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

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Abstract

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.

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Data availability

The data that support the findings of this study are available from the corresponding author upon request.

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Acknowledgements

The authors would like to thank all the coordinating clinicians and staff from the participating hospitals, clinics and medical records departments for their kind assistance. We are also grateful to the individuals who participated in the study.

Funding

The study was supported by the Health and Medical Research Fund (HMRF), the Food & Health Bureau of the HKSAR Government (SMH-47).

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Authors and Affiliations

  1. Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong

    Yuen Kiu So, Ching Yui Chan, Shi Cheng Fung, Tsz Ting Lui, Fu Chun Lau, Kit Wa Chan, Ho Ming Lee, Sai Yu Lui, Lai Ming Hui, Eric Chen & Wing Chung Chang

  2. State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong

    Kit Wa Chan, Eric Chen & Wing Chung Chang

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  1. Yuen Kiu So
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  2. Ching Yui Chan
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Contributions

Authors W.C.C., and E.Y.H.C. designed and conceptualized the study. Authors Y.K.S., C.Y.C. and S.C.F. conducted statistical analysis. Y.K.S. wrote the first draft of the manuscript. Authors W.C.C., Y.K.S., C.Y.C. and S.C.F. interpreted the study data. Author W.C.C. revised and finalized the manuscript. All authors provided critical feedback to the manuscript and have approved the final manuscript.

Corresponding author

Correspondence to Wing Chung Chang.

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Conflicts of interest

Author E.Y.H.C has participated in the scientific advisory board for Otsuka, has received educational grant support from Janssen-Cilag, and has received research funding from Astra-Zeneca, Janssen-Cilag, Eli Lilly, Sanofi-Aventis and Otsuka. The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.

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So, Y.K., Chan, C.Y., Fung, S.C. et al. Rates and correlates of medication non-adherence behaviors and attitudes in adult patients with early psychosis. Soc Psychiatry Psychiatr Epidemiol (2023). https://doi.org/10.1007/s00127-023-02563-4

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