Attitudes toward antipsychotic medication: the impact of clinical variables and relationships with health professionals.
BACKGROUND
Nonadherence to antipsychotic medication is a major cause of psychotic relapse and is strongly influenced by attitudes toward treatment. Although patient variables such as insight and symptoms that contribute toward attitudes have been identified, the contributions of relationship and service factors have not been adequately studied.


OBJECTIVE
To determine relations between clinical and service variables and attitudes toward medication in people with a diagnosis of schizophrenia and schizoaffective disorder.


METHODS
Consecutively admitted patients were approached to take part; 23 refused. Measures included symptoms, insight, drug adverse effects, self-reported adherence, attitudes toward treatment, perceived relationship with the prescriber, ward atmosphere, and admission experience. Data were analyzed by a proportional odds model and structural equation modeling to test predicted paths between experience of admission, relationship variables, attitudes toward treatment, and self-reported adherence to medication.


METHODS
Twenty-eight inpatient wards at 8 hospitals in North Wales and the Northwest of England. Sites included hospitals with inner-city and rural catchment areas. Patients Two hundred twenty-eight patients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder, assessed during acute admission.


METHODS
Attitudes toward treatment and self-reported adherence to medication.


RESULTS
The data fit a model in which attitudes toward treatment were predicted by insight, relationship with staff (especially the physician-prescriber), and the patient's admission experience (maximum likelihood chi(2)(49) = 89.3, P<.001). A poor relationship with the prescriber, experience of coercion during admission, and low insight predicted a negative attitude toward treatment.


CONCLUSIONS
The quality of relationships with clinicians during acute admission appears to be an important determinant of patients' attitudes toward treatment and adherence to medication. Enhancing such relationships may yield important clinical benefits.
Pharmacy Department, Mersey Care NHS Trust, Merseyside, England. Jennie.day@merseycare.nhs.uk
Jennifer C
JC
Day
Richard P
RP
Bentall
Chris
C
Roberts
Fiona
F
Randall
Anne
A
Rogers
Dinah
D
Cattell
David
D
Healy
Pam
P
Rae
Cheryl
C
Power
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D001364:Awareness; D003068:Coercion; D003071:Cognition; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010349:Patient Compliance / Q000523:psychology*; D010817:Physician-Patient Relations; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology*; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D016312:Treatment Refusal / Q000523:psychology
D014150:Antipsychotic Agents