Drug Attitude Inventory Research Articles

Factors associated with pharmacological and psychotherapy treatments adherence in patients with borderline personality disorder.

Borderline personality disorder is a major mental illness characterized by sustained relationship instability, impulsive behavior, and intense affects. Adherence is a complex behavior, from minor refusals to abandonment of treatment, which can be affected by various factors. Therefore, the present study aimed to investigate the factors affecting pharmacological and psychotherapy adherence, patients' attitude toward medication, and assessing medication and treatment adherence in patients with borderline personality disorder referred to an outpatient referral clinic in Tehran, Iran. The study was a cross-sectional study. The files of patients with borderline personality disorder referred to the outpatient clinic of the Tehran Psychiatric Institute were reviewed as the first step. Data were collected using the Drug Attitude Inventory-10 (DAI-10) questionnaire and a questionnaire to determine the attitude of patients toward pharmacological and psychotherapy treatment as well as therapeutic adherence. After collecting data, patients' therapeutic adherence was divided into poor, partial, and good compliance. Ninety-four patients were involved in the study, and fifty-four were women. Findings of DAI showed that 54 (57.4%) participants had negative attitudes toward medication, while 38 (40.4%) participants showed a negative attitude toward psychotherapy treatment. Additionally, the percentage of patients with good psychotherapy adherence (44.7%) was higher than that of patients with good medication adherence (31.9%). The most common reasons for discontinuation of treatment were medication side effects (53.1%), dissatisfaction with the therapist (40.3%), and then fear of medication dependence (40%). Patients with higher education levels and a positive history of hospitalization in a psychiatric ward had better adherence to psychotherapy (P < 0.05). Results of the current study show that attitude toward psychotherapy is more favorable than pharmacotherapy among patients with BPD. The rationale may be that medications are mainly prescribed for comorbid conditions and do not have substantial effects on the BPD symptoms, resulting in low medication adherence.

Pathways of care and attitudes toward psychotropics in patients with depressive disorders and psychotic disorders.

Delay in institution of appropriate mental healthcare is closely linked with attitudes, stigma, and availability of services, which further directs the help seeking pathways. This study was aimed to assess the pathway of care and attitudes toward psychotropic medications among patients with depressive disorder and psychotic disorders. Eighty outpatients with depressive disorder and 40 patients with psychotic disorder were assessed in a tertiary care center for pathways to care and attitude toward psychotropics through Attitude toward Psychotropic Medications Questionnaire and Drug attitude inventory-10. The psychiatrist remained the most common first treatment contact (46% in depression and 62% in psychosis). Greater number of patients in psychotic disorder group had first treatment contact with faith healers or exorcist (17.5%), compared to depressive disorder (6.2%). Patients in depressive group had more favorable attitude toward psychotropics compared to psychosis group. Majority of patients had favorable attitude toward psychotropic medications, but they also had substantial misconceptions about side effects, utility, and need of taking lesser than prescribed doses. Although majority of patients had favorable attitude, they also had substantial misconceptions about medications. These issues need to be addressed for better delivery of comprehensive mental healthcare.

Factors Affecting the Family Attitude Toward the Outpatients With Schizophrenia

Objectives: To identify various factors that might affect a high expressed emotion recognized by primary caregivers of the schizophrenic outpatients.Methods: Of patients who had been receiving outpatient treatments at department of psychiatry of Dong-A university hospital, 154 patients with a DSM-V diagnosis of schizophrenia with stable symptoms and their primary caregivers were enrolled in this study. Family attitude (family attitude scale) was assessed through an interview with primary caregivers. In these patients, symptoms (brief psychiatric rating scale), problem behavior (behavior and symptom identification scale), general health status (shortform 36 health survey), recovery (recovery assessment scale), drug attitude (drug attitude inventory), insight (self-appraisal of illness questionnaire) were assessed through a self reporting questionnaire. Multiple regression analysis were performed in consideration of 15 factors (age, sex, the level of education, marital status, job status, age of onset, duration of illness, number of hospitalization, chlorpromazine equivalent dose, symptoms, problem behavior, general health status, recovery, drug attitude, insight) as explanatory variables for a family attitude.Results: On a multiple regression analysis, the following five factors were found to be significant explanatory variables for a family attitude that is experienced by primary caregivers of the schizophrenic outpatients: job status, duration of illness, number of hospitalization, problem behavior, and drug attitude. A coefficient of determination for these five explanatory variables was 0.58. The high expressed emotion group had significantly higher number of hospitalizations and problem behavior, but lower employment, poorer genral health status, negative drug attitude, and lack of insight compared to the low expressed emotion group.Conclusion: Our results showed that five factors such as job status, duration of illness, number of hospitalization, problem behavior, and drug attitude were found to be significant explanatory variables for family attitude that is experience by primary caregivers of the schizophrenic outpatients. Because these five variables account for 58% of total family attitude, however, further studies are needed to identify other factors that might affect a family attitude.

