Beyond the Usual Suspects: Positive Attitudes Towards Positive Symptoms Is Associated With Medication Noncompliance in Psychosis |
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Authors: | Steffen Moritz Jerome Favrod Christina Andreou Anthony P Morrison Francesca Bohn Ruth Veckenstedt Peter Tonn Anne Karow |
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Institution: | 1.Department of Psychiatry and Psychotherapy, University Medical Center in Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany;2.La Source, Health Campus of the University of Applied Sciences of Western Switzerland, Lausanne, Switzerland;3.Community Psychiatry Service, Department of Psychiatry, University Hospital Center of Lausanne, Switzerland;4.School of Psychological Sciences, University of Manchester, UK |
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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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Keywords: | schizophrenia psychosis neuroleptics antipsychotics compliance adherence |
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