Enquête sur la perception de l'observance dans la schizophrénie (EPOS)

From the patient's viewpoint, good quality compliance supposes a good relationship with his/her doctor; this relationship is directly linked to the therapist's heeding and interest shown to the patient, and not to the patient's symptoms alone. If individual motivation plays an important part at the outset, it will nevertheless be seriously influenced by the relationship between the doctor and his/her patient. It is one of the rare factors for which a positive correlation with compliance can be observed, as shown by practically all medical psychology research. To these well-known classical medical notions correspond average values of non-compliance, which may vary widely according to those concerned. These data are proof of the wide gap existing between what is expected and what is actually achieved. This discrepancy is felt by the patient as well as by his/her therapist, and involves many other factors linked to culture, to medical and religious background, medical anthropology, and the real or supposed proprieties of the Pharmakon. Compliance to antipsychotic medication in schizophrenia continues to be a significant and challenging question in terms of its prevalence as well as its significant impact on the rate of relapse and resource utilization. Most of the published reports, here again, confirm the significant contribution of attitudes towards treatment and their impact on adherence and clinical outcomes. Negative critical attitudes can be enduring and may require specific targeted behavioural interventions in addition to optimization of medication-based treatment. Systematic reviews and a meta-analysis of various approaches to enhance compliance with medication in schizophrenia have yielded inconsistent results, reflecting the many shortcomings of the studies included in the review and the meta-analysis. Most of the interventions tend to be rather complex and resource-intensive. One of the consistent findings has been the lack of impact of approaches based on psycho-education alone, without additional behavioural, family and economic support. Not only does the content of any compliance intervention approach seem to be important, but the time-course of outcome evaluation is also relevant. The need for “booster therapy” seems to be important for maintaining some of the beneficial effects of adherence-improvement therapies. Although second-generation anti-psychotics are subjectively better tolerated than first-generation anti-psychotics, their impact on compliance behaviour and improved attitudes towards treatment has not yet been systematically demonstrated in well-controlled studies. Similarly, differences between individual second-generation antipsychotic medications, in terms of impact on compliance behaviour, need to be explored. Our study aims at synthesizing the most recent data concerning this issue which is still at the core of numerous debates and hardly ever tackled in French language literature. Thanks to the summary of these data and to the testimony of 380 schizophrenic patients, we shall try to have a better understanding of what happens between the patient and his/her therapists from a relationships viewpoint.