Patel Maxine X, de Zoysa Nicole, Bernadt Morris, David Anthony S
Division of Psychological Medicine, Institute of Psychiatry, King's College London, Box 68, De Crespigny Park, London SE5 8AF, UK.
J Clin Psychiatry. 2008 Oct;69(10):1548-56. doi: 10.4088/jcp.v69n1004. Epub 2008 Sep 23.
Antipsychotic depot medications improve medication adherence by reducing covert nonadherence, but some clinicians believe that they are unacceptable to patients. This cross-sectional study investigated patients' perspectives on factors influencing adherence to antipsychotics, from both those taking depots and those taking tablets in ongoing voluntary outpatient care. The study is novel in also encompassing such factors as injection phobia and perceived coercion regarding medication in relation to self-reported adherence.
Seventy-three patients with schizophrenia/schizoaffective disorder (ICD-10 criteria) completed structured clinical interviews that included the Rating of Medication Influences (ROMI) scale as well as instruments that assessed patients' functioning, psychopathology, insight, extrapyramidal symptoms, quality of life, needle anxiety, experience of coercion, and beliefs about medication.
Participants taking depot (vs. oral) medication had higher ROMI noncompliance mean scores (15.7 vs. 14.4, p = .019). Predictive factors for influences on noncompliance included certain beliefs regarding medication (concern and overuse) but not extrapyramidal symptoms. There were no differences between the 2 formulation groups on the ROMI compliance subscale. Further predictive factors associated with influences on compliance included perceived necessity.
Previously, side effects were considered to be a reason for nonadherence to depot more than for oral medications, but our findings do not support this. Rather, beliefs and attitudes are more important than side effects in predicting self-reported adherence and influencing factors thereof. Prescribing a depot medication to enhance relapse prevention will not in itself ensure adherence and therefore must also be accompanied by discussion regarding adherence and associated personal benefits.
抗精神病长效针剂通过减少隐性不依从性来提高药物依从性，但一些临床医生认为患者难以接受。这项横断面研究调查了在持续的自愿门诊护理中，服用长效针剂和片剂的患者对影响抗精神病药物依从性因素的看法。该研究的新颖之处还在于纳入了诸如注射恐惧症以及与自我报告的依从性相关的药物感知强迫等因素。
73例符合精神分裂症/分裂情感性障碍（国际疾病分类第10版标准）的患者完成了结构化临床访谈，其中包括药物影响评定量表（ROMI）以及评估患者功能、精神病理学、洞察力、锥体外系症状、生活质量、针头焦虑、强迫体验和药物信念的工具。
服用长效针剂（与口服药物相比）的参与者ROMI不依从性平均得分更高（15.7对14.4，p = 0.019）。影响不依从性的预测因素包括对药物的某些信念（担忧和过度使用），但不包括锥体外系症状。两组在ROMI依从性子量表上没有差异。与依从性影响相关的进一步预测因素包括感知必要性。
以前，副作用被认为是长效针剂不依从的原因比口服药物更多，但我们的研究结果不支持这一点。相反，在预测自我报告的依从性及其影响因素方面，信念和态度比副作用更重要。开具长效针剂以增强预防复发本身并不能确保依从性，因此还必须同时讨论依从性及相关的个人益处。