Association between functional recovery and medication adherence in schizophrenia.

Medication adherence is important for achieving functional recovery from schizophrenia and is commonly assessed using the Drug Attitude Inventory-30 (DAI-30). Subscales of the DAI-30, including "awareness of the need for medication," "awareness of the effects of psychiatric drugs," and "impression of medication," have been used to assess medication adherence. To determine which of these subscales are associated with the prognosis of schizophrenia, this study followed patients with schizophrenia to identify the prognosis and examine the subscales related to "recovery." In total, 89 patients were recruited, 78 of whom were registered in the study. After assessing adherence using the DAI-30, Positive and Negative Syndrome Scale and Global Assessment of Functioning scores were assessed at 0 and 24week to define the functional prognosis. At the end of the 24-week follow-up period, 36% of patients showed recovery from schizophrenia. A comparison of subscales revealed that the score for "impression of medication" was significantly higher in the recovery than in the non-recovery group. Logistic regression analysis identified only the "impression of medication" score as being predictive of recovery. The results indicated that among the three DAI-30 subscales, "impression of medication" was the most closely associated with recovery in patients with schizophrenia.

Medication Adherence, Attitude Towards Medication, and Quality of Life in Outpatients With Neurotic Disorders in Tehran, Iran: A Six-Month Follow-up Study

Objectives This study aims to investigate the attitude towards medication, medication adherence, and quality of life (QoL) in outpatients with neurotic disorders referred for the first time to the psychiatric clinic of Tehran Psychiatric Institute in Iran. Methods In this study, participants were adult outpatients with neurotic disorders referred to the psychiatric clinic of Tehran Psychiatric Institute for the first time, who had met the inclusion criteria (age 18-60 years, having a neurotic disorder diagnosed by the psychiatrist, and consent to participate in the study). At baseline and in one and six months after the first visit, they completed a demographic form, the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and the drug attitude inventory (DAI-10). Their medication adherence was assessed using the medication possession ratio. Results Of 100 participants, 76 were females and had a mean age of 35.9 years. Favorable medication adherence significantly increased in the sixth month compared to the first month, and the number of patients with favorable medication adherence increased from 38 to 63. In comparing the overall score of QoL, a significant improvement was observed in the 1st and 6th months compared to baseline and in the sixth month compared to the first month (P&lt;0.001). Regarding the domains of the QoL, mental health and general health in the first and sixth months were significantly increased compared to the baseline (P&lt;0.001). Physical health domain was significantly increased in the sixth month compared to the first month (P&lt;0.001). Social relationships domain was significantly increased in the first month compared to the baseline (P= 0.001). Environmental health domain was significantly increased in the first month compared to the baseline (P=0.019). Comparison of the QoL score between patients with favorable and unfavorable medication adherence showed no significant difference (P=0.6). Attitude towards medication was significantly improved from baseline to the sixth month (P&lt;0.001). Conclusion The QoL and its some domains as well as medication adherence and attitude towards medication in outpatients with neurotic disorders seem to be improved after six months of follow-up. There is no significant difference in QoL between outpatients with favorable and unfavorable medication adherence.

Explanatory Models and their Relationship with Drug Attitude in Patients with Depression in South India.

The patient's understanding of the illness may mediate beliefs towards its treatment. There is a paucity of studies examining the relationships between these variables in depression. This study was conducted to know the relationships between explanatory models and attitude to medication in depression. 494 patients with depression in remission were assessed with sociodemographic proforma, Drug Attitude Inventory, and Mental Distress Explanatory Model Questionnaire. A favorable attitude toward medication was observed in 57.49% of participants. Mean scores on MDEMQ subscales Stress, Western Physiology, Non-Western Physiology, and Supernatural were 32.96, 21.87, 10.06, and 47.55, respectively. Statistically significant associations were found between attitude towards medication and the patient's marital status (more negative attitude with single status, χ2 = 11.72, df = 3, P = 0.008) and occupation (more negative attitude among unemployed patients, χ2 = 4.17, df = 1, P = 0.041). The scores of explanatory models did not differ based on positive or negative drug attitude. Though explanatory models are not linked to patient attitudes toward medication, patients who are single or unemployed have a negative attitude toward medications. Such negative attitude may impair compliance and worsen patient outcomes.

