The Effect of Therapeutic Alliance on Attitudes Toward Psychiatric Medications in Schizophrenia

Abstract

Purpose/Background: The differential influence of therapeutic alliance with different health care professionals on patients' medication adherence has never been examined.Methods/Procedures: Ninety-five stable outpatients (91 patients with schizophrenia and 4 patients with schizoaffective disorder) were recruited. Individual, clinical, and medication factors were assessed, along with drug attitude (10-item Drug Attitude Inventory). Comparison on these factors was made between outpatients who identified psychiatrists as the health care professional most involved in their care, as compared with other health care professionals.Findings/Results: Older age, longer duration of illness, presence of medical comorbidities, lower levels of internalized stigma, higher levels of insight, higher levels of functioning, lesser severity of depressive symptoms, and positive symptoms were found to be significantly associated with greater levels of drug attitude (small to moderate associations). Only therapeutic alliance had a large correlation with drug attitude (ρ = 0.503, P < 0.001). The therapeutic alliance scores between the 2 health care professionals groups are not significantly different. However, participants who have identified psychiatrists as the health care professional that contributed the most to their recovery reported a significantly more positive attitude (μ = 6.18, SD = 3.42) toward psychiatric medication as compared with the other health care professionals group (μ = 3.11, SD = 5.32, P = 0.004). Only 2 factors, the Revised Helping Alliance Questionnaire (β = 0.424, P < 0.001) and Personal and Social Performance scale (β = 0.272, P = 0.006), were statistically significant predictors of drug attitude.Implications/Conclusions: Therapeutic alliance is found to be the lead factor associated with drug attitude in patients with schizophrenia. Identifying psychiatrists as the health care professional most involved in the patients' recovery can greatly increase patients' drug attitudes. Maintaining individuals' functioning also contributes to drug attitude.

Attitude Toward Treatment and Medication Adherence Among Chronic Schizophrenia After Undergoing Confinement

“…In addition, they will stop taking the drug when not feeling psychotic symptoms. The results of this study are relevant to studies conducted by Madeline et al [13] shows drug attitude is closely related to drug adherence. Non-compliance with the treatment was found in people with schizophrenia who had a negative attitude to the drug [15].…”

“…Furthermore, in his research, they explained that the drug helps patients to control psychotic symptoms. Based on the background, research needs to be done to find out the relationship between attitudes and drug to schizophrenic persons who have a history of experiencing development [13].…”

Personal and Social Functioning and Health-Related Quality of Life in Patients with Schizophrenia Treated with the Long-Acting Injectable Antipsychotic Risperidone ISM

“… 51 Indeed, the therapeutic alliance and the patient’s level of functioning can significantly impact on their drug attitude since lower levels of positive and depressive symptoms, as well as a higher level of functioning have been associated with better drug attitudes. 52 In contrast, nonadherence has been associated with poorer functional outcomes. 53 Therefore, treatment with Risperidone ISM of patients with schizophrenia may also be an effective way to reinforce the therapeutic alliance between patient and clinician, 54 resulting in improved adherence and acceptance of a LAI formulation 55 , 56 that avoids the need of additional boosting injections or oral risperidone supplementation, thereby providing a rapid effect on positive and negative symptoms, as well as a meaningful impact on the functioning and HR-QoL outcomes.…”