Attitudes toward medications and the relationship to outcomes in patients with schizophrenia
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Little is known regarding factors which are influential in shaping attitudes toward medications in patients with schizophrenia. The purpose of the current study is to evaluate outcomes in schizophrenia which may be related to attitudes toward medications in subjects who were enrolled in Phase 3 of the Texas Medication Algorithm Project. The Texas Medication Algorithm Project (TMAP) was an initiative to develop and implement medication algorithms for the treatment of mental illness. TMAP was divided into three phases. Phase 3 of TMAP was a prospective clinical trial which evaluated the outcomes of algorithm-based care versus treatment as usual. The current study is a retrospective analysis of data collected in Phase 3 which examines the relationships between cognition, adverse events, psychiatric symptomatology, self-reported medication compliance, and attitudes toward medications as measured by the Drug Attitude Inventory (DAI-30).A total of 307 adults with a schizophrenia-related diagnosis who were treated either with algorithm-based care or treatment as usual was identified. Baseline demographic data, psychiatric history data, and severity of illness data were analyzed to examine differences between groups at baseline. Binary logistic regression was used to examine continuous variables (cognition and psychiatric symptoms) which were thought to influence attitudes toward medications. Factors which were thought to influence changes in attitudes over time were evaluated using linear regression. Pearson chi-square tests were used to evaluate the relationship between adverse events, self-reported medication compliance, and attitudes toward medications.Mean Drug Attitude Inventory scores for subjects in this study did not change significantly over the course of 12 months. The odds of having a positive attitude toward medications were significantly increased by higher scores on the Trail Making Test, Part B (p = 0.03) and lower scores on the Scale for the Assessment of Negative Symptoms (p = 0.02). Improvements in general psychopathology, positive symptoms, and negative symptoms of schizophrenia had a significant positive influence on changes in attitudes toward medications over time. Understanding which factors influence attitudes toward medications in patients with schizophrenia is extraordinarily complex. The present study found that cognitive functioning, negative symptoms, and changes in psychiatric symptoms over time may all have a significant influence on attitudes toward medications. Factors which have been identified in the present study may assist in the design of future studies and lend further insight into the complex treatment of persons with schizophrenia.