Revisiting Drug Compliance: The Need for a Holistic Approach in the Treatment of Severe Mental Disorders

Abstract

INTRODUCTION: The limited practice of depot antipsychotics and psychoeducation use, recommended for overcoming the noncompliance of patients with severe mental disorders, is linked to a high incidence of treatment violation. Therefore, the development of personalized mental healthcare approaches is a crucial healthcare task.

AIM: To describe and differentiate the role of clinical, social and psychological factors that lead to different level of treatment engagement of psychiatric inpatients.

METHODS: Secondary analysis of findings from 91 inpatients, based on the Treatment Motivation Assessment Questionnaire and Medication Compliance Scale, as well as the Scale of Internalized Stigma of Mental Illness and Perceived Discrimination and Devaluation Scale. Factorial analysis, cluster analysis and analysis of variance with p-level=0.05 and the calculation of the effect size (ES) according to Cohen’s d and Cramer’s V were used.

RESULTS: The nature of therapy compliance in various categories of patients is mediated differentially, including: the severity of negative symptoms (ES=0.29), the global level of functioning and work maladjustment (ES=0.23–0.26), various motivational and behavioral styles (ES≥0.74) and the intensity of psychiatric stigmatization (ES≥0.88).

CONCLUSIONS: Consideration of the clinical, social and psychological factors should empirically determine the strategies for the personalized use of prolonged antipsychotics and socio-psychotherapeutic interventions when developing an individual treatment plan for psychiatric in-patients.

Keywords

treatment adherence and compliance / patient engagement / motivation / mental disorders / stigma

References

[1] Mosolov S, Tsukarzi E, Alfimov P. Algorithms for biological treatment of schizoprenia. Article in Russian. 2014;(1):27–36.

[2] Dyakov I N, Zyryanov SK. Comparative evaluation of clinical and economic efficiency of paliperidone in various dosage forms used in patients with schizophrenia. Article in Russian. Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(2):85-92. doi:10.17116/jnevro20171172185-92

[3] Lindenmayer JP, Glick ID, Talreja H, Underriner M. Persistent Barriers to the Use of Long-Acting Injectable Antipsychotics for the Treatment of Schizophrenia. J Clin Psychopharmacol. 2020;40(4):346-349. doi:10.1097/JCP.0000000000001225

[4] Civan Kahve A, Kaya H, Gul Cakil A, et al. Multiple antipsychotics use in patients with schizophrenia: Why do we use it, what are the results from patient follow-ups? Asian J Psychiatr. 2020;52:102063. doi:10.1016/j.ajp.2020.102063

[5] Barbui C, Bertolini F, Bartoli F, et al. Reasons for initiating long-acting antipsychotics in psychiatric practice: findings from the STAR Network Depot Study. Ther Adv Psychopharmacol. 2020;10:2045125320978102. doi:10.1177/2045125320978102

[6] Botha UA, Koen L, Joska JA, et al. The revolving door phenomenon in psychiatry: comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country. Soc Psychiatry Psychiatr Epidemiol. 2010;45(4):461-468. doi:10.1007/s00127-009-0085-6

[7] Hasan A, Falkai P, Wobrock T, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects. World J Biol Psychiatry. 2013;14(1):2-44. doi:10.3109/15622975. 2012.739708

[8] Mendel R, Hamann J, Traut-Mattausch E, et al. ‘What would you do if you were me, doctor?’: randomised trial of psychiatrists’ personal v. professional perspectives on treatment recommendations. Br J Psychiatry. 2010;197(6):441-447. doi:10.1192/bjp.bp.110.078006

[9] Link BG, Phelan JC. Conceptualizing Stigma. Annual Review of Sociology. 2001;27(1):363-385. doi:10.1146/annurev.soc.27.1.363

[10] El Abdellati K, De Picker L, Morrens M. Antipsychotic Treatment Failure: A Systematic Review on Risk Factors and Interventions for Treatment Adherence in Psychosis. Front Neurosci. 2020;14:531763. doi:10.3389/fnins.2020.531763

