Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong.
Soc Psychiatry Psychiatr Epidemiol. 2024 Jul;59(7):1215-1225. doi: 10.1007/s00127-023-02563-4. Epub 2023 Oct 14.
Literature on antipsychotic medication adherence in early psychosis primarily assessed adherence behaviors and focused on young patients. There is a paucity of research investigating negative medication attitude and its determinants in the early illness course, particularly in older-aged sample. We aimed to examine prevalence and correlates of medication non-adherence behaviors and negative medication attitudes separately in adult patients with early psychosis.
One hundred ninety-nine Chinese early psychosis patients aged 26-55 years who had received three-year treatment for first psychotic episode in Hong Kong were examined. Assessments encompassing socio-demographics, premorbid adjustment, clinical and treatment profiles, self-stigma and therapeutic alliance were conducted. Patients were evaluated with Medication Compliance Questionnaire, which is a modified Chinese-translated version of Medication Adherence Rating Scale and includes items measuring adherence behaviors and attitudes towards medications.
Rates of medication non-adherence and negative attitude towards medications were 38.7% and 50.8%, respectively. Multivariate regression analysis showed that more severe positive symptoms, greater self-stigma and negative medication attitude were independently associated with medication non-adherence. Negative attitude towards medications was significantly associated with younger age, higher educational attainment, diagnosis of other psychotic disorders, poorer insight, greater self-stigma and less satisfaction with communication with healthcare staff, which represented an index reflecting suboptimal therapeutic alliance.
Antipsychotic non-adherence and negative medication attitudes are frequently observed in adult early psychosis patients. Our findings indicate that poor insight, elevated self-stigma and suboptimal therapeutic alliance may constitute potential treatment targets for promoting medication adherence and rectifying negative medication attitudes in the early illness stage.
早期精神病抗精神病药物治疗依从性的文献主要评估了依从行为，并侧重于年轻患者。关于消极药物态度及其在早期发病过程中的决定因素的研究很少，特别是在老年患者中。我们旨在分别研究成年早期精神病患者的药物不依从行为和消极药物态度的患病率和相关因素。
对香港 199 名年龄在 26-55 岁的首发精神病患者进行了为期三年的治疗，以评估他们的社会人口统计学、病前调整、临床和治疗概况、自我污名和治疗联盟。使用“药物依从性问卷”对患者进行评估，这是“药物依从性评定量表”的中文翻译修订版，包括评估药物依从行为和态度的项目。
药物不依从和对药物的消极态度的发生率分别为 38.7%和 50.8%。多元回归分析显示，更严重的阳性症状、更大的自我污名和消极的药物态度与药物不依从独立相关。对药物的消极态度与年龄较小、教育程度较高、诊断为其他精神病障碍、洞察力较差、自我污名较大以及与医护人员沟通满意度较低显著相关，这反映了治疗联盟不理想的一个指标。
抗精神病药物不依从和消极的药物态度在成年早期精神病患者中经常出现。我们的研究结果表明，洞察力差、自我污名化和不理想的治疗联盟可能是在早期发病阶段促进药物依从性和纠正消极药物态度的潜在治疗目标。
