Clinical Correlates of Treatment Adherence and Insight in Patients with Schizophrenia

Abstract

Aim: The aim of this study was to assess clinical correlates of treatment adherence and insight in patients with schizophrenia. Methods: That cross-sectional study included 229 outpatients with schizophrenia who were admitted to the Psychiatry Outpatient Clinic of Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital. All participants were administered a socio-demographic form, Morisky Medication Adherence Questionnaire, Schedule for Assessing the three components of insight, Brief Psychiatric Rating Scale, Positive and Negative Symptoms Rating Scale, Calgary Depression Scale for Schizophrenia, and Global Assessment of Functioning Scale. Collected data were analyzed with descriptive statistics, Pearson Correlation Analysis, and logistic regression analysis. Results: Poor treatment adherence was associated with male gender, lower insight level, more severe psychotic symptoms, and lower functionality level. The insight score was negatively correlated with the severity of psychotic symptoms, duration of the disorder, and mean antipsychotic dose; but positively correlated with advanced age of onset and higher functionality level. The logistic regression analysis revealed that functionality level was more predictive of poor medication adherence. Conclusion: Poor treatment adherence and lower insight level were closely associated with more severe clinical symptoms and lower functionality level. It was noteworthy that adherence and insight levels both showed a high predictivity for the wellbeing of the patients. Therefore, psychotherapeutic interventions should be implemented to increase treatment adherence and insight in schizophrenia even if the psychotic symptoms show resistance. Further research is needed to clarify clinical associations of the treatment adherence and insight level in patients with schizophrenia.

Keywords

• treatment adherence
• schizophrenia
• insight

Öz

Amaç: Bu çalışmanın amacı şizofreni hastalarında tedaviye uyumu ve içgörü ile ilişkili klinik değişkenleri değerlendirmektir. Yöntemler: Kesitsel nitelikteki bu çalışmaya Sağlık Bilimleri Üniversitesi Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Psikiyatri Polikliniği’ne başvuran 229 şizofreni hastası dahil edildi. Tüm katılımcılara sosyodemografik veri formu, Morisky Tedaviye Uyum Ölçeği, İçgörünün Üç Bileşenini Değerlendirme Ölçeği, Kısa Psikiyatrik Değerlendirme Ölçeği, Pozitif ve Negatif Belirtileri Değerlendirme Ölçeği, Calgary Şizofrenide Depresyon Ölçeği ve İşlevselliğin Genel Değerlendirilmesi Ölçeği uygulanmıştır. İstatiksel analizde tanımlayıcı analizler, Pearson Korelasyon Analizi ve lojistik regresyon analizi kullanıldı. Bulgular: Şizofrenide düşük tedavi uyumu bulunması erkek cinsiyet, düşük içgörü düzeyi, yüksek psikotik belirti şiddeti ve düşük işlevsellik düzeyi ile ilişkili bulundu. İçgörü düzeyi ise psikotik belirti şiddeti, hastalığın süresi ve ortalama antipsikotik ilaç dozu ile negatif korelasyon gösterirken; geç başlangıç yaşı ve yüksek işlevsellik düzeyi ile pozitif korelasyon gösterdi. Lojistik regresyon analizinde ise işlevsellik düzeyinin düşük tedavi uyumunu öngörmede daha etkili olduğu belirlendi. Sonuç: Düşük tedavi uyumu ve içgörü düzeyi yüksek klinik belirti şiddetiyle ve düşük işlevsellik düzeyiyle güçlü korelasyon gösterdi. Tedavi uyumu ve içgörü düzeyi hastaların iyilik durumu üzerinde önemli prediktif faktörler olarak saptandı. Bu nedenle psikotik belirtiler dirençli olsa dahi şizofreni hastalarında tedavi uyumu ve içgörüyü arttırmaya yönelik psikososyal tedaviler uygulanmalıdır. Şizofreni hastalarında tedavi uyumu ve içgörü düzeyi ile ilişkili klinik değişkenlerin daha iyi anlaşılması için gelecekte yapılacak çalışmalar önemli olacaktır.

Anahtar Kelimeler

• tedavi uyumu
• şizofreni
• içgörü

Kaynakça

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