|Year : 2018 | Volume
| Issue : 3 | Page : 200-202
Attitude toward antipsychotics and its correlation with psychopathology and insight in patients with schizophrenia
Mamta Sood1, Rakesh Kumar Chadda1, Ashwani Kumar Mishra1, Kalpana Kumari1, Ritushree Kukreti2
1 Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pharmacogenomics, Institute of Genomics and Integrative Biology, New Delhi, India
|Date of Web Publication||27-Sep-2018|
Prof. Rakesh Kumar Chadda
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
Background: Attitude to antipsychotics is likely to affect adherence to treatment and hence the outcome in schizophrenia. Methods: The present study was conducted to assess the attitude to antipsychotics and its correlates in patients with schizophrenia. Attitude to antipsychotics, insight, and psychopathology were assessed in 331 patients with schizophrenia using standardized measures. Results: Most patients showed a positive attitude toward antipsychotics. A negative correlation was observed between attitude and severity of psychopathology, whereas a positive attitude was seen between insight and attitude. Conclusion: The study emphasizes the need for psychoeducation at improving insight in patients with schizophrenia so as to enhance treatment adherence and outcome.
Keywords: Attitude, insight, psychopathology, schizophrenia, treatment
|How to cite this article:|
Sood M, Chadda RK, Mishra AK, Kumari K, Kukreti R. Attitude toward antipsychotics and its correlation with psychopathology and insight in patients with schizophrenia. Indian J Soc Psychiatry 2018;34:200-2
|How to cite this URL:|
Sood M, Chadda RK, Mishra AK, Kumari K, Kukreti R. Attitude toward antipsychotics and its correlation with psychopathology and insight in patients with schizophrenia. Indian J Soc Psychiatry [serial online] 2018 [cited 2019 Feb 17];34:200-2. Available from: http://www.indjsp.org/text.asp?2018/34/3/200/242356
| Introduction|| |
Antipsychotics are the mainstay of treatment for patients with schizophrenia and play a significant role in improvement in psychopathology, recovery from the illness, and relapse prevention. About half of the patients with schizophrenia remain nonadherent to medications. Attitude toward medications and insight into illness have been identified as important factors affecting adherence to treatment., It is, thus, important for the clinicians to take into consideration attitude toward medications when prescribing medication. Lack of insight, severity of psychopathology, presence of deficit symptoms, employment status, severity of side effects, first- versus second-generation antipsychotics, and later age of onset have been reported to be associated with negative attitude toward medications in patients with schizophrenia.,
Most of the work on attitude toward medications in patients with schizophrenia is from the high-income countries., The subject matter has not been much investigated in the non-Western world. Course and outcome of schizophrenia have been reported to be better in India and other Non-Western countries, as compared to the Western world. Patients in the non-Western world are often more receptive to the advice of their doctors and may have more positive attitude to the medication. The present study was conducted to assess attitude toward medications and its correlates in patients diagnosed as schizophrenia in a tertiary care center in India.
| Methods|| |
The study was conducted in a general hospital psychiatric unit of a tertiary care medical school in North India. Three hundred and thirty-one patients diagnosed as schizophrenia on DSM IV TR, aged 16–55, and of either gender were recruited to the study over a period of 3 years from 2009 to 2012. Patients with comorbid substance use disorders except nicotine dependence and physical illness necessitating treatment were excluded from the study. Informed consent was obtained from the patients or their legal representative.
Severity of illness was assessed using the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression (CGI) Scale. Drug attitude inventory-30 (DAI-30) was used to assess the attitude of patients toward medications. DAI is a 30-item self-administered instrument. Every positive response to an item is scored as plus 1 and negative response is scored as minus 1. The sum of all the responses may be positive or negative, reflecting positive or negative attitude toward treatment. Schedule for Assessment of Insight (SAI) was used for the assessment of insight. SAI assesses insight in three dimensions: treatment adherence (SAI 1), awareness of illness (SAI 2), and the ability to recognize abnormal mental events as pathological (SAI 3). The total score can vary from 0 to 4 or 6 on different dimensions with a maximum total score of 14. The study was approved by the Institute Ethics Committee.
The data were tabulated with the quantitative demographic and clinical variables expressed by mean + standard deviation and the categorical variables by frequency (%). Attitude toward medications was compared across sociodemographic and clinical subgroups by two independent sample ‘t'-test and one-way analysis of variance. Correlation of attitude to drugs with insight and psychopathology was estimated by Karl Pearson's correlation coefficient. The data were analyzed using the licensed SPSS 21.0 version software (Armonk, NY: IBM Corp).
| Results|| |
Three hundred and thirty-one patients with schizophrenia were recruited over a period of 3 years. Mean age of the participants was 32.8 ± 9.2 years. About half (54.4%) of them were males. Fifty-three percent of the participants were married, and 42% had never married. Forty-two percent of the patients were in paid employment, 26% were housewives, and 6% were students.
