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

Moritz, Steffen; Favrod, Jerome; Andreou, Christina; Morrison, Anthony P; Bohn, Francesca; Veckenstedt, Ruth; Tonn, Peter; Karow, Anne

Schizophrenia bulletin. 2012;.

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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.

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Digital Object Identifier:
10.1093/schbul/sbs005
Pubmed Identifier:
22337789
Pii Identifier:
sbs005
Access state:
Active

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Manchester eScholar ID:
uk-ac-man-scw:179683
Created by:
Morrison, Anthony
Created:
17th October, 2012, 08:49:41
Last modified by:
Morrison, Anthony
Last modified:
17th October, 2012, 08:49:41

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