El Ammouri A, Kisra H
Centre d'addictologie, avenue Abdellah Chefchaouni, Tétouan, Maroc.
Hôpital psychiatrique universitaire Ar-Razi, Salé, Maroc.
Encephale. 2017 Dec;43(6):522-527. doi: 10.1016/j.encep.2016.02.022. Epub 2016 Sep 20.
Schizophrenia is a chronic, relapsing, mental disorder, and lack of adherence is a common and severe problem in such patients leadingto global and heavy consequences for patients (relapses, hospitalizations, impaired quality of life…), for the family and for society. Improved understanding of the underlying reasons will help to form intervention strategies relevant to the context.
We aimed to assess medication adherence among stable patients suffering from schizophrenia and to identify factors associated with non-adherence.
This is a retrospective cohort study of outpatients with schizophrenia at the psychiatric hospital Ar-razi of Salé (Maroc). The patients were aged over 18, clinically stabilized under the same treatment during the three months prior to inclusion. Data (demographic, clinical and therapeutic) was collected by a questionnaire developed for this purpose. Assessment of adherence and awareness of the disorder (insight) were performed respectively by two validated scales: Medication Adherence Rating Scale the (MARS) and scale Q8.
Fourty percent of schizophrenic patients included in our study were not compliant to treatment. Compared to adherent patients, non-adherent patients had history of substance use (57.6 % vs. 42.4 %, P<0.05), were less aware of their disorder (77.8 % vs. 22.2 %, P<0.01), had significantly more drug intake per day (2.4 vs. 1.9, P<0.01), took significantly more tablets per day (2.8 vs. 2.2; P<0.05) and complained of significantly more side effects (43.2 vs. 56.8, P<0.05). A logistic regression model had shown that only side effects, lack of insight, and a history of substances use are significant predictors of poor adherence in patients with schizophrenia.
The results of this work should guide our efforts to improve adherence in patients with schizophrenia. Waiting for new drugs with fewer side effects and better benefit/risk, some strategies would help to improve adherence to treatment. For example: implementation of strategies to manage psychoactive substance use, structured psycho-educational strategies to improve insight, and training therapists to improve the therapeutic alliance should be established.
精神分裂症是一种慢性、复发性精神障碍，而治疗依从性差是这类患者中常见且严重的问题，会给患者（复发、住院、生活质量受损……）、家庭和社会带来全面且严重的后果。更好地理解潜在原因将有助于制定符合实际情况的干预策略。
我们旨在评估稳定期精神分裂症患者的药物治疗依从性，并确定与不依从相关的因素。
这是一项对摩洛哥萨勒市拉齐精神病院门诊精神分裂症患者的回顾性队列研究。患者年龄超过18岁，在纳入研究前的三个月内接受相同治疗且病情稳定。通过为此目的开发的问卷收集数据（人口统计学、临床和治疗数据）。分别使用两个经过验证的量表评估依从性和对疾病的认知（自知力）：药物治疗依从性评定量表（MARS）和Q8量表。
我们研究中纳入的精神分裂症患者有40%治疗不依从。与依从患者相比，不依从患者有物质使用史（57.6%对42.4%，P<0.05），对自身疾病的认知较差（77.8%对22.2%，P<0.01），每天服药种类显著更多（2.4对1.9，P<0.01），每天服药片数显著更多（2.8对2.2；P<0.05），且抱怨有更多副作用（43.2对56.8，P<0.05）。逻辑回归模型显示，只有副作用、缺乏自知力和物质使用史是精神分裂症患者依从性差的显著预测因素。
这项工作的结果应指导我们努力提高精神分裂症患者的依从性。在等待副作用更少、效益/风险比更好的新药出现时，一些策略有助于提高治疗依从性。例如：应制定管理精神活性物质使用的策略、采用结构化心理教育策略以提高自知力，以及培训治疗师以改善治疗联盟。
