Beyond the Usual Suspects: Positive Attitudes Towards Positive Symptoms Is Associated With Medication Noncompliance in Psychosis
Open accessAbstract
Antipsychotic medication represents the treatment of choice in psychosis according to clinical guidelines. Nevertheless, studies show that half to almost three-quarter of all patients discontinue medication with antipsychotics after some time, a fact which is traditionally ascribed to side-effects, mistrust against the clinician and poor illness insight. The present study investigated whether positive attitudes toward psychotic symptoms (ie, gain from illness) represent a further factor for medication noncompliance. An anonymous online survey was set up in order to prevent conservative response biases that likely emerge in a clinical setting. Following an iterative selection process, data from a total of 113 patients with a likely diagnosis of schizophrenia and a history of antipsychotic treatment were retained for the final analyses (80%). While side-effect profile and mistrust emerged as the most frequent reasons for drug discontinuation, 28% of the sample reported gain from illness (eg, missing voices, feeling of power) as a motive for noncompliance. At least every fourth patient reported the following reasons: stigma (31%), mistrust against the physician/therapist (31%), and rejection of medication in general (28%). Approximately every fifth patient had discontinued antipsychotic treatment because of forgetfulness. On average, patients provided 4 different explanations for noncompliance. Ambivalence toward symptoms and treatment should thoroughly be considered when planning treatment in psychosis. While antipsychotic medication represents the evidence-based cornerstone of the current treatment in schizophrenia, further research is needed on nonpharmacological interventions for noncompliant patients who are willing to undergo intervention but refuse pharmacotherapy.
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Patients' non-adherence to psychotropic medication was associated with non-modifiable demographic factors such as age and gender in one study.
“Patients’ non-adherence to their psychotropic medication was associated with some non-modifiable demographic factors such as age and gender) [28].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [28]
The perception or feeling of psychiatric patients being stigmatized by families, neighbors, health professionals, and other community members was a factor associated with medication non-adherence in eight studies.
“In eight studies, the perception or the feeling of psychiatric patients being stigmatized by their families, neighbors, health professionals, and other community members was a factor associated with medication non-adherence [24, 25, 28, 36, 37, 41, 45, 65].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [28]
Psychotropic medication non-adherence was associated with medication-related side-effects in several studies.
“In several studies, psychotropic medication non-adherence was associated with medication-related side-effects [11, 22–25, 28–30, 32–37, 39, 44, 50, 52, 55, 64, 65].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [28]
Patients' complete rejection of the medication was a main cause of discontinuation and non-adherence to their medication in one study.
“In the worst scenario, patients’ complete rejection of the medication was a main cause of discontinuation and non-adherence to their medication [28].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [28]
Patients' lack of insight about their illness and medication was a common factor associated with psychotropic medication non-adherence in seven studies.
“In seven studies, patients’ lack of insight (level of awareness or understanding) about their illness and medication was a common factor associated with psychotropic medication non-adherence [21, 23, 28, 39, 40, 50, 51].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [28]
Feeling of powerlessness, insomnia, difficulty thinking or concentrating, restlessness, or feeling jittery were found to be associated with medication non-adherence in two studies.
“Another two studies, feeling of powerlessness, insomnia, difficulty thinking or concentrating, restlessness, or feeling jittery were found to be associated with medication non-adherence [28, 37].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [28]
Medication non-adherence was affected by the number of hospitalizations, irregular hospitalization and frequently discharge of patients, length of stay, lack of patients' satisfaction with health care services, and long distance to access the health service/recollect medications.
“Medication non-adherence was affected by the number of hospitalizations [28], irregular hospitalization and frequently discharge of patients, length of stay [42, 46], lack of patients’ satisfaction with health care services [44], and long distance to access the health service/recollect medications [50].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [28]
Unfriendly, judgmental behavior, inflexible appointment systems, mistrust, and having negative patient-physician relationships were factors associated with patients' psychotropic medication non-adherence in three studies.
“Consequently, unfriendly, judgmental behavior, inflexible appointment systems, mistrust, and having negative patient-physician relationships were the factors associated with patients’ psychotropic mediation non-adherence [28, 30, 60].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [28]
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- Authors
- Moritz, S., Favrod, J., Andreou, C., Morrison, A. P., Bohn, F., Veckenstedt, R., Tonn, P., & Karow, A.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- University of Manchester (GB)
- Corresponding author
- Moritz, Steffen
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-02-15
- Volume
- 39
- Issue
- 4
- Pages
- 917-922
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC3686441
- OpenAlex
- W2097580073
- Cited by
- 112
- References
- 37
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 8 · 2022: 14 · 2021: 11 · 2020: 8 · 2019: 4 · 2018: 8 · 2017: 10 · 2016: 13 · 2015: 7 · 2014: 8 · 2013: 5 · 2012: 3
- FWCI
- 5.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Schizophrenia Bulletin (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- medication non-adherence, psychosis
- MeSH terms
- Adult, Attitude to Health, Female, Humans, Male, Middle Aged, Psychotic Disorders, Schizophrenia, Schizophrenic Psychology, Antipsychotic Agents, Logistic Models, Medication Adherence
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