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

Medina, Esteban; Salvà, Joan; Ampudia, Rubén; Mauriño, Jorge; Larumbe, Juan

doi:10.2147/ppa.s34345

Cited by 18 publications

(26 citation statements)

References 40 publications

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“…Then, they assessed a mean DAI score of 4.92 for adherent patients, which is comparable to the score measured in our study (4.79 at follow-up). An observational study by Medina et al reported a mean DAI score of 2.1 at discharge in patients with schizophrenia and bipolar patients [ 42 ], which corresponds to the DAI score of control patients (2.12) in our trial. Even though a high percentage achieved a DAI score > 0, the absolute scores of (non-) adherent patients remain rather low, between 2 and 5.…”

Section: Discussionsupporting

confidence: 56%

Effect of a Multi-Dimensional and Inter-Sectoral Intervention on the Adherence of Psychiatric Patients

et al. 2015

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BackgroundIn psychiatry, hospital stays and transitions to the ambulatory sector are susceptible to major changes in drug therapy that lead to complex medication regimens and common non-adherence among psychiatric patients. A multi-dimensional and inter-sectoral intervention is hypothesized to improve the adherence of psychiatric patients to their pharmacotherapy.Methods269 patients from a German university hospital were included in a prospective, open, clinical trial with consecutive control and intervention groups. Control patients (09/2012-03/2013) received usual care, whereas intervention patients (05/2013-12/2013) underwent a program to enhance adherence during their stay and up to three months after discharge. The program consisted of therapy simplification and individualized patient education (multi-dimensional component) during the stay and at discharge, as well as subsequent phone calls after discharge (inter-sectoral component). Adherence was measured by the “Medication Adherence Report Scale” (MARS) and the “Drug Attitude Inventory” (DAI).ResultsThe improvement in the MARS score between admission and three months after discharge was 1.33 points (95% CI: 0.73–1.93) higher in the intervention group compared to controls. In addition, the DAI score improved 1.93 points (95% CI: 1.15–2.72) more for intervention patients.ConclusionThese two findings indicate significantly higher medication adherence following the investigated multi-dimensional and inter-sectoral program.Trial RegistrationGerman Clinical Trials Register DRKS00006358

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Section: Discussionsupporting

confidence: 56%

Effect of a Multi-Dimensional and Inter-Sectoral Intervention on the Adherence of Psychiatric Patients

et al. 2015

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“…Aki et al [18] suggested that the patient's QOL could be predicted by the life skills measured by a family member and suggested that active treatment for depressive and negative symptoms might be recommended to improve the patient's QOL and life skills. An earlier study [19] also supports the value of patients' attitudes towards antipsychotic treatment at hospital discharge. Therefore, patient education is important in order to provide appropriate information to the patient, and patients' better understanding about basic information of their illness and treatments, including not only pharmacological treatments but also psychosocial approach to mental health, at the time of the first medical examination.…”

Section: Discussionmentioning

confidence: 53%

The Effect of a Psycho-Educational Program on Psychiatric Symptoms, Drug Attitude and Treatment Satisfaction of Patients with Schizophrenia

Zhao¹,

Yasuhara²,

Tanioka³

et al. 2015

OJPsych

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The purpose of this study was to determine the effect of a Comprehensive Psycho-Educational Approach and Scheme Set (COMPASS) for patients with schizophrenia who were treated with risperidone long-acting injectable (RLAI), on their psychiatric symptoms, drug attitudes, and treatment satisfaction levels. Participants were sixty-five patients at thirteen hospitals in Japan who met ICD-10 F2 criteria for schizophrenia or schizo-affective disorder and were treated with RLAI. A correlational study design was used to measure the effect of the COMPASS on the psychiatric symptoms, drug attitudes, and treatment satisfaction levels of patients treated with RLAI. Using the following evaluation indicators: The Subjective Satisfaction to Treatment Scale (SSTS), Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF), Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS), and Drug Attitude Inventory-10 (DAI-10), measurements were taken at the beginning of the program (baseline), at the end of the program, and six months after (endpoint). Data analysis included descriptive statistics, Mann-Whitney U test or Wilcoxon signedrank test, and Spearman's rank correlation coefficient. Significant differences were observed in BPRS total (p < 0.001), sub-scales of BPRS positive (p < 0.001), BPRS negative (p < 0.01), BPRS affective (p < 0.01), and GAF (p < 0.001). However, there was no significant change in subscale of BPRS manic, DAI-10, DIEPSS, or SSTS but significant positive correlations were found between SSTS and DAI-10 and GAF at baseline; a negative correlation was found between SSTS and BPRS. The findings of the study suggested the benefit of using the COMPASS in conjunction with RLAI to decrease patients' psychiatric symptomatology and improve treatment satisfaction. In addition, patient satisfaction was found to be an important factor to be considered by the psychiatrist.

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“…Our results are consistent with previous studies that have analysed the relationship between these variables. For example, a cross-sectional study of patients with schizophrenia or bipolar disorder admitted due to acute exacerbation of their condition found that insight was related to patient attitude towards antipsychotic treatment at hospital discharge [ 24 ]. Another cross-sectional study with 38 inpatients who met ICD-10 criteria for schizophrenia or schizoaffective disorder showed that therapeutic alliance was significantly correlated with adherence and that a weak therapeutic alliance and low insight were associated with poor adherence [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship of insight with medication adherence and the impact on outcomes in patients with schizophrenia and bipolar disorder: results from a 1-year European outpatient observational study

Montgomery²,

et al. 2015

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BackgroundMany patients with schizophrenia and bipolar disorder have impaired insight and low medication adherence. The aim of this post hoc analysis was to explore the relationship between insight and medication adherence.MethodsWe included 903 patients with schizophrenia or bipolar disorder who participated in an observational study conducted in Europe on the outcomes of patients treated with two oral formulations of olanzapine over a 1-year period. Evaluations included Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), insight (Scale to Assess Unawareness of Mental Disorder, SUMD) medication adherence (Medication Adherence Rating Scale, MARS), and therapeutic alliance (Working Alliance Inventory, WAI).ResultsMedication adherence was higher in bipolar patients (mean MARS score (SD) 6.5 (2.8) versus 5.8 (2.7) in schizophrenia; p < 0.001). Patients with schizophrenia had lower insight (i.e., SUMD item 1, unawareness of mental disorder, mean (SD) of 2.5 (1.3) in schizophrenia versus 1.9 (1.2) in bipolar, p < 0.001). Better insight was associated with higher adherence (Spearman Correlation Coefficient, SCC, ranging from 0.39 to 0.49 for the three SUMD general items, p < 0.0001 in all cases). Higher insight was related to a stronger therapeutic alliance (SCC ranging from 0.38 to 0.48, p < 0.0001). A path analysis revealed a positive impact of insight on adherence and alliance and that stronger alliance was related to lower clinical severity (lower CGI score).ConclusionInsight and adherence were found to be closely related. Insight impacts on the therapeutic alliance with mental health professionals. These factors are associated to treatment outcomes.

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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

Cited by 18 publications

References 40 publications

Effect of a Multi-Dimensional and Inter-Sectoral Intervention on the Adherence of Psychiatric Patients

Effect of a Multi-Dimensional and Inter-Sectoral Intervention on the Adherence of Psychiatric Patients

The Effect of a Psycho-Educational Program on Psychiatric Symptoms, Drug Attitude and Treatment Satisfaction of Patients with Schizophrenia

Relationship of insight with medication adherence and the impact on outcomes in patients with schizophrenia and bipolar disorder: results from a 1-year European outpatient observational study

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