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Patient Attitude, Lack of Insight Significant Reasons for Non-Adherence in Early Treatment of Schizophrenia

Negative attitudes and lack of insight regarding illness and treatment are significantly associated with poor treatment adherence in patients in the first episode of schizophrenia, according to a recent British study.

Response to treatment is heavily influenced by a patient's adherence to medication. In patients in the early stages of schizophrenia, discontinuation of antipsychotic medication can have serious implications on the progression of illness and increases the risk of hospitalisation.

Little information is available regarding the reasons for non-adherence in the early stages of treatment for schizophrenia.

Mr. Stanley H. Mutsatsa and colleagues at the Imperial College London, United Kingdom, therefore evaluated factors associated with adherence during the first-episode of schizophrenia.

The study included 101 patients recently diagnosed with schizophrenia who had received less than 12 weeks of antipsychotic medication. Adherence was assessed using a 7-point Compliance Rating Scale (CRS) that was based on primary nurse, doctor, and relative reports. This rating was analysed with respect to attitudes toward medication, insight, substance misuse, side effects and psychopathology.

Patients with poor adherence reported more negative attitudes toward medications than those with good adherence. They also had poorer insight than did patients with good adherence, including less awareness of illness, an inferior capacity to re-label psychotic experiences, and a low appreciation for the need for treatment adherence.

Attitude and insight were the only variables found to correlate significantly with adherence. These 2 factors accounted for 27% of all non-adherence.

Patients with poor adherence had a significantly higher mean score on the negative and disorganisation syndromes than that recorded in patients with good adherence; however, this did not contribute to adherence.

The subjective well being and prevalence of akathisia, Parkinsonism or non-neurological side effects had no significant influence on adherence. There also was no difference between groups regarding substance abuse.

Mr. Mutsatsa concludes that "attitudes towards treatment are a major influence on medication adherence in the early stages of antipsychotic drug treatment for first episode schizophrenia." He also notes that "poor insight explained a significant proportion of non-adherence behaviour."




Acta Psychiatr Scand 2003 Dec;108:6:439-46. "Clinical correlates of early medication adherence: West London first episode schizophrenia study"

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