Impact of diabetes-related knowledge and medication adherence on quality of life among type 2 diabetes patients in a tertiary health facility in Multan, Pakistan

Purpose: To assess the impact of drug adherence and diabetes-related knowledge on the quality of life (QoL) of type 2 diabetes patients in a hospital in Pakistan.Methods: A cross-sectional study was conducted in City Hospital, Multan, Pakistan between March and September 2020. A total of 151 patients diagnosed with type 2 diabetes mellitus (T2DM) were recruited. Medication adherence, diabetes-related knowledge, and QoL were assessed by Drug attitude inventory-10 (DAI-10), the Michigan Diabetes Knowledge Test (MDKT), and EQ-5D-3L tools, respectively. The association between sociodemographic data and study variables was assessed by independent t-test and one-way ANOVA.Results: Among the 151 patients, 53 % were males. The mean MDKT score was 0.33 ± 0.18, indicating poor knowledge of diabetes. An overall moderate level of adherence was observed among the participants (mean adherence score, 6.14 ± 1.39). Mean QoL score was 1.31 ± 0.28, and the Visual Analog Scale score (VAS) was 59.6 ± 12.21, indicating a good to moderate QoL among the study participants. Study participants with a longer duration of diabetes and poor adherence to their medications showed poor QoL (p = 0.01, p = 0.004 respectively).Conclusion: Overall, the patients reported poor knowledge, moderate adherence, and good to moderate QoL. Moreover, patients with poor adherence to medication, longer duration of diabetes, and poorly controlled HbA1c showed poor QoL.

The effect of Working Alliance on drug attitude in patients with Major Depressive Disorder

IntroductionWorking Alliance is defined as the emotional bond and the agreement on therapeutic goals and tasks between patients and therapists. Despite the wide use of the construct of working alliance in research on psychotherapy, few studies have investigated the role of working alliance in influencing adherence to pharmacotherapy, and drug attitude. A deeper knowledge of the interplay between working alliance and drug attitude could help to challenge low adherence to psychopharmacological treatments in Major Depressive Disorder.ObjectivesThis study aimed to investigate the relationship between working alliance and drug attitude in patients with Major Depressive Disorder.Methods27 patients admitted in the Psychiatric Unit of Careggi with diagnosis of Major Depressive Disorders were enrolled. Working Alliance Inventory - patient version (WAI-P), Drug Attitude Inventory (DAI) and Beliefs about Medicines (BMQ) were administered. Pearson’s correlation was used to assess relationships between variables.ResultsA significant positive correlation was detected between BMQ total scores, DAI total scores and WAI-P task, bond, and goal subscales.Correlations between WAI-P subscales and BMQ and DAI total scores DAI total scores BMQ total scoresrprpWAI-P task0.5510.0030.6130.001WAI-P bond0.4300.0010.5600.004WAI-P goal0.6210.0010.6030.002ConclusionsSuch preliminary data suggest a relationship between Working Alliance and drug attitude. This could contribute to provide tools to challenge low adherence to psychopharmacological treatments in patients with Major Depressive Disorder.DisclosureNo significant relationships.

Role of DSM5 Anxious Distress Specifier Interview in symptoms severity and medication adherence in 1st episode mania

