Wong Mimi M C, Chen E Y H, Lui Simon S Y, Tso Steve
Castle Peak Hospital, Hong Kong.
Clin Schizophr Relat Psychoses. 2011 Oct;5(3):135-41. doi: 10.3371/CSRP.5.3.3.
Medication adherence is critical to the management of psychotic disorder. Different factors associated with medication adherence have been investigated in previous studies. However, the association with subjective weight perception, which is related to the weight gain side effect of antipsychotics, has not been thoroughly investigated. Subjective weight perception may not equal objective weight status. This study tests the hypothesis that medication adherence is related to subjective weight perception in a group of patients with first-episode psychotic disorder who have taken antipsychotics for one year.
This study recruited 160 participants with one-year histories of first-episode psychotic disorder and measured their actual and perceived weights, amount of weight gain in the past year, body size satisfaction and medication adherence levels. The associations between medication adherence and both the actual and perceived weight status were analyzed controlling for other confounding factors including insight, drug attitude, illness severity and other medication side effects.
Stepwise multiple regression analysis found that the participants' perceived weight status, negative attitude toward their drugs and insight were the major factors associated with poor medication adherence. Of the participants who perceived themselves as being overweight, 86% believed that antipsychotics were responsible. Among those who had such beliefs, 72% had reduced their antipsychotic dosages on their own. About half of the participants had gained more than 7% of their baseline weight and 43.1% of the participants were found to be overweight after one year of treatment with antipsychotics.
The results of this study indicate that medication adherence is associated with perceived weight status. Healthcare professionals should be aware of this relationship and address this issue early in the management of patients. Apart from weight management programs, education on a correct weight perception should be carried out with the promotion of proper drug attitudes and better insight for the improvement of medication adherence in the early course of psychotic disorder.
药物依从性对于精神障碍的管理至关重要。先前的研究已经调查了与药物依从性相关的不同因素。然而，与主观体重认知的关联尚未得到充分研究，主观体重认知与抗精神病药物的体重增加副作用有关。主观体重认知可能并不等同于客观体重状况。本研究检验了一个假设，即在一组服用抗精神病药物一年的首发精神障碍患者中，药物依从性与主观体重认知有关。
本研究招募了160名有一年首发精神障碍病史的参与者，测量了他们的实际体重和感知体重、过去一年的体重增加量、身体尺寸满意度和药物依从性水平。在控制其他混杂因素（包括洞察力、药物态度、疾病严重程度和其他药物副作用）的情况下，分析了药物依从性与实际和感知体重状况之间的关联。
逐步多元回归分析发现，参与者的感知体重状况、对药物的消极态度和洞察力是与药物依从性差相关的主要因素。在那些认为自己超重的参与者中，86%认为是抗精神病药物导致的。在有这种看法的人中，72%自行减少了抗精神病药物的剂量。约一半的参与者体重比基线增加了7%以上，在接受抗精神病药物治疗一年后，43.1%的参与者被发现超重。
本研究结果表明，药物依从性与感知体重状况有关。医疗保健专业人员应意识到这种关系，并在患者管理的早期解决这个问题。除了体重管理计划外，还应开展关于正确体重认知的教育，同时促进正确的药物态度和更好的洞察力，以提高精神障碍早期阶段的药物依从性。
