Understanding the multidimensional phenomenon of medication adherence attitudes in psychosis. (January 2021)

• Record Type: Journal Article
• Authors: Surmann, Marian; Falke, Sebastian; von Gruchalla, Lara; Maisch, Birgit; Uhlmann, Christina; Arolt, Volker; Lencer, Rebekka
• Is Part Of: Psychiatry research. Volume 295(2021)
• Publication Date: 2021-01
• Subjects: Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2020.113601
• Languages: English
• ISSNs: 0165-1781

Abstract

Highlights: Therapeutic alliance judged by the patient predicts medication adherence attitudes, while judgement of the therapeutic alliance by the clinician is unrelated to adherence attitudes. Clinicians' focus mainly on positive symptom expression is too narrow and they seem to underestimate the relevance of self-stigmatization for patients Therefore, clinicians should take the patients' perspective more into account during the treatment process in order to achieve goal agreement, one key element in building a good therapeutic alliance. Abstract: There is an urgent need for a better understanding of the multidimensional factors of medication adherence attitudes in patients with psychosis in order to enhance adherence as up to 75% of patients stop or change their medication within a year. 81 patients with psychosis were assessed on symptom expression, self-stigmatization, adherence attitudes, QoL, social support and therapeutic alliance judged by patients and clinicians. Regression analyses were used to test whether better QoL, more social support and a better therapeutic alliance are associated with more positive and less negative adherence attitudes. More positive clinician input, higher state anxiety and lower levels of self-stigmatization predicted more positive adherence attitudes, while less positive collaboration with the clinician and higher levels of self-stigmatization were associated with more negative adherence attitudes. QoL and social support were unrelated to adherence attitudes. The quality of the therapeutic alliance perceived by patients appears crucial regarding their medication adherence attitudes. Thus, clinicians' focus on psychotic symptom expression is not sufficient to achieve goal agreement. Rather, it is imperative to consider the individual subjective needs of patients as a key element for sustained therapeutic alliance.