Introduction-Anxious Distress Specifier is one of the newly added specifier in diagnosis and managment of bipolar disorder.This unique item may paly a role in not only the symptoms severity but also the degree of adherence to the psychotropics. -DSM5 Anxious distress specifier is not well studied in the 1st manic episode of bipolar disorder.Objectives1-To study the role of DSM5 Anxious Distress Specifier in the symptoms severity of 1st diagnosed manic episode 2-To investigate its role in medication adherence in thses patientsMethods1-DSM 5 Anxious distress specifier interview which includes 5 items : a- Keyed up or tense b-Restlessness c-Impaired concentration. d-Sense of foreboding e-Loss of control 2-The Young Mania Rating Scale (YMRS) is one of the most frequently utilized rating scales to assess manic symptoms. The scale has 11 items and is based on the patient’s subjective report of his or her clinical condition 3-Drug Attitude Inventory:consists of a questionnaire that is completed by the patient, pertaining to various aspects of the patient’s perceptions and experiences of treatment.Results1-There is a positive correlation between the mean score of Young mania Rating scale in 1st episode manic patients and the mean score of DSM5 Anxious Distress specifier Interview 2-The presence of high score of DSM5 Anxious Distress Specifier Interview is positively correlated to the mean score of Drug Attitude Inventory during the follow up visits after controlling the 1st episode maniaConclusionsThe presence of high levels of Anxious Distress in the 1st episde mania affected the symptoms severity and medication adherenceDisclosureNo significant relationships.

Psychometric properties of Drug Attitude Inventory among patients with schizophrenia.

BackgroundThe treatment of patients diagnosed with schizophrenia has remained three-fold physical (pharmacological), psychological and social. Furthermore, the need to monitor adherence to the physical aspect of treatment has been a major concern to mental health practitioners as this usually affects the success of psychological and social treatment.AimMy study aimed to determine the psychometric properties of Drug Attitude Inventory (DAI) among patients with schizophrenia. The study was carried out at the Neuropsychiatric Hospital, Aro Abeokuta Ogun State and on an average, about 150 patients were seen daily at the outpatient clinic.MethodsInternal consistency, item-total correlation (the two-way mixed method with absolute agreement) and Cronbach’s alpha were evaluated using an intra-class correlation coefficient (ICC). This instrument’s level of adequacy was determined using factor analysis (principal component analysis with varimax rotation).ResultMarital status and level of education were significantly associated with adherence. The Cronbach’s alpha was 0.56 and principal components factor analysis with varimax rotation produced a three-factor solution.ConclusionMy study has shown that the DAI is a valid and reliable instrument and can be used in a clinical setting where there are limitations with time such as the outpatient clinic.

Effectiveness of group metacognitive training and cognitive-behavioural therapy in a transdiagnostic manner for young patients with psychotic and non-psychotic disorders.

To investigate group metacognitive training and cognitive-behavioural therapy (MCT/CBT) prospectively in a young population with various psychiatric disorders, including psychotic and mood disorders. This was a prospective study to investigate the effectiveness of group MCT/CBT on quality of life, psychotic symptoms, depression, self-esteem, perceived stress, social function and social cognition. The objective measures included the Positive and Negative Syndrome Scale (PANSS), clinical global impression (CGI), personal and social performance scale for social functioning, a computerized continuous performance test for sustained attention and a computerized emotional recognition test for social cognition. Self-report measures administered included the Subjective Well-being under Neuroleptics for quality of life, Ambiguous Intentions Hostility Questionnaire for suspiciousness, Drug Attitude Inventory, Beck Depression Inventory, Perceived Stress Scale, Brief Resilience Scale, Rosenberg Self-esteem Scale and visual analogue scale for the EQ-5D. Among 110 young patients with early psychosis and mood disorders who participated, 82 (74.5%) completed the study. Social functioning, quality of life, self-esteem, resilience, depression, suspiciousness, social cognition, sustained attention and scores on the PANSS and CGI improved significantly after completing group MCT/CBT. Perceived stress, resilience and suspiciousness improved significantly only in participants with a non-psychotic disorder. Improvements in subjective well-being of the participants were associated with increases in self-esteem and resilience and decreases in depression and perceived stress. Our study showed that group transdiagnostic MCT/CBT for young patients with mental illness improved subjective wellbeing, self-esteem, resilience, social cognition and social functioning and significantly diminished suspiciousness, perceived stress and depression.

The drug attitude inventory used in long-term patients in Kamenge neuropsychiatric center

The drug attitude inventory used in long-term patients in Kamenge neuropsychiatric center

The Role of Attitudes Toward Medication and Treatment Adherence in the Clinical Response to LAIs: Findings From the STAR Network Depot Study.

