The influence of therapeutic alliance and insight on medication adherence in schizophrenia.

David Misdrahi, Marion Petit, Olivier Blanc, Franck Bayle, Pierre-Michel Llorca
Nordic Journal of Psychiatry. 2011-08-10; 66(1): 49-54
DOI: 10.3109/08039488.2011.598556

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1. Nord J Psychiatry. 2012 Feb;66(1):49-54. doi: 10.3109/08039488.2011.598556.
Epub 2011 Aug 10.

The influence of therapeutic alliance and insight on medication adherence in
schizophrenia.

Misdrahi D(1), Petit M, Blanc O, Bayle F, Llorca PM.

Author information:
(1)C.H. Charles Perrens, Pole de Psychiatrie 347, 121, rue de la Béchade, 33076
Bordeaux cedex, France.

BACKGROUND: Poor adherence is one of the leading problems affecting the
effectiveness of treatment in schizophrenia. It is an identified factor for
relapse and hospitalizations with major social and economic consequences.
Various determinants of poor adherence have been identified but few studies
investigate the role of therapeutic alliance on medication adherence in routine
mental healthcare.
AIMS: To investigate links between therapeutic alliance insight and medication
adherence in routine care and community psychiatry.
METHODS: In this cross-sectional study, 38 inpatients that met ICD-10 criteria
for schizophrenia or schizoaffective disorder were recruited and independently
interviewed just before discharge. Various rating scales were used: the
self-reported 4-Point ordinal Alliance Scale (4PAS), the Medication Adherence
Rating Scale (MARS) and the Scale to assess Unawareness of Mental Disorder
(SUMD). In addition, we investigated the relationships between medication
adherence and clinical variables through uni- and multivariate analysis.
RESULTS: Therapeutic alliance was significantly correlated with adherence (r =
0.663, P < 0.0001) and insight (r =-0.664, P < 0.0001). Poor adherence was
associated in patients with substance or alcohol use disorders (5.4 vs. 2.9, P =
0.0075, t = 2.83). No significant difference was found between the demographic
characteristics of the sample, the characteristics of the treatments and
adherence.
CONCLUSIONS: A weak therapeutic alliance and low insight are associated with
poor adherence in patients with schizophrenia or schizoaffective disorder who
were hospitalized. Specific psycho-educational programs to improve therapeutic
alliance and insight should be implemented to achieve better therapeutic
adherence and outcome.

DOI: 10.3109/08039488.2011.598556
PMID: 21830849 [Indexed for MEDLINE]

Auteurs Bordeaux Neurocampus