Insight and attitudes towards medication among inpatients with chronic schizophrenia in the US and China

Abstract

The impact of culture on insight on illness and attitudes towards medication among patients with schizophrenia has not been well studied. We compared inpatients in the US and in China (a culture that numerous studies have shown heavily stigmatizes mental illness and psychosis), on measures of insight and acceptance of medication, controlling for overall severity of schizophrenia symptoms. Clinical antipsychotic treatment for intervention effectiveness (CATIE) was a large study of pharmacotherapy of people with schizophrenia across the US. Insight was measured using the insight and treatment attitudes questionnaire (ITAQ) and attitudes towards medication by the drug attitude inventory (DAI) and symptoms of schizophrenia by the Positive and Negative Syndrome Scale (PANSS). These measures were applied to a sample of hospitalized patients diagnosed with schizophrenia at the Guangzhou Psychiatric hospital, the largest psychiatric hospital in Southern China. Mean ITAQ and DAI scores, net of total schizophrenia symptoms and other differences were compared at the time of admission using analysis of covariance. Both insight and favourable attitudes towards medication were significantly and substantially lower in the sample from Guangzhou on bivariate analysis even after adjusting for severity of overall schizophrenia symptoms on the PANSS. Inpatients in China had far lower scores on measures of insight and acceptance of their need for and benefits of medication, controlling for overall severity of schizophrenia symptoms, suggesting a significant impact of Chinese culture which is presumed to more heavily stigmatize mental illness and especially psychosis, although other explanations can not be ruled out.