Lecomte Tania, Spidel Alicia, Leclerc Claude, MacEwan G William, Greaves Caroline, Bentall Richard P
University of Montreal, Canada.
Schizophr Res. 2008 Jul;102(1-3):295-302. doi: 10.1016/j.schres.2008.01.024. Epub 2008 Mar 4.
Treatment adherence in early psychosis individuals is considered problematic. Some studies have tried to understand reasons for medication non-adherence in this population, though few have also considered engagement in services. We conducted a cross-sectional study with 118 early psychosis individuals, assessing multiple constructs (symptoms, insight, personality traits, alliance, childhood trauma, substance abuse, social functioning and sociodemographics) suggested in the literature as potentially linked to medication adherence or engagement in services. Forward Wald logistic regression suggested that more positive symptoms, having witnessed violence as a child and high agreeableness as a personality trait predicted poor medication adherence. Forward linear regression revealed that physical abuse as a child, lack of knowledge regarding consumer rights, difficulties in building an alliance, low neuroticism and high agreeableness predicted poor service engagement. Profiles of non-adherers or low service engagement were strongly linked to childhood trauma, and high agreeableness, as well as more severe symptoms and poor alliance. Males with histories of legal problems were also more prevalent in both groups. No significant differences were found for insight or substance abuse. Overall, individuals with early psychosis who adhered less to treatment in general could have issues with trusting authority and place more importance on peer acceptance. Results are presented in light of the existing literature and clinical implications are discussed.
早期精神病患者的治疗依从性被认为存在问题。一些研究试图了解该人群药物治疗不依从的原因，不过很少有研究同时考虑其接受服务的情况。我们对118名早期精神病患者进行了一项横断面研究，评估了文献中提出的多种可能与药物治疗依从性或接受服务情况相关的因素（症状、自知力、人格特质、医患关系、童年创伤、药物滥用、社会功能和社会人口统计学因素）。向前Wald逻辑回归分析表明，阳性症状较多、童年目睹过暴力以及具有高宜人性人格特质预示着药物治疗依从性较差。向前线性回归分析显示，童年遭受身体虐待、缺乏消费者权益知识、建立医患关系困难、低神经质和高宜人性预示着接受服务情况较差。不依从或接受服务程度低的患者特征与童年创伤、高宜人性、更严重的症状以及不良医患关系密切相关。有法律问题史的男性在这两组中也更为普遍。在自知力或药物滥用方面未发现显著差异。总体而言，一般治疗依从性较差的早期精神病患者可能在信任权威方面存在问题，并且更看重同伴的认可。我们结合现有文献呈现了研究结果，并讨论了其临床意义。
