A Clinimetric Approach for Improving the Measurement of Pharmacophobia with Replication in Two Other Samples

Cuevas, Carlos De las; Leon, José de

doi:10.1159/000495940

Cited by 6 publications

(7 citation statements)

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“…Attitudes of psychiatric patients toward psychiatric medication were assessed by an improved clinimetric version of the DAI,25 specifically modified to obtain a more accurate prediction of non-adherence 20. To assess patients’ differences in reactance proneness, that is, individuals’ trait propensity to experience psychological reactance, the three most representative items of the HPRS22,26 were selected.…”

Section: Methodsmentioning

confidence: 99%

“…This inventory originally had 30 items (DAI-30) but a shorter version with ten items (DAI-10) measures a unique clinical cluster of attitudes toward prescribed treatment relevant to non-adherence 19. Our clinimetric version of the DAI-10 was developed to provide a measure of pharmacophobia more suitable for clinical use by reducing the number of items from ten to eight, replacing the original dichotomy response format by a 6-point Likert scale and confirming a 2-factor orthogonal structure reflecting positive and negative effects of the prescribed medication 20…”

Section: Introductionmentioning

confidence: 99%

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Development and validation of the Patient’s Health Belief Questionnaire on Psychiatric Treatment

Cuevas¹,

Leon²

2019

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Background Our previous studies with regard to adherence to psychiatric medications measured pharmacophobia, psychological reactance, and locus of control using a 42-item questionnaire requiring ~1.5 hours for completion. This study aims to develop the Patient’s Health Belief Questionnaire on Psychiatric Treatment, a 17-item inventory which requires only 15 minutes to complete. Methods Our new questionnaire with five subscales was based on 17 items from three previously validated scales (on pharmacophobia, psychological reactance, and locus of control). In 588 consecutive Spanish psychiatric outpatients taking 1,114 psychiatric medications, we studied the responses to the questionnaire; to validate it, medication adherence was assessed by the Sidorkiewicz tool. Results Validation of the construct was addressed by performing two exploratory factor analyses independent of each other (one for the eight-item section measuring the attitudes of patients toward psychotropic drugs and one for the nine-item section measuring perceived health locus of control [HLOC]), which led to five subscales that were called Positive and Negative Aspects of Medications, Doctor-HLOC, Internal-HLOC, and Psychological Reactance. The five subscales showed better internal consistency when corrected by number of items than the original 17-item scale. Logistic regression models of the continuous scores, dichotomized subscales, and Chi-squared Automatic Interaction Detector (CHAID) analysis indicated that all five subscales help in predicting adequate adherence, although the various subscales behave differently in different analyses. Conclusion Future studies need to verify and further extend the preliminary findings of this study that the questionnaire may have construct and predictive validity.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development and validation of the Patient’s Health Belief Questionnaire on Psychiatric Treatment

Cuevas¹,

Leon²

2019

PPA

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“…During the stage of remission, their assessment may suggest the use of cognitive behavioral therapies and/or well-being enhancing psychotherapeutic strategies to improve residual symptomatology and thus long-term outcome in depression 135 . Furthermore, dysfunctional cognitive schemas (e.g., "no matter what I do, it will not work", "I must always be in control") are likely to affect individual attitudes to medication 280 . If a patient has problems with adherence to antidepressant drugs, this is a clinical area that is worth exploring.…”

Section: Dysfunctional Cognitive Schemasmentioning

confidence: 99%

“…If a patient has problems with adherence to antidepressant drugs, this is a clinical area that is worth exploring. The Drug Attitude Inventory is a brief questionnaire 280 that may facilitate such exploration.…”

Section: Dysfunctional Cognitive Schemasmentioning

confidence: 99%

The clinical characterization of the adult patient with depression aimed at personalization of management

