Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstr. 7, 80336 Munich, Germany.
J Psychiatr Res. 2009 Dec;43(16):1294-301. doi: 10.1016/j.jpsychires.2009.05.003. Epub 2009 Jun 7.
Purpose of the present study was to assess the attitude towards adherence at discharge and to verify its predictability using anamnestic and sociodemographic variables, factors influencing clinical treatment as well as the medical treatment applied.
Attitude towards adherence was evaluated in 369 inpatients with schizophrenic spectrum disorders within a naturalistic multicenter trial using the Compliance Rating Scale (CRS) by Kemp. Biweekly ratings of the PANSS, UKU and the Subjective Well-being under Neuroleptic Treatment Scale (SWN-K) were applied. Logistic regression and CART analyses were used to determine significant predictor variables for the attitude towards adherence at discharge.
Sixty-seven percent of the patients were rated to have an attitude of active participation and moderate participation (=positive attitude towards adherence) and 33% of the patients to have an attitude of passive acceptance, occasional or permanent reluctance towards treatment as well as refusing treatment (=negative attitude towards adherence). A significant correlation was found between patients with a positive attitude towards adherence and course of all PANSS subscales. Statistical analyses revealed a reduction in PANSS general psychopathology subscore, employment status, greater illness insight and treatment with atypical antipsychotics to be significantly predictive for a positive attitude towards adherence at discharge.
The importance of an adequate antipsychotic treatment as a precondition for a favourable adherence attitude and the need to incorporate adherence-focused psychotherapy and psychoeducation into daily clinical practice are highlighted.
本研究旨在评估出院时的遵医态度，并通过病史和社会人口学变量、影响临床治疗的因素以及所应用的治疗方法来验证其可预测性。
在一项自然主义的多中心试验中，我们使用 Kemp 的依从性评定量表（CRS）评估了 369 例精神分裂症谱系障碍住院患者的遵医态度。每周两次评定 PANSS、UKU 和神经阻滞剂治疗下的主观幸福感量表（SWN-K）。采用逻辑回归和 CART 分析确定出院时遵医态度的显著预测变量。
67%的患者被评定为具有积极参与和适度参与的态度（=遵医态度积极），33%的患者具有被动接受、偶尔或持续抗拒治疗以及拒绝治疗的态度（=遵医态度消极）。遵医态度积极的患者与所有 PANSS 子量表的病程呈显著相关。统计分析显示，PANSS 一般精神病学子量表评分降低、就业状况、更高的疾病认识和使用非典型抗精神病药物治疗对出院时的遵医态度具有显著预测作用。
强调了充分的抗精神病治疗作为良好遵医态度的前提的重要性，以及将以遵医为重点的心理治疗和心理教育纳入日常临床实践的必要性。
