Daily functioning and symptom factors contributing to attitudes toward antipsychotic treatment and treatment adherence in outpatients with schizophrenia spectrum disorders

J Leijala,O Kampman,J Suvisaari,S Eskelinen

doi:10.1186/s12888-021-03037-0

Abstract

BackgroundPoor adherence and negative attitudes to treatment are common clinical problems when treating psychotic disorders. This study investigated how schizophrenia core symptoms and daily functioning affect treatment adherence and attitudes toward antipsychotic medication and to compare patients using clozapine or other antipsychotics.MethodA cross-sectional study with data from 275 patients diagnosed with schizophrenia spectrum disorder. Patients adherence, attitudes, insight and side-effects were evaluated using the Attitudes toward Neuroleptic Treatment scale. Overall symptomology was measured using the Brief Psychiatric Rating Scale (BPRS), the Health of the Nation Outcome Scale (HoNOS). The functioning was assessed using activities of daily living scale, instrumental activities of daily living scale and social functioning of daily living scale.ResultsSelf-reported treatment adherence was high. Of the patients, 83% reported using at least 75% of the prescribed medication. Having more symptoms was related with more negative attitude towards treatment. There was a modest association with functioning and treatment adherence and attitude toward antipsychotic treatment. Attitudes affected on adherence in non-clozapine but not in clozapine groups.ConclusionEarly detection of non-adherence is difficult. Systematic evaluation of attitudes toward the treatment could be one way to assess this problem, along with optimized medication, prompt evaluation of side effects and flexible use of psychosocial treatments.

Highlights

Poor adherence and negative attitudes to treatment are common clinical problems when treating psychotic disorders
There was a modest association with functioning and treatment adherence and attitude toward antipsychotic treatment
Less is known about partial treatment adherence. As it is so far unclear how functioning affect attitudes an adherence to antipsychotic medication, we investigated how attitudes and adherence are explained by psychiatric symptoms, daily functioning and compared adherence between patients using clozapine and those using other antipsychotic medications

Summary

Introduction

Poor adherence and negative attitudes to treatment are common clinical problems when treating psychotic disorders. This study investigated how schizophrenia core symptoms and daily functioning affect treatment adherence and attitudes toward antipsychotic medication and to compare patients using clozapine or other antipsychotics. Schizophrenia is a chronic and often disabling illness, usually requiring maintenance treatment with antipsychotic medication. The majority of patients experience several relapses during course of the illness [1,2,3], whereas antipsychotic medication use reduces the risk of relapse markedly [4,5,6,7,8]. Poor adherence and negative attitudes to treatment are common clinical problems in psychiatry when treating psychotic disorders. Poor adherence to treatment is often noticed when the patient does not show up to an appointment or suffers a relapse. Recent review found negative attitudes toward medication to be the primary reason directly associated with intentional nonadherence [12]

Objectives

Methods

Results

Discussion

Conclusion