Department of Psychiatry at Columbia University, New York State Psychiatric Institute, USA.
Psychiatry. 2013 Fall;76(3):203-9. doi: 10.1521/psyc.2013.76.3.203.
Treatment non-adherence in psycho-pharmacotherapy remains a significant challenge to the effective clinical management of psychiatric disorders, especially among underserved racial/ethnic groups. This article introduces motivational pharmacotherapy, an approach that integrates motivational interviewing into psycho-pharmacotherapy sessions in order to increase treatment adherence. We describe what aspects of motivational interviewing were incorporated into motivational pharmacotherapy and how we tailored the intervention to the clinical and cultural characteristics of monolingual Spanish-speaking immigrants with major depressive disorder. Transcriptions of the interactions between psychiatrists and patients help illustrate this approach. In our experience, motivational pharmacotherapy differs substantially from standard pharmacotherapy in how it recasts clinicians and patients as equal experts, prioritizes patients' motivation to engage in treatment rather than clinicians' multiple inquiries about symptoms, encourages patients' self-efficacy to overcome barriers, and attends to the momentum of patients' language about commitment to change. We also found that motivational pharmacotherapy can be feasibly incorporated into medication treatment, can be tailored to patients' culture and disorder, and may help increase adherence to psycho-pharmacotherapy.
心理药理学治疗的不依从仍然是有效治疗精神疾病的临床管理的一个重大挑战，尤其是在服务不足的种族/族裔群体中。本文介绍了动机药理学治疗，这是一种将动机性访谈整合到心理药理学治疗中的方法，以提高治疗的依从性。我们描述了动机性访谈的哪些方面被纳入了动机药理学治疗中，以及我们如何根据患有重度抑郁症的单语西班牙语移民的临床和文化特点来调整干预措施。精神科医生和患者之间的互动转录有助于说明这种方法。根据我们的经验，动机药理学治疗与标准药理学治疗有很大的不同，它将临床医生和患者视为平等的专家，将患者参与治疗的动机置于首位，而不是临床医生对症状的多次询问，鼓励患者克服障碍的自我效能，并关注患者对改变承诺的语言的动力。我们还发现，动机药理学治疗可以切实地纳入药物治疗中，可以根据患者的文化和疾病进行调整，并可能有助于提高心理药理学治疗的依从性。
