow up the participants will not receive any cue. Participants will be assessed using
Memory for Intentions Screening Test (MIST), Brief Adherence Rating Scale (BARS), Trail
Making Test (TMT), Beck Cognitive Insight Scale (BCIS) and Independent Living Skills
Survey (ILSS) during baseline, first follow up and second follow up. During each sessions
patients as well as family will be enquired if they suffered from any distress related to
the study, both psychological and physical. In that case it will be explored in detail
and if required necessary intervention will be given after after consulting with the
treating psychiatrists.