Beyond the usual suspects: positive attitudes towards positive symptoms is associated with medication noncompliance in psychosis.

TY - JOUR

T1 - Beyond the usual suspects: positive attitudes towards positive symptoms is associated with medication noncompliance in psychosis.

AU - Moritz, Steffen

AU - Favrod, Jerome

AU - Andreou, Christina

AU - Morrison, Anthony P

AU - Bohn, Francesca

AU - Veckenstedt, Ruth

AU - Tonn, Peter

AU - Karow, Anne

PY - 2013

Y1 - 2013

N2 - Antipsychotic medication represents the treatment of choice in psychosis according to clinical guidelines. Nevertheless, studies show that half to almost three-quarter of all patients discontinue medication with antipsychotics after some time, a fact which is traditionally ascribed to side-effects, mistrust against the clinician and poor illness insight. The present study investigated whether positive attitudes toward psychotic symptoms (ie, gain from illness) represent a further factor for medication noncompliance. An anonymous online survey was set up in order to prevent conservative response biases that likely emerge in a clinical setting. Following an iterative selection process, data from a total of 113 patients with a likely diagnosis of schizophrenia and a history of antipsychotic treatment were retained for the final analyses (80%). While side-effect profile and mistrust emerged as the most frequent reasons for drug discontinuation, 28% of the sample reported gain from illness (eg, missing voices, feeling of power) as a motive for noncompliance. At least every fourth patient reported the following reasons: stigma (31%), mistrust against the physician/therapist (31%), and rejection of medication in general (28%). Approximately every fifth patient had discontinued antipsychotic treatment because of forgetfulness. On average, patients provided 4 different explanations for noncompliance. Ambivalence toward symptoms and treatment should thoroughly be considered when planning treatment in psychosis. While antipsychotic medication represents the evidence-based cornerstone of the current treatment in schizophrenia, further research is needed on nonpharmacological interventions for noncompliant patients who are willing to undergo intervention but refuse pharmacotherapy.

AB - Antipsychotic medication represents the treatment of choice in psychosis according to clinical guidelines. Nevertheless, studies show that half to almost three-quarter of all patients discontinue medication with antipsychotics after some time, a fact which is traditionally ascribed to side-effects, mistrust against the clinician and poor illness insight. The present study investigated whether positive attitudes toward psychotic symptoms (ie, gain from illness) represent a further factor for medication noncompliance. An anonymous online survey was set up in order to prevent conservative response biases that likely emerge in a clinical setting. Following an iterative selection process, data from a total of 113 patients with a likely diagnosis of schizophrenia and a history of antipsychotic treatment were retained for the final analyses (80%). While side-effect profile and mistrust emerged as the most frequent reasons for drug discontinuation, 28% of the sample reported gain from illness (eg, missing voices, feeling of power) as a motive for noncompliance. At least every fourth patient reported the following reasons: stigma (31%), mistrust against the physician/therapist (31%), and rejection of medication in general (28%). Approximately every fifth patient had discontinued antipsychotic treatment because of forgetfulness. On average, patients provided 4 different explanations for noncompliance. Ambivalence toward symptoms and treatment should thoroughly be considered when planning treatment in psychosis. While antipsychotic medication represents the evidence-based cornerstone of the current treatment in schizophrenia, further research is needed on nonpharmacological interventions for noncompliant patients who are willing to undergo intervention but refuse pharmacotherapy.

KW - Adult

KW - Antipsychotic Agents

KW - Attitude to Health

KW - Female

KW - Humans

KW - Logistic Models

KW - Male

KW - Medication Adherence

KW - Middle Aged

KW - Psychotic Disorders

KW - Schizophrenia

KW - Schizophrenic Psychology

U2 - 10.1093/schbul/sbs005

DO - 10.1093/schbul/sbs005

M3 - SCORING: Journal article

C2 - 22337789

VL - 39

SP - 917

EP - 922

JO - SCHIZOPHRENIA BULL

JF - SCHIZOPHRENIA BULL

SN - 0586-7614

IS - 4

M1 - 4

ER -