Beyond the Usual Suspects: Positive Attitudes Towards Positive Symptoms Is Associated With Medication Noncompliance in Psychosis

Abstract

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.

Mindfulness and relaxation treatment reduce depressive symptoms in individuals with psychosis

“…We added a psychosis lie scale consisting of four items [38] mirroring common misconceptions about psychosis (cutoff: 8 points): seeing tiny objects like white mice (indicating delirium rather than psychosis); alien abduction (a rare but highly publicized cliché symptom); being a famous historical personality (a rare but highly publicized cliché symptom); mental lapses during which one becomes another person (i.e., ''split personality''; a rare/implausible but highly publicized cliché symptom).…”

Internet- und mobilbasierte Interventionen bei Schizophrenie

“…Apps und Texterinnerungen sind vor allem bei der großen Subgruppe der PatientInnen geeignet, die ihre Medikation aus Vergesslichkeit nicht einnehmen [Moritz et al, 2013]. Das in mehreren Studien untersuchte ITAREPS-Programm bittet wöchentlich PatientInnen und ihre Angehörigen per SMS, einen 10-Item-Fragebogen zu Frühwarnsignalen ebenfalls per Textnachricht auszufüllen [Španiel et al, 2008a].…”

Liberale Akzeptanz als kognitiver Mechanismus bei Psychose: Eine 2-Stufen-Theorie der Pathogenese schizophrener Positivsymptome

“…Wie bereits die Gründern der modernen Psychiatrie hervorhoben [Jaspers, 1913;Kraepelin, 1919], gehen Wahnvorstellungen oft mit einer Erleichterung (insight relief) einher [Kapur, 2003]. Trotz unangenehmer Erlebnisse, vor allem des Gefühls, verfolgt zu werden, «kennt» der/die Betroffene seinen/ihren Gegner und kann sich darauf einstellen, hat eine Erklärung für erlittene emotionale Krisen und fühlt sich zugleich oft aufgewertet, weil die angeblichen Gegner bedeutsame und einflussreiche Menschen oder Organisationen sind [Moritz et al, 2013b[Moritz et al, , 2015cSundag et al, 2014]. Religiöse Institutionen oder Geheimdienstorganisationen sind probate Widersacher, da diese (angeblich) über die Macht und die Mittel verfügen, um für die diversen Beschwerden und Probleme verantwortlich sein zu können, unter denen ein Betroffener leidet.…”