Relationship of insight with medication adherence and the impact on outcomes in patients with schizophrenia and bipolar disorder: results from a 1-year European outpatient observational study
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BACKGROUND: Many patients with schizophrenia and bipolar disorder have impaired insight and low medication adherence. The aim of this post hoc analysis was to explore the relationship between insight and medication adherence. METHODS: We included 903 patients with schizophrenia or bipolar disorder who participated in an observational study conducted in Europe on the outcomes of patients treated with two oral formulations of olanzapine over a 1-year period. Evaluations included Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), insight (Scale to Assess Unawareness of Mental Disorder, SUMD) medication adherence (Medication Adherence Rating Scale, MARS), and therapeutic alliance (Working Alliance Inventory, WAI). RESULTS: Medication adherence was higher in bipolar patients (mean MARS score (SD) 6.5 (2.8) versus 5.8 (2.7) in schizophrenia; p < 0.001). Patients with schizophrenia had lower insight (i.e., SUMD item 1, unawareness of mental disorder, mean (SD) of 2.5 (1.3) in schizophrenia versus 1.9 (1.2) in bipolar, p < 0.001). Better insight was associated with higher adherence (Spearman Correlation Coefficient, SCC, ranging from 0.39 to 0.49 for the three SUMD general items, p < 0.0001 in all cases). Higher insight was related to a stronger therapeutic alliance (SCC ranging from 0.38 to 0.48, p < 0.0001). A path analysis revealed a positive impact of insight on adherence and alliance and that stronger alliance was related to lower clinical severity (lower CGI score). CONCLUSION: Insight and adherence were found to be closely related. Insight impacts on the therapeutic alliance with mental health professionals. These factors are associated to treatment outcomes.
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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 [30]
Misunderstanding about treatment consequences, lack of awareness of their illness and/or mental disorder in general, and sometimes appreciating subjective relief symptoms were factors associated with medication non-adherence among major psychiatric disorder patients.
“Likewise, misunderstanding about the treatment consequences, lack of awareness of their illness and or mental disorder in general, and sometimes appreciating subjective relief symptoms [30, 36, 37] were the factors associated with medication non-adherence among major psychiatric disorder patients.”
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 [30]
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 [30]
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- Authors
- Novick, D., Montgomery, W., Treuer, T., Aguado, J., Kraemer, S., & Haro, J. M.
- Affiliations
- Eli Lilly (United Kingdom) (GB)
- Eli Lilly (Australia) (AU)
- Centro de Investigación Biomédica en Red de Salud Mental (ES)
- Eli Lilly (Germany) (DE)
- Corresponding author
- Novick, Diego
- Venue
- BMC Psychiatry
- Published
- 2015-08-05
- Volume
- 15
- Issue
- 1
- Pages
- 189-189
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC4524170
- OpenAlex
- W1807166034
- Cited by
- 127
- References
- 29
- Citations by year
- 2026: 12 · 2025: 7 · 2024: 13 · 2023: 17 · 2022: 13 · 2021: 10 · 2020: 12 · 2019: 8 · 2018: 13 · 2017: 13 · 2016: 9
- FWCI
- 9.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (publishedVersion, cc-by)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- insight, medication adherence, schizophrenia, bipolar disorder, olanzapine, therapeutic relationship, awareness of mental disorder, treatment outcomes, clinical severity, Scale to Assess Unawareness of Mental Disorder, Working Alliance Inventory
- MeSH terms
- Olanzapine, Adult, Benzodiazepines, Bipolar Disorder, Europe, Female, Humans, Male, Middle Aged, Outpatients, Schizophrenia, Schizophrenic Psychology, Treatment Outcome, Comprehension, Medication Adherence
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