Insight Into Illness and Attitudes Toward Medications Among Inpatients With Schizophrenia

Abstract

This study assessed symptoms, severity of illness functional level, insight into illness, and attitudes toward medication in a sample of psychiatric patients who were newly admitted to a state hospital. The patients were evaluated before and after treatment with atypical, conventional, or mixed (atypical plus conventional) antipsychotic medication regimens with the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression, the Global Assessment of Functioning, the Scale to Assess Unawareness of Mental Disorder, and the Drug Attitude Inventory. Overall, the patients showed significant improvement in symptoms, severity of illness, functional level, and insight into their illness during the course of hospitalization. Their attitudes toward medications changed minimally during treatment. Only the patients who were treated with conventional antipsychotics showed significant improvement in their attitudes toward medication. However, the change was not large enough to differentiate the conventional antipsychotic treatment group from the other treatment groups.

Determinants of functioning and well-being among individuals with schizophrenia: An integrated model

“…This study found that, compared with treatment as usual, participation in an insight-focused cognitive-behavioral intervention was associated with modest but significant improvements in insight at a 1-year follow-up. There is also tentative evidence for a possible impact of treatment on insight from naturalistic studies (Mintz, Addington, & Addington, 2004;Sajatovic et al, 2002;Smith et al, 2004;Weiler, Fleisher, & McArthur-Campbell, 2000), which found that insight improved over the course of a brief hospitalization and up to 12 months after an initial psychiatric hospitalization.…”

“…The literature on medication adherence has also consistently found that attitudes and beliefs about medication, rather than insight, are the most important predictors of adherence (Lacro, Dunn, & Dolder, 2002). In addition, while insight, traditionally defined, may be responsive to the interventions offered in an inpatient treatment setting, attitudes and beliefs about medication may not be (see Sajatovic et al, 2002).…”

Visual Feedback Therapy to Enhance Medication Adherence in Psychosis

“…Multiple factors have been found to be multicollinearly associated with nonadherence, including low insight or beliefs (Carroll, Pantelis, & Harvey, 2004;Kampman et al, 2002;McCabe, Quayle, Beirne, & Anne Duane, 2002;Perkins, 2002;Sajatovic et al, 2002;Weiden & Olfson, 1995), low cognitive functioning (Robinson et al, 2002), history of nonadherence (Olfson et al, 2000), ethnicity (Opolka, Rascati, Brown, & Gibson, 2003), comorbidity with substance abuse or dependency (Lloyd et al, 1998;Olfson et al, 2000;Owen, Fischer, Booth, & Cuffel, 1996), acuity of psychiatric symptoms (Kampman et al, 2002), and side effects of medications including EPSs (Kampman et al, 2002;Robinson et al, 2002) and weight gain (Weiden, Mackell, & McDonnell, 2004).…”

Neurocognition, Insight and Medication Nonadherence in Schizophrenia: A Structural Equation Modeling Approach

“…Several issues could be explored in more depth, thus casting new light on the relationships among neurocognition, insight and nonadherence in patients with schizophrenia. Prior studies often used confounded assessments that (1) did not include the three main composites of neurocognition (i.e., memory, attention, and executive functions) [13], [20], (2) considered insight to be a one-dimensional phenomenon, using for example the “Lack of Judgment and Insight” item on the Positive and Negative Syndrome Scale (PANSS) or only a few dimensions of the Scale to assess Unawareness of Mental Disorder (SUMD) [21], [22], and (3) did not distinguish between adherence behavior and attitudes towards medication [5], [19]. Moreover, although adherence is considered to be a dynamic and continuous behavior that is influenced by the complex interactions of many factors [23], most studies have examined the impact of each determinant in isolation [4], [5].…”