Interactive risk factors for treatment adherence in a chronic psychotic disorders population

• Published in: Psychiatry research Vol. 89; no. 3; pp. 269 - 274
• Main Authors: Corriss, David J, Smith, Thomas E, Hull, James W, Lim, Rosa W, Pratt, Sarah I, Romanelli, Susan
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 27-12-1999; Elsevier
• Subjects: Adult; Antipsychotic Agents - administration & dosage; Antipsychotic Agents - adverse effects; BASIS-32; Biological and medical sciences; Chronic Disease; Combined Modality Therapy; Day Care, Medical - psychology; Female; Humans; Male; Medical sciences; Medication compliance; Middle Aged; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychosis; Psychotherapy; Psychotic Disorders - psychology; Psychotic Disorders - therapy; Recurrence; Risk Factors; Schizophrenia; Substance abuse; Therapeutical relation and framework; Treatment alliance; Treatment Refusal - psychology; Treatments; Working alliance inventory; Psychosis; Treatment alliance; BASIS-32; Working alliance inventory; Schizophrenia; Substance abuse; Medication compliance; Mood disorder; Human; Schizoaffective psychosis; Abuse; Illicit drug; Neuroleptic; Psychotropic; Paranoid schizophrenia; Psychotic depression; Prediction; Depression; Therapeutic relation; Drug compliance; Alcoholic beverage; Symptomatology; Chemotherapy; Chronic; Treatment; Follow up study; Treatment compliance; Severity score; Therapeutic schedule
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/S0165-1781(99)00111-0

This study identified the unique and primary contributions of several concurrent risk factors for poor adherence to treatment recommendations in a clinic population of individuals with chronic psychotic disorders, i.e. 48% had DSM-IV diagnoses of schizoaffective disorder, 38% had schizophrenia, paranoid type, 12% had schizophrenia, undifferentiated type, and 2% had affective disorder with psychotic features. The target cohort consisted of 87 consecutive admissions to a continuing day treatment program. As part of a services-oriented quality assurance program, clinical staff completed rating scales for all patients. These included the BASIS-32 rating scale, which consisted of the following five subscales: psychosis; depression/anxiety; impulsive/addictive behavior; relation to self and others; and daily living and role functioning, and the Working Alliance Inventory-short form (therapist version), which consisted of the following three subscales: goal; task; and bond. These data were used to identify risk factors that weaken a patient’s adherence to medication and non-medication treatment during the first 2 weeks of treatment in the clinic. Medication treatment consisted of both typical and atypical neuroleptic medications, with most patients being on multiple medications. Correlational analyses suggested that many of the risk factor variables were significantly associated with poor treatment adherence. Regression analyses suggested that the degree of psychoticism was most strongly associated with poor adherence to medication treatment and that difficulties relating to self and others were the strongest predictor of poor adherence to non-medication treatment. A large-sample services research design such as this can begin to determine patterns of associations between previous identified risk factors and poor treatment adherence in individuals with chronic psychotic disorders.