title: Relationship of insight with medication adherence and the impact on outcomes in patients with schizophrenia and bipolar disorder: results from a 1-year European outpatient observational study.
abstract: BACKGROUND
  Many patients with schizophrenia and bipolar disorder have impaired insight and low medication adherence. The aim of this post hoc analysis was to explore the relationship between insight and medication adherence.
  
  
  METHODS
  We included 903 patients with schizophrenia or bipolar disorder who participated in an observational study conducted in Europe on the outcomes of patients treated with two oral formulations of olanzapine over a 1-year period. Evaluations included Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), insight (Scale to Assess Unawareness of Mental Disorder, SUMD) medication adherence (Medication Adherence Rating Scale, MARS), and therapeutic alliance (Working Alliance Inventory, WAI).
  
  
  RESULTS
  Medication adherence was higher in bipolar patients (mean MARS score (SD) 6.5 (2.8) versus 5.8 (2.7) in schizophrenia; p < 0.001). Patients with schizophrenia had lower insight (i.e., SUMD item 1, unawareness of mental disorder, mean (SD) of 2.5 (1.3) in schizophrenia versus 1.9 (1.2) in bipolar, p < 0.001). Better insight was associated with higher adherence (Spearman Correlation Coefficient, SCC, ranging from 0.39 to 0.49 for the three SUMD general items, p < 0.0001 in all cases). Higher insight was related to a stronger therapeutic alliance (SCC ranging from 0.38 to 0.48, p < 0.0001). A path analysis revealed a positive impact of insight on adherence and alliance and that stronger alliance was related to lower clinical severity (lower CGI score).
  
  
  CONCLUSIONS
  Insight and adherence were found to be closely related. Insight impacts on the therapeutic alliance with mental health professionals. These factors are associated to treatment outcomes.
authors.affiliation: Global Health Outcomes Research, Lilly Research Centre, Eli Lilly and Company, Erl Wood Manor, Windlesham, Surrey, GU20 6PH, UK. novick_diego@lilly.com.
authors.forename: Diego
authors.initials: D
authors.lastname: Novick
authors.affiliation: Eli Lilly Australia Pty Ltd, West Ryde, Australia. montgomery_bill@lilly.com.
authors.forename: William
authors.initials: W
authors.lastname: Montgomery
authors.affiliation: Eli Lilly and Company, Budapest, Hungary. treuer_tamas@lilly.com.
authors.forename: Tamas
authors.initials: T
authors.lastname: Treuer
authors.affiliation: Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain. jaguado@pssjd.org.
authors.forename: Jaume
authors.initials: J
authors.lastname: Aguado
authors.affiliation: Lilly Deutschland GmbH, Bad Homburg, Germany. kraemer_susanne@lilly.com.
authors.forename: Susanne
authors.initials: S
authors.lastname: Kraemer
authors.affiliation: Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain. 27652jha@comb.cat.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
mesh_terms: D000328:Adult; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology*; D032882:Comprehension; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D000077152:Olanzapine; D010045:Outpatients / Q000523:psychology; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D016896:Treatment Outcome
chemical_list: D001569:Benzodiazepines; D000077152:Olanzapine