Misdrahi David, Petit Marion, Blanc Olivier, Bayle Franck, Llorca Pierre-Michel
C.H. Charles Perrens, Pole de Psychiatrie 347, 121, rue de la Béchade, 33076 Bordeaux cedex, France.
Nord J Psychiatry. 2012 Feb;66(1):49-54. doi: 10.3109/08039488.2011.598556. Epub 2011 Aug 10.
Poor adherence is one of the leading problems affecting the effectiveness of treatment in schizophrenia. It is an identified factor for relapse and hospitalizations with major social and economic consequences. Various determinants of poor adherence have been identified but few studies investigate the role of therapeutic alliance on medication adherence in routine mental healthcare.
To investigate links between therapeutic alliance insight and medication adherence in routine care and community psychiatry.
In this cross-sectional study, 38 inpatients that met ICD-10 criteria for schizophrenia or schizoaffective disorder were recruited and independently interviewed just before discharge. Various rating scales were used: the self-reported 4-Point ordinal Alliance Scale (4PAS), the Medication Adherence Rating Scale (MARS) and the Scale to assess Unawareness of Mental Disorder (SUMD). In addition, we investigated the relationships between medication adherence and clinical variables through uni- and multivariate analysis.
Therapeutic alliance was significantly correlated with adherence (r = 0.663, P < 0.0001) and insight (r =-0.664, P < 0.0001). Poor adherence was associated in patients with substance or alcohol use disorders (5.4 vs. 2.9, P = 0.0075, t = 2.83). No significant difference was found between the demographic characteristics of the sample, the characteristics of the treatments and adherence.
A weak therapeutic alliance and low insight are associated with poor adherence in patients with schizophrenia or schizoaffective disorder who were hospitalized. Specific psycho-educational programs to improve therapeutic alliance and insight should be implemented to achieve better therapeutic adherence and outcome.
依从性差是影响精神分裂症治疗效果的主要问题之一。它是复发和住院的一个已确定因素，会带来重大的社会和经济后果。虽然已经确定了导致依从性差的各种决定因素，但很少有研究调查治疗联盟在常规精神卫生保健中对药物依从性的作用。
调查常规护理和社区精神病学中治疗联盟洞察力与药物依从性之间的联系。
在这项横断面研究中，招募了38名符合ICD-10精神分裂症或分裂情感性障碍标准的住院患者，并在出院前进行独立访谈。使用了各种评定量表：自我报告的4点序贯联盟量表（4PAS）、药物依从性评定量表（MARS）和精神障碍无自知力评定量表（SUMD）。此外，我们通过单因素和多因素分析研究了药物依从性与临床变量之间 的关系。
治疗联盟与依从性（r = 0.663，P < 0.0001）和洞察力（r = -0.664，P < 0.0001）显著相关。物质或酒精使用障碍患者的依从性较差（5.4对2.9，P = 0.0075，t = 2.83）。在样本的人口统计学特征、治疗特征和依从性之间未发现显著差异。
治疗联盟薄弱和洞察力低与住院的精神分裂症或分裂情感性障碍患者的依从性差有关。应实施特定的心理教育计划，以改善治疗联盟和洞察力，从而实现更好的治疗依从性和治疗效果。