Background: Long-acting injectable (LAI) antipsychotics are efficacious in managing psychotic symptoms in people affected by severe mental disorders, such as schizophrenia and bipolar disorder. The present study aimed to investigate whether attitude toward treatment and treatment adherence represent predictors of symptoms changes over time.Methods: The STAR Network “Depot Study” was a naturalistic, multicenter, observational, prospective study that enrolled people initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centers were assessed at three time points: baseline, 6-month, and 12-month follow-up. Psychopathological symptoms, attitude toward medication and treatment adherence were measured using the Brief Psychiatric Rating Scale (BPRS), the Drug Attitude Inventory (DAI-10) and the Kemp's 7-point scale, respectively. Linear mixed-effects models were used to evaluate whether attitude toward medication and treatment adherence independently predicted symptoms changes over time. Analyses were conducted on the overall sample and then stratified according to the baseline severity (BPRS < 41 or BPRS ≥ 41).Results: We included 461 participants of which 276 were males. The majority of participants had received a primary diagnosis of a schizophrenia spectrum disorder (71.80%) and initiated a treatment with a second-generation LAI (69.63%). BPRS, DAI-10, and Kemp's scale scores improved over time. Six linear regressions—conducted considering the outcome and predictors at baseline, 6-month, and 12-month follow-up independently—showed that both DAI-10 and Kemp's scale negatively associated with BPRS scores at the three considered time points. Linear mixed-effects models conducted on the overall sample did not show any significant association between attitude toward medication or treatment adherence and changes in psychiatric symptoms over time. However, after stratification according to baseline severity, we found that both DAI-10 and Kemp's scale negatively predicted changes in BPRS scores at 12-month follow-up regardless of baseline severity. The association at 6-month follow-up was confirmed only in the group with moderate or severe symptoms at baseline.Conclusion: Our findings corroborate the importance of improving the quality of relationship between clinicians and patients. Shared decision making and thorough discussions about benefits and side effects may improve the outcome in patients with severe mental disorders.

Satisfaction Survey on Antipsychotic Formulations by Schizophrenia Patients in Japan.

ObjectiveTo identify factors affecting adherence to medication, a subjective questionnaire survey was administered to schizophrenia patients regarding the prescribed antipsychotic formulations.MethodsWe evaluated the patients’ satisfaction and dissatisfaction with prescribed antipsychotic formulations, and patients answered the Drug Attitude Inventory-10 Questionnaire (DAI-10). Inclusion criteria for patients are as follows age between 20 and 75 years and taking antipsychotic agents containing the same ingredients and formulations, for at least 1 month.ResultsIn total, 301 patients answered the questionnaire survey. Tablets were found to be the most commonly used antipsychotic formulations among schizophrenia patients (n = 174, 57.8%), followed by long-acting injections (LAIs, n = 93, 30.9%). No significant differences in the formulation satisfaction level and DAI-10 scores were observed between all formulations. Formulations, except for LAI, were selected by physicians in more than half of the patients. Patients who answered “Decided by consultation with physicians” had significantly higher satisfaction levels and DAI-10 scores compared to those who answered “Decided by physicians” (4.11 ± 0.77 vs. 3.80 ± 1.00, p = 0.0073 and 6.20 ± 3.51 vs. 4.39 ± 4.56, p < 0.001, respectively). Satisfaction levels moderately correlated with DAI-10 scores (r = 0.48, p < 0.001).ConclusionNo formulation had a high satisfaction level in all patients, and it is important to be reflect the patients’ individual preferences in pharmacotherapy. Shared decision-making in the selection of the formulations is seen to be useful for improving medication adherence.

Alcohol-Induced Psychotic Disorder and Depressive Disorder: a Dual Diagnosis Case Series

Alcohol-induced psychotic disorder (AIPD) is a diagnosis in the ICD 10. Previous studies of AIPD do not appear to have reported the co-morbid presence of depressive disorder in either prevalence studies or treatment studies. Five cases are presented with a dual diagnosis of AIPD and depressive disorder. These cases were assessed using the Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression Severity score (CGI-S), Clinical Global Impression Improvement score (CGI-I), Drug Attitude Inventory 10 (DAI 10), Short Assessment Personality-Abbreviated Scale (SAPAS) and Modified Sainsbury Tool. Antidepressants and antipsychotics were chosen based on drug attitude scores from DAI 10. Cases demonstrate inpatient and outpatient treatment with good treatment outcomes after six months. Three cases demonstrate suicide risk. The majority did not have a personality disorder. These cases highlight the importance of treating a depressive disorder in AIPD and of tailored medication treatments for poor medication compliance.

