Weiden P, Rapkin B, Mott T, Zygmunt A, Goldman D, Horvitz-Lennon M, Frances A
St. Luke's/Roosevelt Hospital Center, Dept. of Psychiatry, New York, NY 10019.
Schizophr Bull. 1994;20(2):297-310. doi: 10.1093/schbul/20.2.297.
Noncompliance with neuroleptic treatment is a major barrier to delivery of effective treatment for schizophrenia outpatients. This article describes the development of a standardized measure for the assessment of attitudinal and behavioral factors influencing patient compliance with neuroleptic treatment. The Rating of Medication Influences (ROMI) scale was developed as part of a longitudinal study of neuroleptic noncompliance in schizophrenia and administered to 115 discharged schizophrenia outpatients. Analyses of the following were conducted to assess the scale's psychometric properties: (1) interrater reliability, (2) internal consistency, (3) principal components, (4) correlation with other subjective measures, and (5) correlation with independent family reports. Most (95%) of the ROMI patient-report items were reliable, whereas rater-judgment items were not reliable. The rater section was dropped. A principal components analysis of the reliable patient-report items yielded three subscales related to compliance (Prevention, Influence of Others, and Medication Affinity) and five subscales related to noncompliance (Denial/Dysphoria, Logistical Problems, Rejection of Label, Family Influence, and Negative Therapeutic Alliance). There were significant correlations between these subscales, and independently obtained family-report ROMI items were significant. The Denial/Dysphoria subscale correlated strongly with two other published measures of dysphoric response to neuroleptics, whereas the other noncompliance subscales did not. The ROMI is a reliable and valid instrument that can be used to assess the patient's subjective reasons for medication compliance and non-compliance. The subscale findings suggest that the ROMI provides a more comprehensive data base for patient-reported compliance attitudes than the other available subjective measures. Indications for use of the ROMI and other subjective measures of neuroleptic response are reviewed.
不依从抗精神病药物治疗是为精神分裂症门诊患者提供有效治疗的主要障碍。本文描述了一种标准化测量方法的开发过程，该方法用于评估影响患者依从抗精神病药物治疗的态度和行为因素。药物影响评定（ROMI）量表是作为一项关于精神分裂症患者抗精神病药物治疗不依从性的纵向研究的一部分而开发的，并应用于115名出院的精神分裂症门诊患者。对以下方面进行了分析以评估该量表的心理测量特性：（1）评分者间信度，（2）内部一致性，（3）主成分，（4）与其他主观测量的相关性，以及（5）与独立的家属报告的相关性。ROMI患者报告项目中的大多数（95%）是可靠的，而评分者判断项目不可靠。评分者部分被删除。对可靠的患者报告项目进行主成分分析，得出了与依从性相关的三个子量表（预防、他人影响和药物亲和力）和与不依从性相关的五个子量表（否认/烦躁、后勤问题、拒绝标签、家庭影响和消极治疗联盟）。这些子量表之间存在显著相关性，并且独立获得的家属报告的ROMI项目也具有显著性。否认/烦躁子量表与另外两项已发表的关于对抗精神病药物烦躁反应的测量方法密切相关，而其他不依从性子量表则不然。ROMI是一种可靠且有效的工具，可用于评估患者依从或不依从药物治疗的主观原因。子量表的研究结果表明，与其他现有的主观测量方法相比，ROMI为患者报告的依从态度提供了更全面的数据库。本文还回顾了ROMI及其他抗精神病药物反应主观测量方法的使用指征。
