title: Are we addressing the 'right stuff' to enhance adherence in schizophrenia? Understanding the role of insight and attitudes towards medication.
abstract: BACKGROUND
  Despite the fact that medication adherence is among the most important health related behaviors in relapse prevention and recovery in schizophrenia, it is often not sufficiently endorsed by patients. Poor insight and negative attitudes towards medication are risk factors for non-adherence. Their relationship and the influence of more general attitudes towards pharmacotherapy besides attitudes towards antipsychotics have not been fully understood. The present study investigated whether these factors independently influence adherence or whether they mediate one another.
  
  
  METHODS
  A cross-sectional sample of 150 outpatients completed the Beliefs about Medication Questionnaire. It assesses patients' beliefs about antipsychotic medication in terms of necessity and concerns and more general beliefs about pharmacotherapy in terms of distrust. Additionally, the patients' global awareness of illness (Scale to assess Unawareness of Mental Disorder), and medication adherence (Brief Adherence Rating Scale, Service Engagement Scale) were assessed.
  
  
  RESULTS
  Using structural equation modeling, the study found evidence for a mediational model. Awareness of illness contributed to medication adherence via patients' perceived necessity of antipsychotics. The model further revealed a direct negative relationship between concerns regarding antipsychotics and adherence and an indirect negative effect of a general distrust regarding pharmacotherapy and adherence via antipsychotic specific attitudes.
  
  
  CONCLUSIONS
  Interventions to enhance medication adherence may be more effective if they focus on treatment related attitudes rather than on global insight into illness. Clinicians may not only enhance the patients' perceived necessity of antipsychotic treatment but also explore and address concerns and the patients' distrust in pharmacotherapy in a more personalized way.
authors.affiliation: Department of Psychiatric Outpatient Treatment (Psychiatrische Universitätspoliklinik), Psychiatric University Hospital of Basel, Claragraben 95, CH-4057 Basel, Switzerland.
authors.forename: Eva-Marina
authors.initials: EM
authors.lastname: Beck
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Cavelti
authors.forename: Sara
authors.initials: S
authors.lastname: Kvrgic
authors.forename: Birgit
authors.initials: B
authors.lastname: Kleim
authors.forename: Roland
authors.initials: R
authors.lastname: Vauth
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001290:Attitude; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D015233:Models, Statistical; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D011795:Surveys and Questionnaires
chemical_list: D014150:Antipsychotic Agents