title: The therapeutic relationship and adherence to antipsychotic medication in schizophrenia.
abstract: OBJECTIVE
  Previous research has shown that a better therapeutic relationship (TR) predicts more positive attitudes towards antipsychotic medication, but did not address whether it is also linked with actual adherence. This study investigated whether the TR is associated with adherence to antipsychotics in patients with schizophrenia.
  
  
  METHODS
  134 clinicians and 507 of their patients with schizophrenia or a related psychotic disorder participated in a European multi-centre study. A logistic regression model examined how the TR as rated by patients and by clinicians is associated with medication adherence, adjusting for clinician clustering and symptom severity.
  
  
  RESULTS
  Patient and clinician ratings of the TR were weakly inter-correlated (r(s) = 0.13, p = 0.004), but each was independently linked with better adherence. After adjusting for patient rated TR and symptom severity, each unit increase in clinician rated TR was associated with an increase of the odds ratio of good compliance by 65.9% (95% CI: 34.6% to 104.5%). After adjusting for clinician rated TR and symptom severity, for each unit increase in patient rated TR the odds ratio of good compliance was increased by 20.8% (95% CI: 4.4% to 39.8%).
  
  
  CONCLUSIONS
  A better TR is associated with better adherence to medication among patients with schizophrenia. Patients' and clinicians' perspectives of the TR are both important, but may reflect distinct aspects.
authors.affiliation: Unit of Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom. r.mccabe@qmul.ac.uk
authors.forename: Rosemarie
authors.initials: R
authors.lastname: McCabe
authors.forename: Jens
authors.initials: J
authors.lastname: Bullenkamp
authors.forename: Lars
authors.initials: L
authors.lastname: Hansson
authors.forename: Christoph
authors.initials: C
authors.lastname: Lauber
authors.forename: Rafael
authors.initials: R
authors.lastname: Martinez-Leal
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
authors.forename: Hans Joachim
authors.initials: HJ
authors.lastname: Salize
authors.forename: Bengt
authors.initials: B
authors.lastname: Svensson
authors.forename: Francisco
authors.initials: F
authors.lastname: Torres-Gonzalez
authors.forename: Rob
authors.initials: R
authors.lastname: van den Brink
authors.forename: Durk
authors.initials: D
authors.lastname: Wiersma
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D010817:Physician-Patient Relations; D010820:Physicians; D011361:Professional Competence; D012044:Regression Analysis; D012559:Schizophrenia / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents