Compliance and psychological reactance in schizophrenia

Abstract

Objectives. Non-compliance with neuroleptic medication in schizophrenia is a major cause of relapse. A number of sociodemographic variables, and illness, attitudinal and treatment variables, have been demonstrated to be associated with non-compliance. The present study examined a range of these variables and their predictive value in determining past and current compliance. Methods.Thirty-nine patients suåering from schizophrenia and three patients suåering from schizoaåective disorder completed a series of questionnaires assessing psychological reactance, insight, subjective response to medication, perceived threat to freedom of choice, and degree of current and past compliance. Logistic regression analyses were performed to determine which factors best predicted past and current compliance.Results. Psychological reactance and age were found to be the best predictors of past compliance, with an interaction between reactance and perceived threat to freedom of choice posed by treatment provision also making a signi®cant contribution. Past compliance behaviour and subjective response to medication predicted current compliance most signi®cantly. Conclusions.Reactance is an important predictor of compliance history especially when patients perceive treatment to be a threat to freedom of choice. Subjective response to neuroleptics is most important in predicting current compliance. Implications for intervention are discussed.Compliance with antipsychotic medication is crucial in the prevention of symptom aggravation and relapse in patients suåering from schizophrenia. It has been shown that over a 9-month period, approximately 50% of patients relapse when not

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“…The perception of treatment as a threat to freedom of choice has been correlated with poor compliance in some vulnerable populations [36]. Participant-centered clinical research, which addresses the patients' goals, interests, and abilities has been advocated by some authors [35].…”

Modeling Determinants of Medication Attitudes and Poor Adherence in Early Nonaffective Psychosis: Implications for Intervention

“…There is evidence in early illness that actual benefit 58,68 is important and that patients test this with antipsychotic "holidays" to see if symptoms re-emerge. 69 Reactance, the disposition to reverse perceived losses of autonomy, affects perceived benefit 70 as does insight, [70][71][72] especially recognizing symptoms during first episodes. 52 However, there appears an independent effect of perceived benefit too.…”

Working with reactant patients: are we prescribing nonadherence?

“…The HPRS [26] is a 14-item scale measuring four empirically derived factors: [26,27] freedom of choice, conformity reactance, behavioral freedom, and reactance to advice and recommendations. The HPRS has been demonstrated to have high test-retest reliability for a 2-week interval in a general public sample (.89), [26] and adequate internal consistency reliability in psychiatric [19] and general public samples [26,27] (Cronbach's a 5 .86, .81, and .77, respectively).…”

“…Moore et al [19] found that among 42 patients receiving neuroleptic treatment (n 5 39 schizophrenia, n 5 3 schizoaffective disorder), patient reactance as well as its interaction with the perceived degree of threat to freedom posed by treatment predicted past, but not current, self-reported medication adherence. However, Seibel and Dowd [18] found that reactance was unrelated to therapist-rated ''medication compliance'' among a diagnostically heterogeneous sample of 90 psychotherapy outpatients.…”