Modeling Determinants of Medication Attitudes and Poor Adherence in Early Nonaffective Psychosis: Implications for Intervention
Open accessAbstract
We aimed to design a multimodal intervention to improve adherence following first episode psychosis, consistent with current evidence. Existing literature identified medication attitudes, insight, and characteristics of support as important determinants of adherence to medication: we examined medication attitudes, self-esteem, and insight in an early psychosis cohort better to understand their relationships. Existing longitudinal data from 309 patients with early Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nonaffective psychosis (83% first episode) were analyzed to test the hypothesis that medication attitudes, while meaningfully different from "insight," correlated with insight and self-esteem, and change in each influenced the others. Rosenberg Self-Esteem Scale, Birchwood Insight Scale, and Positive and Negative Syndrome Scale insight were assessed at presentation, after 6 weeks and 3 and 18 months. Drug Attitudes Inventory (DAI) and treatment satisfaction were rated from 6 weeks onward. Structural equation models of their relationships were compared. Insight measures' and DAI's predictive validity were compared against relapse, readmission, and remission. Analysis found five latent constructs best fitted the data: medication attitudes, self-esteem, accepting need for treatment, self-rated insight, and objective insight. All were related and each affected the others as it changed, except self-esteem and medication attitudes. Low self-reported insight at presentation predicted readmission. Good 6-week insight (unlike drug attitudes) predicted remission. Literature review and data modeling indicated that a multimodal intervention using motivational interviewing, online psychoeducation, and SMS text medication reminders to enhance adherence without damaging self-concept was feasible and appropriate.
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Early intervention programs must combine both pharmacological and psychosocial strategies.
“early intervention programs must combine both pharmacological and psychosocial strategies [5, 6]”
Poor insight predicts greater likelihood of involuntary legal commitment to treatment and hospital readmission in first-episode psychosis.
“Poor insight has also been found to predict a greater likelihood of involuntary legal commitment to treatment 69 and hospital readmission in first-episode psychosis 70 .”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [70]
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- Authors
- Drake, R. J., Nordentoft, M., Haddock, G., Arango, C., Fleischhacker, W. W., Glenthøj, B., Leboyer, M., Leucht, S., Leweke, M., McGuire, P., Meyer-Lindenberg, A., Rujescu, D., Sommer, I. E., Kahn, R. S., & Lewis, S. W.
- Affiliations
- Manchester Academic Health Science Centre (GB)
- University of Copenhagen (DK)
- Universidad Complutense de Madrid (ES)
- Innsbruck Medical University (AT)
- Inserm (FR)
- Technical University of Munich (DE)
- Martin Luther University Halle-Wittenberg (DE)
- University Medical Center Utrecht (NL)
- Corresponding author
- Drake, Richard J.
- ORCID
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-03-05
- Volume
- 41
- Issue
- 3
- Pages
- 584-596
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC4393703
- OpenAlex
- W2127158799
- Cited by
- 42
- References
- 133
- Citations by year
- 2026: 4 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 4 · 2020: 6 · 2019: 5 · 2018: 3 · 2017: 5 · 2016: 4 · 2015: 3
- FWCI
- 4.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Schizophrenia Bulletin (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- Lundbeckfonden (R155-2013-16337, R155-2014-1724)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- medication adherence, attitudes toward medication
- MeSH terms
- Adult, Awareness, Humans, Health Knowledge, Attitudes, Practice, Longitudinal Studies, Psychotic Disorders, Self Concept, Models, Statistical, Medication Adherence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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