Mean age of onset of illness was 25.8 ± 7.6 years with a mean duration of 311.3 ± 294.2 weeks. Most (97.3%) of the participants were on second-generation antipsychotics. Mean total score on DAI was 12.9 ± 6.8. Most of the participants showed a positive attitude (93.7%) to the medications. Mean total score on PANSS was 56.2 ± 16.6 with scores on positive, negative, and general psychopathology subscales being 12.8 ± 6.2, 13.8 ± 5.1, and 29.6 ± 7.2, respectively. Mean total score on SAI was 8.3 ± 2.7.
A negative correlation was observed between scores on DAI and various subscales of the PANSS, namely, total score (r = −0.40), positive scale (−0. 31), negative scale (r = −0.35), and general psychopathology scale (r = −0.41). Similarly, a positive correlation was observed between scores on DAI and SAI (r = 0.50) and also with various dimensions of insight such as adherence to medications (r = 0.38), awareness of illness (r = −0.45), and ability to recognize abnormal mental events as pathological (r = 0.42). A negative correlation was observed between scores on SAI and CGI (r = −0.21) [Table 1].
|Table 1: Correlation of attitude to drugs with insight and psychopathology in patients with schizophrenia (n=331)|
Click here to view
No significant differences were observed in the attitude to medications and insight across gender, religion, domicile, residence, family history, marital status, education, and mode of onset. However, the participants in paid employment had significantly lower scores on DAI, as compared to the other subgroups.
| Discussion|| |
A great majority of the patients with schizophrenia in our study showed a favorable attitude toward antipsychotics. A positive correlation was observed between positive attitude to drugs and insight for the illness, whereas a negative correlation was seen with severity of psychopathology.
More than 90% of the patients had a positive attitude toward antipsychotic medications. Mean score in our study was on much positive direction as compared to earlier studies. A positive attitude toward medication has been reported to be associated with better adherence to treatment. In our study, most of the participants displayed a positive attitude toward the medication. The participants had been on treatment from our center for a varying period and had shown improvement with treatment, which could be the reason for a positive attitude toward medication in most of the participants. It could also be because of the selection bias that patients with a positive attitude could have been included in the study.
We did not find any significant association of attitude with various sociodemographic factors except that of being employed was being associated with poor attitude toward medications. Reasons for this could be that feeling stigmatized due to medication may interfere with performance at work. It is also possible that a person in employment may not consider medication as necessary.
Attitude to medications showed a negative correlation with all domains of psychopathology including positive symptoms, negative symptoms, and general psychopathology. Severity of psychosis is associated with a negative attitude to medications. The findings are similar to earlier research on the participant.,,
Insight into illness is likely to affect attitude to treatment and medications. We also found a positive correlation between positive attitude to drugs and all the three dimensions of insight. The correlation was not only with the dimension of treatment adherence but also with recognition of mental illness and ability to recognize abnormal mental events as pathological.
The study had a reasonably large sample size but had a limitation of being cross-sectional in nature and not assessing nonadherence to treatment. The study did not assess for side effects, which could be an important factor affecting attitude to the medications.
The study shows that the attitude to medication is affected by insight into illness and severity of illness and emphasizes on a need to correct the negative attitudes toward the medication as a part of psychoeducation, which is likely to affect adherence to treatment and hence the outcome. Further longitudinal studies, especially from the non-Western countries, are required to study the changes in the attitude to medications with treatment and improvement in psychopathology.
Financial support and sponsorship
The work was supported by grants from the Council of Scientific and Industrial Research (BSC0123) and Department of Biotechnology, Ministry of Science and Technology (GAP0040).
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: A comprehensive review of recent literature. J Clin Psychiatry 2002;63:892-909.
Sendt KV, Tracy DK, Bhattacharyya S. A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders. Psychiatry Res 2015;225:14-30.
Mohamed S, Rosenheck R, He H, Yuping N. Insight and attitudes towards medication among inpatients with chronic schizophrenia in the US and China. Soc Psychiatry Psychiatr Epidemiol 2014;49:1063-70.
Hofer A, Fleischhacker WW. Attitudes towards medication in patients with schizophrenia. Acta Psychiatr Scand 2006;113:161-2.
Mohamed S, Rosenheck R, McEvoy J, Swartz M, Stroup S, Lieberman JA, et al
. Cross-sectional and longitudinal relationships between insight and attitudes toward medication and clinical outcomes in chronic schizophrenia. Schizophr Bull 2009;35:336-46.
Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261-76.
Guy W, editor. ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: US Department of Health, Education, and Welfare Public Health Service Alcohol, Drug Abuse, and Mental Health Administration; 1976.
Hogan TP, Awad AG, Eastwood R. A self-report scale predictive of drug compliance in schizophrenics: Reliability and discriminative validity. Psychol Med 1983;13:177-83.
David AS. Insight and psychosis. Br J Psychiatry 1990;156:798-808.
Rocca P, Crivelli B, Marino F, Mongini T, Portaleone F, Bogetto F, et al
. Correlations of attitudes toward antipsychotic drugs with insight and objective psychopathology in schizophrenia. Compr Psychiatry 2008;49:170-6.