Rates and correlates of medication non-adherence behaviors and attitudes in adult patients with early psychosis

• Published in: Social Psychiatry and Psychiatric Epidemiology 2024-07, Vol.59 (7), p.1215-1225
• Main Authors: So, Yuen Kiu, Chan, Ching Yui, Fung, Shi Cheng, Lui, Tsz Ting, Lau, Fu Chun, Chan, Kit Wa, Lee, Ho Ming, Lui, Sai Yu, Hui, Lai Ming, Chen, Eric, Chang, Wing Chung
• Format: Article
• Language: English
• Subjects: Adult; Antipsychotic Agents - therapeutic use; Antipsychotics; Attitudes; Demographics; Epidemiology; Female; Health services; Hong Kong; Humans; Illnesses; Male; Medication Adherence - psychology; Medication Adherence - statistics & numerical data; Medicine; Medicine & Public Health; Middle Aged; Patient compliance; Psychiatric Status Rating Scales; Psychiatry; Psychosis; Psychotic Disorders - drug therapy; Psychotic Disorders - psychology; Psychotropic drugs; Regression analysis; Signs and symptoms; Social Stigma; Stigma; Surveys and Questionnaires
• ISSN: 0933-7954; 1433-9285; 1433-9285
• DOI: 10.1007/s00127-023-02563-4

Purpose Literature on antipsychotic medication adherence in early psychosis primarily assessed adherence behaviors and focused on young patients. There is a paucity of research investigating negative medication attitude and its determinants in the early illness course, particularly in older-aged sample. We aimed to examine prevalence and correlates of medication non-adherence behaviors and negative medication attitudes separately in adult patients with early psychosis. Methods One hundred ninety-nine Chinese early psychosis patients aged 26–55 years who had received three-year treatment for first psychotic episode in Hong Kong were examined. Assessments encompassing socio-demographics, premorbid adjustment, clinical and treatment profiles, self-stigma and therapeutic alliance were conducted. Patients were evaluated with Medication Compliance Questionnaire, which is a modified Chinese-translated version of Medication Adherence Rating Scale and includes items measuring adherence behaviors and attitudes towards medications. Results Rates of medication non-adherence and negative attitude towards medications were 38.7% and 50.8%, respectively. Multivariate regression analysis showed that more severe positive symptoms, greater self-stigma and negative medication attitude were independently associated with medication non-adherence. Negative attitude towards medications was significantly associated with younger age, higher educational attainment, diagnosis of other psychotic disorders, poorer insight, greater self-stigma and less satisfaction with communication with healthcare staff, which represented an index reflecting suboptimal therapeutic alliance. Conclusion Antipsychotic non-adherence and negative medication attitudes are frequently observed in adult early psychosis patients. Our findings indicate that poor insight, elevated self-stigma and suboptimal therapeutic alliance may constitute potential treatment targets for promoting medication adherence and rectifying negative medication attitudes in the early illness stage.