Reviving Research on Medication Attitudes for Improving Pharmacotherapy: Focusing on Adherence

Abstract

There is little current interest in research into patients' attitudes toward medications. In the 1960s, psychiatric researchers including Uhlenhuth, Rickels and Covi focused on this area, but this research topic needs to be revived in the 21st century. The Health Belief Model may hold potential for doing this. This model was initially developed by 2 health psychologists, Rosenstock and Becker, to explain why patients did not follow medical interventions. The application of this model to study medication adherence in psychiatric outpatients has provided multiple findings including the conclusions that adherence is associated with: (1) the balance between internal and external health control beliefs, (2) psychological reactance, (3) patients' attitudes toward prescribed drug treatment in general and (4) the balance between the necessity of taking medications versus the concerns derived from adverse drug reactions (ADRs). Poor adherence is associated with several cognitive styles of patients, including: (1) high internal and external health control beliefs (patients who feel that their health is controlled both by external factors and their own beliefs), (2) higher psychological reactance, (3) pharmacophobia (present in 1/6 patients) and (4) skepticism about medications (a high concern for ADRs and a low belief in the necessity of taking medications). All of these findings suggest that shared decision-making is particularly important in fostering adherence in psychiatric patients. Two wider applications of this article can be made: (1) opening psychiatry to advances in clinical psychology and (2) expanding studies on attitudes toward medications to other medical disciplines.

A Trial Integrating Different Methods to Assess Psychosocial Problems in Primary Care

“…About a quarter of patients (26.5%) were identified with DCPR criteria for illness behavior, which provides an explanatory model for clinical phenomena that do not find room in customary taxonomy [19-21]. The DCPR spectrum of illness behavior encompasses a number of syndromes (Fig.…”

The Clinical Inadequacy of the Placebo Model and the Development of an Alternative Conceptual Framework

“…Such an occurrence reflects the fact that, in clinical trials where differentiation according to cogent subgroups is made, a treatment which is helpful on average may be ineffective in some patients (no difference with placebo) and even harmful in someone else (worse than placebo) [53,54]. For instance, in psychiatric practice one can observe that certain types of patients seem to antagonize drug effects, whether this is due to psychological reactance (a motivational force that leads individuals to fear loss of control), the balance between internal and external health control beliefs, and illness behavior [55]. Such paradoxical clinical phenomena can be easily found in the setting of personality disturbances [56].…”

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

“…Treatment adherence [1] may be an important topic in clinical pharmacopsychology [2] (see online suppl. Introduction; see www.karger.com/doi/10.1159/000495940 for all online suppl.…”

“…Pharmacophobia is one of the major variables associated with poor adherence [4] when measured by self-report in our Spanish studies, within the context of the Health Belief Model [1]. In a multivariate analysis of 940 psychiatric outpatients from Spain [5], we found that pharmacophobia was associated with poor adherence; the adjusted odds ratio (OR) was 2.54 (95% confidence intervals 1.84–3.50) after adjusting for the other 3 psychological dimensions known to influence poor adherence.…”