title: Beyond the usual suspects: positive attitudes towards positive symptoms is associated with medication noncompliance in psychosis.
abstract: 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.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center in Hamburg-Eppendorf, Hamburg, Germany. moritz@uke.uni-hamburg.de
authors.forename: Steffen
authors.initials: S
authors.lastname: Moritz
authors.forename: Jerome
authors.initials: J
authors.lastname: Favrod
authors.forename: Christina
authors.initials: C
authors.lastname: Andreou
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Morrison
authors.forename: Francesca
authors.initials: F
authors.lastname: Bohn
authors.forename: Ruth
authors.initials: R
authors.lastname: Veckenstedt
authors.forename: Peter
authors.initials: P
authors.lastname: Tonn
authors.forename: Anne
authors.initials: A
authors.lastname: Karow
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology
chemical_list: D014150:Antipsychotic Agents