Attitudes Toward Antipsychotic Medication, Insight and Psychopathology in Outpatients with Schizophrenia

Department of Psychiatry, Medical University, Sofia, Bulgaria.
Folia medica 01/2012; 54(4):62-8. DOI: 10.2478/v10153-012-0007-3
Source: PubMed


Attitude toward antipsychotic medication is considered as one of the main predictors for medication adherence in schizophrenia. The present non-interventional cross-sectional study aims to explore the associations between attitudes toward antipsychotic medication, insight and other clinical variables in outpatients with schizophrenia.
Attitudes toward antipsychotic medication, clinical and social variables, sociodemographic and illness-related characteristics were assessed via a set of semi-structured clinical interviews and self-rating scales in a total of 226 patients with schizophrenia on a long-term antipsychotic treatment in community based settings. The associations between attitudes toward medication and severity of psychopathology, insight and medication side effects were examined.
The greater hospitalization rate in the previous year was associated with more severe psychopathology at the time of the study, more pronounced side effects of the therapy and lack of insight. The lack of insight, the presence of more severe negative and depressive symptoms and disease duration less than 5 years correlated significantly with negative attitudes toward antipsychotic medication. The severity of medication side effects was not associated with the drug attitudes.
Psychoeducational and psychotherapeutical interventions, along with pharmacotherapy, can be beneficial in forming positive attitudes toward medication and improving medication adherence in schizophrenia, especially in patients with a short duration of the disease.

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    • "After the selection procedure (see Fig. 1), 59 studies were included (Amador et al., 1993; Collins et al., 1997; Sanz et al., 1998; Smith et al., 1998, 2000; Carroll et al., 1999; Moore et al., 1999; Kampman et al., 2002; Drake et al., 2004; Mintz et al., 2004; Pedrelli et al., 2004; Granholm et al., 2005; Kaiser et al., 2006; Mutsatsa et al., 2006; Palmer and Jeste, 2006; Schwartz-Stav et al., 2006; Simon et al., 2006; Sumich et al., 2006; Watson et al., 2006; Bell et al., 2007; Cooke et al., 2007; Saeedi et al., 2007; Warman et al., 2007; Karow et al., 2008; Roseman et al., 2008; Sitzer et al., 2008; Ulas et al., 2008; Yanos et al., 2008; Kruck et al., 2009; Mohamed et al., 2009; Staring et al., 2009; Barrett et al., 2010; Wiffen et al., 2010; Ayesa-Arriola et al., 2011; Engh et al., 2011; Kao and Liu, 2011; Kao et al., 2011; Kurtz and Tolman, 2011; Norman et al., 2011; Parellada et al., 2011; Wang et al., 2011; Ampalam et al., 2012; Birchwood et al., 2012; Cavelti et al., 2012b; Ekinci et al., 2012; Haug et al., 2012; Majadas et al., 2012; Pena et al., 2012; Romm et al., 2012; Sharaf et al., 2012; Vassileva and Milanova, 2012; Xiang et al., 2012; Innamorati et al., 2013; Konstantakopoulos et al., 2013; Raffard et al., 2013; Schrank et al., 2013; Sonmez et al., 2013; Tsai and Rosenheck, 2013; Thomas et al., 2014). These studies were conducted on 9276 patients with a mean age of 35.2 years (SD = 9.0); 36.6% females (SD = 14.8) and 28.8% inpatients (SD = 42.3). "
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    ABSTRACT: Among patients with schizophrenia, better insight may be associated with depression, but the findings on this issue are mixed. We examined the association between insight and depression in schizophrenia by conducting a systematic review and meta-analysis. The meta-analysis was based on 59 correlational studies and showed that global clinical insight was associated weakly, but significantly with depression (effect size r=0.14), as were the insight into the mental disorder (r=0.14), insight into symptoms (r=0.14), and symptoms' attributions (r=0.17). Conversely, neither insight into the social consequences of the disorder nor into the need for treatment was associated with symptoms of depression. Better cognitive insight was significantly associated with higher levels of depression. The exploratory meta-regression showed that methodological factors (e.g. the instrument used to assess depression and the phase of the illness) can significantly influence the magnitude of the association between insight and depression. Moreover, results from longitudinal studies suggest that the relation between insight and depression might be stronger than what is observed at the cross-sectional level. Finally, internalized stigma, illness perception, recovery attitudes, ruminative style, and premorbid adjustment seem to be relevant moderators and/or mediators of the association between insight and depression. In conclusion, literature indicates that among patients with schizophrenia, better insight is associated with higher levels of depressive symptoms. Thus, interventions aimed at promoting patients' insight should take into account the clinical implications of these findings. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Jan 2015 · Schizophrenia Research