Patient perspectives on antipsychotic treatments and their association with clinical outcomes

Abstract

This analysis examined patient-reported attitudes toward antipsychotic medication and the relationship of these attitudes with clinical outcomes and pharmacotherapy adherence. The analysis included three randomized, double-blind studies in patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition and randomly assigned to treatment with olanzapine 5-20 mg/day or another antipsychotic (haloperidol 2-20 mg/day, risperidone 2-10 mg/day, or ziprasidone 80-160 mg/day). Patient-reported improvements were significantly greater for olanzapine (n = 488) versus other treatments (haloperidol n = 145, risperidone n = 158, or ziprasidone n = 271) on multiple Drug Attitude Inventory items. A positive attitude toward medication reported by patients was significantly associated with greater clinical improvement on the Positive and Negative Syndrome Scale and lower discontinuation rates. These results suggest that patients' perceptions of treatment benefits are associated with objective clinical measures, including reduction of symptom severity and lower discontinuation rates. Furthermore, olanzapine may be associated with more positive treatment attitudes. These findings may contribute to a better understanding of reasons for treatment adherence from patients' own perspectives.

Factors Associated with the Effectiveness of a Telephone-Based Nursing Strategy for Enhancing Medication Adherence in Schizophrenia

“…The critical importance of optimal adherence to prescribed antipsychotic treatments has been convincingly demonstrated in patients with schizophrenia [ 4 ]. Positive attitude towards medication, as measured by the DAI-10, is associated with significantly higher adherence rates [ 9 ].…”

Risk and protective factors for relapse among Individuals with Schizophrenia: A Qualitative Study in Dar es Salaam, Tanzania

“…Previous studies have also found that non adherence appears to be one of the factors most likely to increase the risk of relapse in schizophrenic patients [ 6 ]. Medication noncompliance and under-compliance continues to be a problem in the treatment of schizophrenia in the United States and Canada; the vast majority of hospital admissions for exacerbation of psychosis have been linked to noncompliance [ 12 ]. In Germany it has been found that patients who tend to experience a relapse are less likely to have a positive attitude toward treatment adherence [ 3 ].…”

“…Antipsychotic medication compliance was expressed by patients and their care givers to be a strong protector of relapse. It was found that the relapse risk was substantially lower when a patient was adhering properly to the antipsychotic therapy [ 12 ]. Improvement in symptoms and the recognition of this improvement by patients may have led to improvement in their attitude to medication [ 12 ].…”

Short-term clinical stability and lack of insight are associated with a negative attitude towards antipsychotic treatment at discharge in patients with schizophrenia and bipolar disorder

“…20 , 31 Positive attitude towards medication, as measured by the DAI-10, is associated with significantly higher adherence rates. 32 , 33 The attitude towards treatment in outpatients has been additionally related to factors, such as employment status, duration of untreated psychosis (DUP), disease severity, treatment response, hospital profile, and therapeutic alliance with the medical staff. 7 , 26 , 27 , 34 , 35 Moreover, the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study found that the degree of clinical improvement due to treatment and patient quality of life are factors also related to the attitude towards medication.…”