title: Negative impact of self-stigmatization on attitude toward medication adherence in patients with psychosis.
abstract: BACKGROUND
  Up to 75% of patients suffering from schizophrenia do not take their antipsychotic medication in the way it is prescribed. Nonadherence has been shown to be associated with poorer therapy outcomes, higher hospitalization rates, and increased costs for health care systems. One important contributing factor to negative attitudes toward medication adherence may be self-stigmatization.
  
  
  METHODS
  23 inpatients with a schizophrenia spectrum disorder, all receiving antipsychotic treatment, were assessed for attitude toward medication adherence (using the Rating of Medication Influences [ROMI] scale), subjective well-being under medication (using the Subjective Well-Being under Neuroleptics Scale), and self-stigmatization (using the Internalized Stigma of Mental Illness Inventory). Multiple linear regression analyses were used to predict attitude toward medication adherence from demographic and clinical data and level of self-stigmatization.
  
  
  RESULTS
  Patients' gender and their level of self-stigmatization explained 29% of the variance in total attitude toward medication. Inclusion of the self-stigmatization subscore for alienation resulted in an increase of explained variance to 36%. Follow-up analyses of the ROMI pro-adherence subscale scores revealed no correlations with any assessed variables. In contrast, 70% of the variance in the ROMI nonadherence subscale scores was explained by greater alienation, higher number of experienced side effects, less subjective well-being under medication, and female gender.
  
  
  CONCLUSIONS
  Our findings imply that reducing the extent of self-stigmatization, especially the feeling of being alienated from society, could improve a negative attitude toward medication adherence in psychosis patients. Cognitive-behavioral therapy offers a variety of therapeutic strategies that could support patients in developing a more positive self-image and in more readily accepting antipsychotic medication as a tool for reaching personal life goals.
authors.affiliation: UHLMANN, UNSER, AROLT, and LENCER: University Hospital Muenster, Muenster, Germany; KAEHLER: University Hospital Muenster and University of Groningen, Groningen, Netherlands; HARRIS: Jesse Brown VA Medical Center, Chicago, IL.
authors.forename: Christina
authors.initials: C
authors.lastname: Uhlmann
authors.forename: Janis
authors.initials: J
authors.lastname: Kaehler
authors.forename: Margret S H
authors.initials: MS
authors.lastname: Harris
authors.forename: Julia
authors.initials: J
authors.lastname: Unser
authors.forename: Volker
authors.initials: V
authors.lastname: Arolt
authors.forename: Rebekka
authors.initials: R
authors.lastname: Lencer
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001294:Attitude to Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology*; D012559:Schizophrenia / Q000188:drug therapy; D012565:Schizophrenic Psychology; D017678:Sex Distribution; D013240:Stereotyping; D016903:Drug Monitoring
chemical_list: D014150:Antipsychotic Agents