Skip to main content Accessibility help

Randomised controlled trial of compliance therapy: 18-month follow-up

  • Roisin Kemp (a1), George Kirov (a2), Brian Everitt (a3), Peter Hayward (a4) and Anthony David (a5)...



A randomised controlled trial was conducted in an acute treatment setting to examine the effectiveness of compliance therapy, a brief pragmatic intervention targeting treatment adherence in psychotic disorders, based on motivational interviewing and recent cognitive approaches to psychosis.


Seventy-four patients with psychotic disorders according to DSM–III–R criteria recruited from consecutive admissions to an acute in-patient unit, received 4–6 sessions of either compliance therapy or non-specific counselling, and were followed-up over 18 months. The principal outcome measures were observer-rated compliance, attitudes to treatment, insight and social functioning.


Significant advantages were found for the compliance therapy group post-treatment on measures of insight, attitudes to treatment and observer-rated compliance which were retained over the follow-up period. Global social functioning improved relatively more over time in the compliance therapy group compared with the control group. Survival in the community prior to readmission was significantly longer in the compliance therapy group.


The results support the effectiveness of compliance therapy in improving functioning and community tenure after an acute psychotic episode.


Corresponding author

Dr Roisin Kemp, University of Psychiatry, Royal Free Hospital, Pond Street, London NW3 2QG. Tel: 0171 794 0500. Fax: 0171 830 2808. E-mail:


Hide All

Related paper pp. 420–424, this issue.



Hide All
Amador, X. F., Flaum, M., Andreasen, N. C., et al (1994) Awareness of illness in schizophrenia and schizoaffective and mood disorders. Archives of General Psychiatry, 51, 826836.
Amador, X. F., Friedman, J. H., Kasapis, C., et al (1996) Suicidal behaviour in schizophrenia and its relationship to awareness of illness. American Journal of Psychiatry, 153, 11851188.
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised). Washington, DC: APA.
Babiker, I. E. (1986) Noncompliance in schizophrenia. Psychiatric Developments, 4, 329337.
Barnes, T. R. E. (1989) A rating scale for drug-induced akathisia. British Journal of Psychiatry, 154, 672676.
Beecham, J. K. & Knapp, M. R. J. (1992) Costing psychiatric interventions. In Measuring Mental Health Needs (eds G. Thornicroft, C. Brewin & J. K. Wing), pp. 163183. London: Gaskell.
Churchill, D. N. (1985) Compliance – how to measure it. Modern Medicine of Canada, 40, 10681070.
Corrigan, P. W., Liberman, R. P. & Engel, J. D. (1990) From noncompliance to collaboration in the treatment of schizophrenia. Hospital and Community Psychiatry, 41, 12031211.
Cox, D. R. (1972) Regression models and life tables. Journal of the Royal Statistical Society, 34, 187200.
David, A. S. (1990) Insight and psychosis. British Journal of Psychiatry, 156, 798808.
Diggle, P. J. & Kenward, M. G. (1994) Informative drop-outs in longitudinal data analysis. Applied Statistics, 43, 4993.
Diggle, P. J., Liang, K. Y. & Zeger, S. L. (1994) Analysis of Longitudinal Data. Oxford: Oxford Science Publications.
Drury, V., Birchwood, M., Cochrane, R., et al (1996) Cognitive therapy and recovery from acute psychosis: a controlled trial: I. Impact on psychotic symptoms. British Journal of Psychiatry, 169, 593601.
Everitt, B. S. (1995) The analysis of repeated measures: a practical review with examples. Statistician, 44, 113135.
Everitt, B. S. (1998) Analysis of longitudinal data. Beyond MANOVA. British Journal of Psychiatry, 172, 710.
Falloon, I. R. (1984) Developing and maintaining adherence to long-term drug-taking regimens. Schizophremo Bulletin, 10, 412417.
Garety, P. A., Kulpers, L., Fowler, D., et al (1994) Cognitive behavioural therapy for drug-resistant psychosis. British Journol of Medical Psychology, 67, 259271.
Goldstein, M. J. (1992) Psychosocial strategies for maximizing the effects of psychotropic medications for schizophrenia and mood disorder. Psychopharmacology Bulletin, 28, 237240.
Hayward, P., Chan, N., Kemp, R., et al (1995) Medication self-management: a preliminary report on an intervention to improve medication compliance. Journal of Mental Health, 4, 511517.
Hogan, T. P., Awad, A. G. & Eastwood, R. (1983) A self report scale predictive of drug compliance in schizophrenics: Reliability and discriminative validity. Psychological Medicine, 13, 177183.
Kane, J. (1983) Problems of compliance in the outpatient treatment of schizophrenia. Journal of Clinical Psychiatry, 44, 36.
Kemp, R., Hayward, P., Applewhaite, G., et al (1996a) Compliance therapy in psychotic patients: randomised controlled trial. British Medical Journal, 312, 345349.
Kemp, R., David, A. & Hayward, P. (1996b) Compliance therapy: An intervention targeting insight and treatment adherence in psychotic patients. Behavioural and Cognitive Psychotherapy 24, 331350.
Kemp, R., & David, A. (1997) Insight and Compliance. In Compliance and the Treatment Alliance in Serious Mental Illness (ed. B. Blackwell). Newark. NJ: Gordon and Breach Publishing Group.
Lukoff, D., Nuechterlein, K. H. & Ventura, J. (1996) Manual for the expanded BPRS. Schizophrenia Bulletin, 12, 594602.
McGorry, P. D. (1995) Psychoeducation in first-episode psychosis – a therapeutic process. Psychiatry, 58, 313328.
Nelson, H. E. (1982) National Adult Reading Test (NART): test manual. Windsor: NFER.
Pullar, T., Kumar, S., Tindall, H., et al (1989) Time to stop counting the tablets? Clinical Pharmacology and Therapeutics, 46, 163168.
Royal Pharmaceutical Society of Great Britain (1997) From Compliance to Concordance: Towards Shared Goals in Medicine Taking. London: RPS.
Rudd, P. (1976) In search of the gold standard for compliance measurement. Archives of Internal Medicine, 139, 627628.
Simpson, G. M. & Angus, J. W. S. (1970) Drug-induced extra-pyramidal disorders. Acta Psychiatrica Scandmavica, 45 (suppl. 212): 1119.
Terrier, N., Beckett, R., Harwood, S., et al (1993) A trial of two cognitive-behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients. I. Outcome. British Journal of Psychiatry, 162, 524532.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Randomised controlled trial of compliance therapy: 18-month follow-up

  • Roisin Kemp (a1), George Kirov (a2), Brian Everitt (a3), Peter Hayward (a4) and Anthony David (a5)...
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *