Background. Various factors have been associated with non-compliance with treatment in schizophrenia. The aim of this study was to examine this association using standardised measures.
Method. Compliance was determined and socio-demographic and illness variables recorded. Insight, subjective response to medication and relatives' knowledge and attitude about schizophrenia were measured.
Results. Non-compliant patients were younger, had shorter durations of illness, had an episodic course of illness, reported side-effects less frequently, made incorrect attributions to current positive symptoms more frequently and had a more negative subjective response to medication. Key relatives of non-compliant patients were more often employed.
Conclusions. Patients need to experience for themselves the merits of taking medication before accepting the need to take them long-term. Psychoeducational and cognitive-behavioural interventions need to be targeted at changing attribu tions to current positive symptoms. The presence of a key person in the community is crucial to improve compliance.
Get full access to this article
View all access options for this article.
References
1.
Amador, X.F. ET AL. (1993) Assessment of insight in psychosis. American Journal of Psychiatry, 150, 873-879.
2.
Angermeyer, M.C. & Matschinger, H. (1994) Lay beliefs about schizophrenic disorder: the results of a population survey in Germany. Acta Psychiatrica Scandinavica, 89(suppl 382), 39-45.
3.
Barrowclough, C. & Tarrier, N. (1992) Families of Schizophrenic Patients - Cognitive Behavioural Intervention (1st edn). Chapman and Jones.
4.
Bland, J.M. & Altman, D.G. (1995) Multiple Significance Tests: The Bonferroni Method . British Medical Journal, 310, 170.
5.
Bristow, M.F. & Hirsch, S.R. (1993) Risk of relapse and its prevention in schizophrenia . Clinician, 11(4), 55-67.
6.
Buchanan, A. (1992) A two year prospective study of treatment compliance in patients with schizophrenia. Psychological Medicine, 22, 787-797.
7.
Buchkremer, G., Stricker, K., Holle, R. ET AL. (1991) The predictability of relapse in schizophrenic patients. European Archives of Psychiatry and Clinical Neurosciences , 240, 292-300.
8.
Davis, J.M. & Andriukutis, S. (1986) The Natural Course of Schizophrenia and Effective Maintenance Therapy. Journal of Clinical Psychopharmacology , 6(suppl.), 2-10.
9.
Falloon, I.R.H., Boyd, J.L., Mcgill, C.W. ET AL. (1982) Family management in the prevention of exacerbations of schizophrenia. A controlled study. New England Journal of Medicine, 306, 1437-1440.
10.
Fleischhaker, W.W., Meise, U., Gunther, V. ET AL. (1994) Compliance with Antipsychotic Drug Treatment: Influence of Side-effects. Acta Psychiatrica Scandinavica , 89(suppl.382), 11-15.
11.
Goldstein, M.J. (1992) Psychosocial strategies for maximising the effects of pscyhotropic medications for schizophrenia and mood disorders. Psychopharmacological Bulletin, 28(3), 237-240.
12.
Hogan, T.P., Awad, A.G. & Eastwood, G. (1983) A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychological Medicine, 13, 177-183.
13.
Icd-10 (1993) The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization, Geneva.
14.
Johnson, D.A.W. & Freeman, H. (1973) Drug defaulting by patients on long-acting phenothiazines . Psychological Medicine, 3, 115-119.
15.
Kaplan, H.I. & Sadock, B.J. (1988) Human development throughout the life cycle. In Synopsis of Psychiatry, Behavioural Sciences, Clinical Psychiatry (5th Edn), pp. 44-45. Baltimore: Williams and Wilkins.
16.
Kingdon, D.G. & Turkington, D. (1994) Cognitive Behaviour Therapy of Schizophrenia. Hove: Lawrence Erlbaum.
17.
Levinson, D.J. (1986) A conception of adult development. American Psychologist, 41, 3.
18.
Lin, I.H., Spiga, R. & Fortsch, W. (1979) Insight and adherence to medication in chronic schizophrenics. Journal of Clinical Psychiatry, 40, 430-432.
19.
Marder, S.R., Mebane, A., Chien, C. ET AL. (1983) A comparison of patients who refuse and consent to neuroleptic treatment. American Journal of Psychiatry , 140, 470-472.
20.
Mcevoy, J.P., Apperson, L.J., Appelbaum, P.S. ET AL. (1989) Insight and the clinical outcome of schizophrenic patients. Journal of Nervous and Mental Disease, 177(1), 48-51.
Van Putten, T. (1974) Why do schizophrenic patients refuse to take their drugs?Archives of General Psychiatry,31, 67-72.
23.
Van Putten, T., Crumpton, E. & Yale, C. (1976) Drug refusal in schizophrenia and the wish to be crazy. Archives of General Psychiatry,33, 1443-1446.
24.
Van Putten, T. & May, P.R.A. (1978) Subjective response as a predictor of outcome in pharmacotherapy: The consumer has a point. Archives of General Psychiatry, 35, 477-480.
25.
Van Putten, T. (1981) Subjective response to antipsychotic drugs. Archives of General Psychiatry,38, 187-190.
26.
Willcox, D.R.C., Gillan, R. & Hare, E.H. (1965) Do psychiatric out-patients take their drugs?British Medical Journal, 2, 790-792.
27.
Wistedt, B. (1981) A depot neuroleptic withdrawal study. Acta Psychiatrica Scandinavica, 64, 65-84.