[11] Noordraven EL, Wierdsma AI, Blanken P, Bloemendaal AF, Mulder CL. Depot-medication compliance for patients with psychotic disorders: the importance of illness insight and treatment motivation. Neuropsychiatr Dis Treat. 2016;12:269-274. doi:10.2147/NDT.S97883

[12] Jochems EC, Duivenvoorden HJ, van Dam A, Mulder CL, van der Feltz-Cornelis CM. Testing the Integral Model of treatment motivation in outpatients with severe mental illness. Motiv Emot. 2018;42(6):816-830. doi:10.1007/s11031-018-9708-0

[13] Sorokin MY, Lutova NB, Wied VD. The Role of Treatment Motivation Subsystems in the Overall Structure of Compliance in Patients Undergoing Psychopharmacotherapy. Neuroscience and Behavioral Physiology. 2017;47(8):890-894. doi:10.1007/s11055-017-0486-z

[14] Lutova NB, Sorokin MY, Makarevich OV, Wied VD. The subjective concept of morbidity: its assessment and connection with the motivation for treatment in persons who underwent psychosis. VM Bekhterev Review of Psychiatry and Medical Psychology. 2020(2):73-79. doi:10.31363/2313-7053-2020-2-73-79

[15] Lutova NB, Wied VD. The insight and compliance in patients with schizophrenia. Dynamische Psychiatrie. 2016;49(3-6):235–247

[16] Overall J, Gorham D. The Brief Psychiatric Rating Scale. Psychol Rep. 1962;10(3):799-812. doi:10.2466/pr0.1962.10.3.799

[17] Andreasen N. Negative Symptoms in Schizophrenia. Arch Gen Psychiatry. 1982;39(7):784. doi:10.1001/archpsyc.1982.04290070020005

[18] Salvi G, Leese M, Slade M. Routine use of mental health outcome assessments: choosing the measure. British Journal of Psychiatry. 2005;186(2):146-152. doi:10.1192/bjp.186.2.146

[19] Boyd Ritsher J, Otilingam P, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res. 2003;121(1):31-49. doi:10.1016/j.psychres.2003.08.008

[20] Link B, Cullen F, Struening E, Shrout P, Dohrenwend B. A Modified Labeling Theory Approach to Mental Disorders: An Empirical Assessment. Am Sociol Rev. 1989;54(3):400. doi:10.2307/2095613

[21] Lutova NB, Sorokin MYu, Wied VD. Structure of motivation for treatment and compliance in psychiatric patients. In: Neznanov NG, Vasileva AV, eds. Dynamic Psychiatry of Gunter Ammon. Identity through the Group. Alta Astra;2018:245-254.

[22] Mathews M, Gopal S, Singh A, et al. Comparison of Relapse Prevention with 3 Different Paliperidone Formulations in Patients with Schizophrenia Continuing versus Discontinuing Active Antipsychotic Treatment: A Post-Hoc Analysis of 3 Similarly Designed Randomized Studies. Neuropsychiatr Dis Treat. 2020;16:1533-1542. doi:10.2147/NDT.S221242

[23] Teigen KH. Yerkes-Dodson: A Law for all Seasons. Theory & Psychology. 2016;4(4):525-547. doi:10.1177/0959354394044004

[24] Galderisi S, Rossi A, Rocca P, et al. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry. 2014;13(3):275-287. doi:10.1002/wps.20167

[25] Jochems EC, van der Feltz-Cornelis CM, van Dam A, Duivenvoorden HJ, Mulder CL. The effects of motivation feedback in patients with severe mental illness: a cluster randomized controlled trial. Neuropsychiatr Dis Treat. 2015;11:3049-3064. doi:10.2147/NDT.S95190

[26] Kortrijk HE, Kamperman AM, Mulder CL. Changes in individual needs for care and quality of life in Assertive Community Treatment patients: an observational study. BMC Psychiatry. 2014;14:306. doi:10.1186/s12888-014-0306-8

RIGHTS & PERMISSIONS

Sorokin M.Y., Neznanov N.G., Lutova N.B., Wied V.D.