Understanding the multidimensional phenomenon of medication adherence attitudes in psychosis.

There is an urgent need for a better understanding of the multidimensional factors of medication adherence attitudes in patients with psychosis in order to enhance adherence as up to 75% of patients stop or change their medication within a year. 81 patients with psychosis were assessed on symptom expression, self-stigmatization, adherence attitudes, QoL, social support and therapeutic alliance judged by patients and clinicians. Regression analyses were used to test whether better QoL, more social support and a better therapeutic alliance are associated with more positive and less negative adherence attitudes. More positive clinician input, higher state anxiety and lower levels of self-stigmatization predicted more positive adherence attitudes, while less positive collaboration with the clinician and higher levels of self-stigmatization were associated with more negative adherence attitudes. QoL and social support were unrelated to adherence attitudes. The quality of the therapeutic alliance perceived by patients appears crucial regarding their medication adherence attitudes. Thus, clinicians' focus on psychotic symptom expression is not sufficient to achieve goal agreement. Rather, it is imperative to consider the individual subjective needs of patients as a key element for sustained therapeutic alliance.

The impact of self-stigmatization on medication attitude in schizophrenia patients.

Negative attitudes towards medication in schizophrenia patients are one major factor contributing to non-adherence behavior. Besides, self-stigmatization represents another frequent and important obstacle in patients suffering from psychotic disorders. Here, we investigated possible associations between medication adherence attitude and the extent of self-stigmatization, while also exploring factors related to self-stigmatization. Sociodemographic characteristics, clinical variables, medication attitude and self-stigmatization were assessed among 81 subjects with schizophrenia or schizoaffective disorder. The cross-sectional data was then analyzed by multivariate analyses. A more positive attitude towards medication was predicted by better insight into illness, lower degree of self-stigmatization and good subjective knowledge about medication (adjusted R2 = 0.23). Furthermore, a higher level of self-stigmatization was associated with lower subjective wellbeing, more severe depressive symptoms and male gender (adjusted R2 = 0.58). Other clinical variables had no additional predictive value for medication adherence attitude or the extent of self-stigmatization. Our findings support the notion that self-stigmatization is an influential factor on medication attitude that should therefore be appreciated in clinical practice. Besides this, special emphasis should be taken on depressive symptoms and reduced wellbeing, especially in male patients, to lower the extent of self-stigmatization.

The importance of strengthening competence and control beliefs in patients with psychosis to reduce treatment hindering self-stigmatization.

Different aspects of self-stigmatization represent barriers for recovery in patients with psychosis disorders. It is unclear whether addressing patient's competence and control beliefs could attenuate the extent of self-stigmatization. The major aim of this study was to identify predictors of self-stigmatization derived from competence and control beliefs in patients (N = 80). Sociodemographic characteristics, clinical variables, competence and control beliefs and self-stigmatization were assessed among 80 patients with psychosis disorders. The cross-sectional data was analyzed by correlation and regression analyses. Results indicate deficits in self-concept of own competences, i.e. the capability of acting in new, difficult or ambiguous situations, resulting in also impaired self-efficacy and relatively increased externality in patients compared to a general population sample. Subjective well-being under neuroleptics, trait-anxiety and defining oneself as religious were the most influential predictors of competence and control beliefs. A weaker self-concept of own competences was also revealed as the strongest predictor of overall high self-stigmatization. Our results stress the importance of orienting treatment strategies towards strengthening the self-concept of own competences in patients in order to reduce self-stigmatization and enhance resilience.