Department of Psychiatric Outpatient Treatment (Psychiatrische Universitätspoliklinik), Psychiatric University Hospital of Basel, Claragraben 95, CH-4057 Basel, Switzerland.
Schizophr Res. 2011 Oct;132(1):42-9. doi: 10.1016/j.schres.2011.07.019. Epub 2011 Aug 5.
Despite the fact that medication adherence is among the most important health related behaviors in relapse prevention and recovery in schizophrenia, it is often not sufficiently endorsed by patients. Poor insight and negative attitudes towards medication are risk factors for non-adherence. Their relationship and the influence of more general attitudes towards pharmacotherapy besides attitudes towards antipsychotics have not been fully understood. The present study investigated whether these factors independently influence adherence or whether they mediate one another.
A cross-sectional sample of 150 outpatients completed the Beliefs about Medication Questionnaire. It assesses patients' beliefs about antipsychotic medication in terms of necessity and concerns and more general beliefs about pharmacotherapy in terms of distrust. Additionally, the patients' global awareness of illness (Scale to assess Unawareness of Mental Disorder), and medication adherence (Brief Adherence Rating Scale, Service Engagement Scale) were assessed.
Using structural equation modeling, the study found evidence for a mediational model. Awareness of illness contributed to medication adherence via patients' perceived necessity of antipsychotics. The model further revealed a direct negative relationship between concerns regarding antipsychotics and adherence and an indirect negative effect of a general distrust regarding pharmacotherapy and adherence via antipsychotic specific attitudes.
Interventions to enhance medication adherence may be more effective if they focus on treatment related attitudes rather than on global insight into illness. Clinicians may not only enhance the patients' perceived necessity of antipsychotic treatment but also explore and address concerns and the patients' distrust in pharmacotherapy in a more personalized way.
尽管药物依从性是精神分裂症复发预防和康复中最重要的健康相关行为之一，但患者往往无法充分遵守。对药物的洞察力差和消极态度是不依从的危险因素。他们的关系以及对药物治疗的更普遍态度（除了对抗精神病药物的态度外）对不依从的影响尚未完全了解。本研究调查了这些因素是否独立影响依从性，还是相互影响。
横断面样本包括 150 名门诊患者，完成了《药物信念问卷》。它评估了患者对抗精神病药物的信念，包括必要性和担忧，以及对药物治疗的更普遍信念，包括不信任。此外，还评估了患者的疾病整体意识（评估精神障碍意识不足量表）和药物依从性（简短依从性评定量表、服务参与量表）。
使用结构方程模型，研究发现存在中介模型的证据。疾病意识通过患者对抗精神病药物的必要性感知促进药物依从性。该模型进一步揭示了抗精神病药物的担忧与依从性之间的直接负相关，以及对药物治疗的一般不信任与通过抗精神病药物特定态度对依从性的间接负影响。
如果干预措施侧重于与治疗相关的态度而不是对疾病的整体认识，那么增强药物依从性的干预措施可能会更有效。临床医生不仅可以增强患者对抗精神病治疗的必要性感知，还可以以更个性化的方式探索和解决患者对药物治疗的担忧和不信任。
