Modeling determinants of medication attitudes and poor adherence in early nonaffective psychosis: implications for intervention.
We aimed to design a multimodal intervention to improve adherence following first episode psychosis, consistent with current evidence. Existing literature identified medication attitudes, insight, and characteristics of support as important determinants of adherence to medication: we examined medication attitudes, self-esteem, and insight in an early psychosis cohort better to understand their relationships. Existing longitudinal data from 309 patients with early Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nonaffective psychosis (83% first episode) were analyzed to test the hypothesis that medication attitudes, while meaningfully different from "insight," correlated with insight and self-esteem, and change in each influenced the others. Rosenberg Self-Esteem Scale, Birchwood Insight Scale, and Positive and Negative Syndrome Scale insight were assessed at presentation, after 6 weeks and 3 and 18 months. Drug Attitudes Inventory (DAI) and treatment satisfaction were rated from 6 weeks onward. Structural equation models of their relationships were compared. Insight measures' and DAI's predictive validity were compared against relapse, readmission, and remission. Analysis found five latent constructs best fitted the data: medication attitudes, self-esteem, accepting need for treatment, self-rated insight, and objective insight. All were related and each affected the others as it changed, except self-esteem and medication attitudes. Low self-reported insight at presentation predicted readmission. Good 6-week insight (unlike drug attitudes) predicted remission. Literature review and data modeling indicated that a multimodal intervention using motivational interviewing, online psychoeducation, and SMS text medication reminders to enhance adherence without damaging self-concept was feasible and appropriate.
Manchester Academic Health Sciences Centre, Institute of Brain, Behaviour & Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust, Manchester, UK; richard.drake@manchester.ac.uk.
Richard J
RJ
Drake
Mental Health Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen NV, Denmark;
Merete
M
Nordentoft
Manchester Academic Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust, Manchester, UK; Manchester Academic Health Sciences Centre, School of Psychological Sciences, University of Manchester, Manchester, UK;
Gillian
G
Haddock
Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain;
Celso
C
Arango
Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria;
W Wolfgang
WW
Fleischhacker
Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Psychiatric Hospital Center Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark;
Birte
B
Glenthøj
INSERM U955, Laboratoire Psychopathologie et génétique des maladies mentales, et AP-HP, DHU Pe-PSY, Pole de Psychiatrie et d'addictologie des Hôpitaux Universitaires Henri Mondor, Université Paris-Est, Créteil, France;
Marion
M
Leboyer
Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany;
Stefan
S
Leucht
Central Institute of Mental Health, Mannheim, Germany;
Markus
M
Leweke
King's College London, Institute of Psychiatry, London, UK;
Phillip
P
McGuire
Central Institute of Mental Health, Mannheim, Germany;
Andreas
A
Meyer-Lindenberg
Psychiatry, Molecular and Clinical Neurobiology, Ludwig-Maximilians University, München, München, Germany; Department of Psychiatry, University of Halle, Halle, Germany;
Dan
D
Rujescu
Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands.
Iris E
IE
Sommer
Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands.
René S
RS
Kahn
Manchester Academic Health Sciences Centre, Institute of Brain, Behaviour & Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust, Manchester, UK;
Shon W
SW
Lewis
D000328:Adult; D001364:Awareness / Q000502:physiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D055118:Medication Adherence / Q000523:psychology*; D015233:Models, Statistical; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology*; D012649:Self Concept
adherence; first episode; insight; mHealth; schizophrenia; self-esteem; web-based