Identifying Poor Adherence in Outpatients with Bipolar Disorder: A Comparison of Different Measures.

Objective Unlike schizophrenia, comparisons of different methods of estimating inadequate adherence in bipolar disorder (BD) are scarce. This study compared four methods of identifying inadequate adherence among outpatients with BD. Materials and Methods Two self-reports, the Morisky Medication Adherence Questionnaire (MAQ) and the Drug Attitude Inventory (DAI-10), clinician ratings employing the Compliance Rating Scale (CRS), mood-stabilizer levels, and clinic-based pill counts were compared at intake in 106 outpatients with BD and after 6 months of follow-up ( n = 75). Statistical Analysis Rates of nonadherence were determined for each method. The ability to detect inadequate adherence was based on sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR positive and LR negative). Correlation coefficients and Cohen's kappa values were used to determine the agreement between measures. Correlation coefficients were also used to evaluate the determinants of inadequate adherence Results The MAQ and the DAI-10 (cut-off score of two) yielded higher rates of nonadherence (35–47%) than the other methods. They were better at detecting adherence (specificity, 34–42%; PPV, 40–44%; and LR negative, 0.70–0.96) than other measures and had moderate ability to identify nonadherence compared with them (sensitivity, 63–73%; NPV, 54–70%; and LR positive, 1.02–1.16). They were associated with several established predictors of nonadherence. The MAQ and DAI-10 scores and the MAQ and CRS scores were modestly correlated. Multivariate analysis showed that 20% of the variance in the DAI-10 scores was explained by the MAQ scores. Despite their low yield, serum levels had a high sensitivity (88%) and higher accuracy (55%) in identifying inadequate adherence. CRS ratings and pill counts had high sensitivity but low specificity to detect inadequate adherence. Conclusion Self-reports appeared to be the most efficient method of ascertaining inadequate adherence among outpatients with BD. However, since none of the measures were adequate by themselves, a combination of different measures is more likely to maximize the chances of identifying inadequate adherence among these patients.

Effects of Adherence to Pharmacological Treatment on the Recovery of Patients with Schizophrenia.

The aim of this study was to evaluate the effects of adherence to antipsychotic treatment on the recovery of patients with schizophrenia in northern Chile. One hundred and fifty-one patients diagnosed with schizophrenia completed the Drug Attitude Inventory (DAI-10), Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Recovery Assessment Scale (RAS-24), sociodemographic information, and clinical and treatment characteristics of patients with schizophrenia. Multivariate analysis with multiple linear regression was then performed to identify variables that were potentially associated with the recovery assessment (variable criterion). A significant association was found between adherence to antipsychotic medication and the Willing to Ask for Help dimension of Recovery (β = 0.239, p = 0.005). Association of clinical and socio-demographic variables with recovery were identified: negative symptoms with Personal Confidence and Hope (β = −0.341, p = 0.001) and Goal and Success Orientation (β = −0.266, p = 0.014); cognitive symptoms with Willing to Ask for Help (β = −0.305, p = 0.018) and no domination by symptoms (β = −0.351, p = 0.005); marital status with reliance on others (β = −0.181, p = 0.045); age with Personal Confidence and Hope (β = −0.217, p = 0.021), Goal and Success Orientation (β = −0.296, p = 0.003), and no domination by symptoms (β = 0.214, p = 0.025). Adherence has a positive relationship with personal recovery in this sample of Chilean patients with schizophrenia.

The Effect of Therapeutic Alliance on Attitudes Toward Psychiatric Medications in Schizophrenia.

