Department of Psychiatric Outpatient Treatment, Psychiatric University Hospital of Basel, Claragraben 95, CH-4057 Basel, Switzerland.
Psychiatry Res. 2011 May 15;187(1-2):55-61. doi: 10.1016/j.psychres.2010.10.012. Epub 2010 Nov 12.
Knowledge regarding socio-demographic and clinical risk factors of medication nonadherence does not always help in addressing adherence in individual patients. Classifying patients according to subjective adherence influencing factors may aid practitioners in choosing adequate strategies for improving medication adherence. A total of 171 outpatients with schizophrenia and schizoaffective disorder were classified according to factors influencing their medication adherence assessed using the Rating of Medication Influences Scale. Additionally, psychotic symptoms, depression, and insight, also known to influence pharmacological treatment motivation, were assessed. A cluster analysis yielded 3 groups that were distinguished both by the relative ranking of adherence influences and by specific associations with risk factors of nonadherence. For the "Interpersonal, Future-oriented Group" (n=59, 35% of the sample), interpersonal factors (positive therapeutic relationship, positive attitudes of significant others towards medication), immediate positive consequences of the medication intake (daily benefits, no perceived pressure to take medication), and avoiding future negative consequences of non-compliance, such as relapse and re-hospitalization, were essential for adherence. The "Autonomous, Future-oriented Group" (n=69, 40% of the sample) appraised interpersonal factors as being less important as compared to the other groups. This group exhibited significantly fewer depressive symptoms than the first group and had significantly more stable partnerships as compared to the other groups. The "Autonomous, Present-oriented Group" (n=43, 25% of the sample) was mainly motivated by immediate positive consequences and displayed higher levels of cognitive disorganization and negative symptoms than the second group, as well as the lowest level of insight of all groups. Treatment strategies addressing adherence enhancement in schizophrenia may profit by considering both the patient's subjective adherence attitude profile as well as the specific pattern of risk factors for nonadherence including depression, lack of insight, negative syndrome, cognitive disorganization and socio-demographic factors, which are differentially associated with each adherence attitude profile.
关于社会人口学和临床药物治疗不依从风险因素的知识，并不总是有助于解决个体患者的药物治疗依从性问题。根据影响药物治疗依从性的主观因素对患者进行分类，可能有助于临床医生选择适当的策略来提高药物治疗依从性。共对 171 名精神分裂症和分裂情感障碍的门诊患者进行了分类，分类依据是使用药物影响评定量表评估的影响药物治疗依从性的因素。此外，还评估了影响药物治疗动机的精神病症状、抑郁和洞察力。聚类分析产生了 3 个组，这些组不仅通过药物治疗依从性影响因素的相对排名，而且通过与药物治疗不依从的风险因素的具体关联来区分。对于“人际，未来导向组”（n=59，占样本的 35%），人际因素（积极的治疗关系、重要他人对药物的积极态度）、药物治疗的即时积极后果（日常获益、无感知压力）、避免不依从的未来负面后果（如复发和再住院）对药物治疗依从性至关重要。“自主，未来导向组”（n=69，占样本的 40%）与其他组相比，人际因素的重要性较低。与第一组相比，该组的抑郁症状明显较少，与其他组相比，其稳定的伴侣关系明显更多。“自主，当前导向组”（n=43，占样本的 25%）主要受到即时积极后果的激励，与第二组相比，该组表现出更高的认知障碍和阴性症状水平，以及所有组中最低的洞察力水平。在精神分裂症中，考虑到患者的主观药物治疗依从态度，以及与抑郁、缺乏洞察力、阴性症状、认知障碍和社会人口学因素相关的特定非依从风险因素模式，可能会使提高药物治疗依从性的治疗策略受益。这些因素与每种药物治疗依从态度模式相关。