et al. 2020

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Depression is widely acknowledged to be a heterogeneous entity, and the need to further characterize the individual patient who has received this diagnosis in order to personalize the management plan has been repeatedly emphasized. However, the research evidence that should guide this personalization is at present fragmentary, and the selection of treatment is usually based on the clinician's and/or the patient's preference and on safety issues, in a trial‐and‐error fashion, paying little attention to the particular features of the specific case. This may be one of the reasons why the majority of patients with a diagnosis of depression do not achieve remission with the first treatment they receive. The predominant pessimism about the actual feasibility of the personalization of treatment of depression in routine clinical practice has recently been tempered by some secondary analyses of databases from clinical trials, using approaches such as individual patient data meta‐analysis and machine learning, which indicate that some variables may indeed contribute to the identification of patients who are likely to respond differently to various antidepressant drugs or to antidepressant medication vs. specific psychotherapies. The need to develop decision support tools guiding the personalization of treatment of depression has been recently reaffirmed, and the point made that these tools should be developed through large observational studies using a comprehensive battery of self‐report and clinical measures. The present paper aims to describe systematically the salient domains that should be considered in this effort to personalize depression treatment. For each domain, the available research evidence is summarized, and the relevant assessment instruments are reviewed, with special attention to their suitability for use in routine clinical practice, also in view of their possible inclusion in the above‐mentioned comprehensive battery of measures. The main unmet needs that research should address in this area are emphasized. Where the available evidence allows providing the clinician with specific advice that can already be used today to make the management of depression more personalized, this advice is highlighted. Indeed, some sections of the paper, such as those on neurocognition and on physical comorbidities, indicate that the modern management of depression is becoming increasingly complex, with several components other than simply the choice of an antidepressant and/or a psychotherapy, some of which can already be reliably personalized.

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“…• A clinimetric version of the DAI 70 health behaviors and consequently their mental health outcomes. 78 If patients believe that their own behaviors affect whether they stay healthy, become sick, or recover from an illness, they are said to have an "internal" HLOC orientation.…”

Section: Daimentioning

confidence: 99%

Self-Report for Measuring and Predicting Medication Adherence: Experts’ Experience in Predicting Adherence in Stable Psychiatric Outpatients and in Pharmacokinetics

Cuevas

Leon

2020

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Poor adherence to appropriately prescribed medication is a global challenge for psychiatrists. Prior Studies: Measuring adherence is complicated. In our recent three-country naturalistic study including more than 1000 patients and their adherence to multiple medication prescriptions at the same time, patients' self-report of adherence to each specific drug was the only practical option for measuring adherence. Systematic literature reviews provide inconsistent results for sociodemographic, clinical and medication variables as predictors of adherence to psychiatric drugs. Our studies over the last 10 years in relatively stable psychiatric outpatients have shown that some self-reported health beliefs had consistent, strong effects and a better predictive role. Three dimensions of these health beliefs are characteristics of the individual: 1) attitudes toward psychiatric medication such as pharmacophobia (fear of taking drugs or medicines), 2) health locus of control (the belief patients have about who or what agent determines the state of their health), 3) psychological reactance (an emotional reaction in direct contradiction to rules or regulations that threaten or suppress certain freedoms in behavior). They can be measured by the Patient Health Beliefs Questionnaire on Psychiatric Treatment. The attitude toward each specific medication can be measured by the necessity-concern framework and summarized as the presence or absence of skepticism about that drug. After 25 years conducting pharmacokinetic studies in psychiatric drugs, particularly antipsychotics, we have limited understanding of how to use blood levels to predict the effects of non-adherence or to establish it. Expert Opinion on Future Studies: Future studies to predict adherence should include the inpatient setting and explore insight. Studying the pharmacokinetics associated with nonadherence in each psychiatric drug is a major challenge. Medication adherence is a complex and dynamic process changing over time in the same patient. Personalizing adherence using psychological or pharmacological variables are in their initial stages.

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A Clinimetric Approach for Improving the Measurement of Pharmacophobia with Replication in Two Other Samples

Cited by 6 publications

References 9 publications

<p>Development and validation of the Patient’s Health Belief Questionnaire on Psychiatric Treatment</p>

<p>Development and validation of the Patient’s Health Belief Questionnaire on Psychiatric Treatment</p>

The clinical characterization of the adult patient with depression aimed at personalization of management

<p>Self-Report for Measuring and Predicting Medication Adherence: Experts’ Experience in Predicting Adherence in Stable Psychiatric Outpatients and in Pharmacokinetics</p>

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A Clinimetric Approach for Improving the Measurement of Pharmacophobia with Replication in Two Other Samples

Cited by 6 publications

References 9 publications

<p>Development and validation of the Patient&rsquo;s Health Belief Questionnaire on Psychiatric Treatment</p>

<p>Development and validation of the Patient&rsquo;s Health Belief Questionnaire on Psychiatric Treatment</p>

The clinical characterization of the adult patient with depression aimed at personalization of management

<p>Self-Report for Measuring and Predicting Medication Adherence: Experts’ Experience in Predicting Adherence in Stable Psychiatric Outpatients and in Pharmacokinetics</p>

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<p>Development and validation of the Patient’s Health Belief Questionnaire on Psychiatric Treatment</p>

<p>Development and validation of the Patient’s Health Belief Questionnaire on Psychiatric Treatment</p>