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      Patient Preference and Adherence (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on the growing importance of patient preference and adherence throughout the therapeutic process. Sign up for email alerts here.

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      Attitude Towards Drug Therapy in a Community Mental Health Center Evaluated by the Drug Attitude Inventory

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          Abstract

          Introduction

          Negative attitude towards drug therapy can foster limited adherence to treatment, which remains one of the biggest obstacles for implementing effective treatments, especially long term.

          Purposes

          The purposes of the study were 1) to evaluate the attitude towards drug therapy among a representative sample of patients treated in a community psychiatric service using 30-item Drug Attitude Inventory (DAI-30); 2) to evaluate the DAI-30 dimensions, applying factorial analysis; and 3) to highlight the socio-demographic and clinical variables correlated to DAI-30 score and factors.

          Methods

          The DAI was administered, over a 7-month period, to all patients treated in our psychiatric outpatient services who agreed to participate in this study and provided their informed consent. Data were statistically analyzed.

          Results

          With a response rate of 63.3%, 164 females and 136 males completed the DAI-30 with an average score of 14.24 (±10.46 SD), indicating moderately positive attitude towards drug therapy. The analysis of DAI-30 internal consistency confirmed its reliability (Cronbach’s alpha=0.84). Our factorial analysis highlighted three factors: Factor 1 (Cronbach’s alpha=0.81), composed of 7 items which indicate positive, trustful attitude; Factor 2 (Cronbach’s alpha=0.78), composed of 5 items indicating negative attitude of suspiciousness; and Factor 3 (Cronbach’s alpha=0.66), composed of 4 items suggesting defensive and control attitude towards drug therapy.

          Discussion

          Among the selected variables, “monotherapy” and “total number of hospitalizations” were negatively correlated to the final score of DAI-30, whereas being “married” was positively correlated to it, in a statistically significant way, using the multiple linear regression model. These correlations suggest that positive attitude towards drug therapy could be reinforced by the condition of being married and reduced by relapses with hospitalization, as literature highlighted, and, paradoxically, by a monotherapy, which could suggest a sort of psychological dependence on therapy and, indirectly, on psychiatric service, potentially correlated to the long-term treatments of our patients.

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          Most cited references56

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          Adherence to Antipsychotic Medication in Bipolar Disorder and Schizophrenic Patients

          Abstract Antipsychotics are the drugs prescribed to treat psychotic disorders; however, patients often fail to adhere to their treatment, and this has a severe negative effect on prognosis in these kinds of illnesses. Among the wide range of risk factors for treatment nonadherence, this systematic review covers those that are most important from the point of view of clinicians and patients and proposes guidelines for addressing them. Analyzing 38 studies conducted in a total of 51,796 patients, including patients with schizophrenia spectrum disorders and bipolar disorder, we found that younger age, substance abuse, poor insight, cognitive impairments, low level of education, minority ethnicity, poor therapeutic alliance, experience of barriers to care, high intensity of delusional symptoms and suspiciousness, and low socioeconomic status are the main risk factors for medication nonadherence in both types of disorder. In the future, prospective studies should be conducted on the use of personalized patient-tailored treatments, taking into account risk factors that may affect each individual, to assess the ability of such approaches to improve adherence and hence prognosis in these patients.
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            Why do psychiatric patients stop antipsychotic medication? A systematic review of reasons for nonadherence to medication in patients with serious mental illness

            Background Antipsychotic medication reduces the severity of serious mental illness (SMI) and improves patient outcomes only when medicines were taken as prescribed. Nonadherence to the treatment of SMI increases the risk of relapse and hospitalization and reduces the quality of life. It is necessary to understand the factors influencing nonadherence to medication in order to identify appropriate interventions. This systematic review assessed the published evidence on modifiable reasons for nonadherence to antipsychotic medication in patients with SMI. Methods Articles published between January 1, 2005, and September 10, 2015, were searched on MEDLINE through PubMed. Abstracts were independently screened by 2 randomly assigned authors for inclusion, and disagreement was resolved by another author. Selected full-text articles were divided among all authors for review. Results A qualitative analysis of data from 36 articles identified 11 categories of reasons for nonadherence. Poor insight was identified as a reason for nonadherence in 55.6% (20/36) of studies, followed by substance abuse (36.1%, 13/36), a negative attitude toward medication (30.5%, 11/36), medication side effects (27.8%, 10/36), and cognitive impairments (13.4%, 7/36). A key reason directly associated with intentional nonadherence was a negative attitude toward medication, a mediator of effects of insight and therapeutic alliance. Substance abuse was the only reason consistently associated with unintentional nonadherence, regardless of type and stage of SMI. Discussion Although adherence research is inherently biased because of numerous methodological limitations and specific reasons under investigation, reasons for nonadherence consistently identified as significant across studies likely reflect valid existing associations with important clinical implications. Conclusion This systematic review suggests that a negative attitude toward medication and substance abuse are consistent reasons for nonadherence to antipsychotic medication among people with SMI. Adherence enhancement approaches that specifically target these reasons may improve adherence in a high-risk group. However, it is also important to identify drivers of poor adherence specific to each patient in selecting and implementing intervention strategies.
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              Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia

              Key Points Question Are there specific antipsychotic combinations that are superior to monotherapies in the maintenance treatment of schizophrenia? Findings This cohort study on 62 250 individuals with schizophrenia with up to 20-year follow-up used within-individual analysis to minimize selection bias and showed that antipsychotic polypharmacy in general was associated with slightly lower risk of psychiatric rehospitalization than monotherapy. Clozapine plus aripiprazole combination was associated with the best outcome, having 14% to 23% lower risk of rehospitalization than clozapine alone, which was the monotherapy associated with the best outcomes. Meaning The findings of this study suggest that certain types of polypharmacy may be associated with fewer rehospitalizations than monotherapies.
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                Author and article information

                Journal
                Patient Prefer Adherence
                Patient Prefer Adherence
                PPA
                ppa
                Patient preference and adherence
                Dove
                1177-889X
                17 June 2020
                2020
                : 14
                : 995-1010
                Affiliations
                [1 ]Mental Health and Drug Abuse Department of AUSL-Modena, Psychiatric Intensive Treatment Facility , Modena 41122, Italy
                [2 ]Mental Health Department, UOC Psychiatry , Fermo 63900, Italy
                [3 ]School of Nursing, University of Modena and Reggio Emilia , Modena 41124, Italy
                [4 ]School of Specialization in Psychiatry, University of Modena and Reggio Emilia , Modena 41124, Italy
                [5 ]General and Applied Hygiene, Department of Biomedical, Metabolic and Neural Sciences, Public Health Section , Modena, 41125, Italy
                [6 ]Nursing, Department of Biomedical, Metabolic and Neural Sciences, Public Health Section , Modena, 41125, Italy
                Author notes
                Correspondence: Rosaria Di Lorenzo Email saradilorenzo1@alice.it
                Article
                251993
                10.2147/PPA.S251993
                7307441
                1479585b-e90d-4a7d-86be-6c289955ed25
                © 2020 Di Lorenzo et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 4, Tables: 5, References: 76, Pages: 16
                Categories
                Original Research

                Medicine
                attitude towards drugs,psychiatric disorders,community mental health center,therapy adherence

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