The differential influence of therapeutic alliance with different health care professionals on patients' medication adherence has never been examined. Ninety-five stable outpatients (91 patients with schizophrenia and 4 patients with schizoaffective disorder) were recruited. Individual, clinical, and medication factors were assessed, along with drug attitude (10-item Drug Attitude Inventory). Comparison on these factors was made between outpatients who identified psychiatrists as the health care professional most involved in their care, as compared with other health care professionals. Older age, longer duration of illness, presence of medical comorbidities, lower levels of internalized stigma, higher levels of insight, higher levels of functioning, lesser severity of depressive symptoms, and positive symptoms were found to be significantly associated with greater levels of drug attitude (small to moderate associations). Only therapeutic alliance had a large correlation with drug attitude (ρ = 0.503, P < 0.001). The therapeutic alliance scores between the 2 health care professionals groups are not significantly different. However, participants who have identified psychiatrists as the health care professional that contributed the most to their recovery reported a significantly more positive attitude (μ = 6.18, SD = 3.42) toward psychiatric medication as compared with the other health care professionals group (μ = 3.11, SD = 5.32, P = 0.004). Only 2 factors, the Revised Helping Alliance Questionnaire (β = 0.424, P < 0.001) and Personal and Social Performance scale (β = 0.272, P = 0.006), were statistically significant predictors of drug attitude. Therapeutic alliance is found to be the lead factor associated with drug attitude in patients with schizophrenia. Identifying psychiatrists as the health care professional most involved in the patients' recovery can greatly increase patients' drug attitudes. Maintaining individuals' functioning also contributes to drug attitude.

Sleep quality and adherence to medical therapy among hemodialysis patients with depression: a cross-sectional study from a developing country

AimsDepression is a fairly common finding among end-stage renal disease (ESRD) patients on hemodialysis and is an independent risk factor for morbidity and mortality. The psychiatric manifestations of the disease may affect their compliance to medications and alter sleep quality that is often overlooked by nephrologists. This translates into poor quality of life and poorer disease prognosis. Thus, Our study aims to assess the prevalence of depression and its association with compliance to medical therapy and sleep quality among ESRD patients on hemodialysis.MethodIn this cross-sectional study, a total of 288 hemodialysis patients with a confirmed diagnosis of ESRD were evaluated for depression using Patient Health Questionnaire-9 (PHQ-9) scale. Only the patients with moderate to severe depressive symptoms on PHQ-9 were further evaluated for sleep quality and compliance to medications using the Pittsburgh Sleep Quality Index (PSQI) and Drug Attitude Inventory-10 (DAI-10) respectively. The characteristics of ESRD patients with depression were also assessed. Median PHQ-9, DAI-10, and PSQI scores were calculated and the correlation between study variables was assessed using spearman's correlation.ResultOf the 288 included participants, 188 (65.27%) had depression as evaluated via PHQ-9. Of these 188 patients, 114 were males while 74 were females. A total of 113 (60.01%) of the depressed patients had poor compliance with medication while 137 (72.87%) patients had poor sleep quality. Higher PHQ-9 scores were positively correlated with disease duration, dialysis years, and time between diagnosis and therapy (r = 0.41, 0.39, and 0.43 respectively) and negatively with marital and employment status (r = −0.32 and −0.49 respectively). Spearman's correlation matrix showed that PHQ-9 scores were negatively correlated with DAI-10 but positively correlated with PSQI scores.ConclusionThe study indicates a high prevalence of depression among ESRD patients on hemodialysis. Poor sleep quality and non-adherence to medications are extremely common among ESRD patients with depression. These psychiatric components must be considered to optimize medical treatment and improve the quality of life in this subset of patients.

Patients\u2019 perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors

PurposeThe present study investigates perceived coercion in psychiatric inpatients under prescribed antipsychotic medication without a court order. The objective of this study was to investigate whether and to what extent involuntary and voluntary inpatients feel coerced to take their medication and which factors affect perceived coercion.MethodsVoluntarily and involuntarily admitted patients (55 and 36, respectively) were interviewed about the extent of perceived coercion. In addition, socio-demographic and clinical data were collected. The Admission Experience Scale (aAES) was used to assess perceived coercion concerning medication. To measure insight into illness, attitude towards medication, and symptom severity, we used a questionnaire on insight into illness (FKE-10), the Drug Attitude Inventory (DAI-10), and the Brief Psychiatric Rating Scale (BPRS-24), respectively.ResultsVoluntarily treated patients experienced significantly less coercion when taking prescribed medication in inpatient settings than involuntarily treated patients. The experience of coercion was not related to socio-demographic or clinical variables nor to the BPRS-24 score, but to insight into illness and attitude towards medication. Patients who had experienced at least one coercive measure during the index hospital stay showed a higher level of perceived coercion.ConclusionPerceived coercion related to medication is dependent on insight into illness and experience of previous coercive interventions rather than on the severity of psychopathological symptoms. These findings are very similar to a previous study in a forensic psychiatric sample. Having experience of at least one coercive measure seems to be a decisive aspect of the extent of the patients’ perceived coercion.