Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2015

Open Access 01-12-2015 | Research article

Relationship of insight with medication adherence and the impact on outcomes in patients with schizophrenia and bipolar disorder: results from a 1-year European outpatient observational study

Authors: Diego Novick, William Montgomery, Tamas Treuer, Jaume Aguado, Susanne Kraemer, Josep Maria Haro

Published in: BMC Psychiatry | Issue 1/2015

Login to get access

Abstract

Background

Many patients with schizophrenia and bipolar disorder have impaired insight and low medication adherence. The aim of this post hoc analysis was to explore the relationship between insight and medication adherence.

Methods

We included 903 patients with schizophrenia or bipolar disorder who participated in an observational study conducted in Europe on the outcomes of patients treated with two oral formulations of olanzapine over a 1-year period. Evaluations included Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), insight (Scale to Assess Unawareness of Mental Disorder, SUMD) medication adherence (Medication Adherence Rating Scale, MARS), and therapeutic alliance (Working Alliance Inventory, WAI).

Results

Medication adherence was higher in bipolar patients (mean MARS score (SD) 6.5 (2.8) versus 5.8 (2.7) in schizophrenia; p < 0.001). Patients with schizophrenia had lower insight (i.e., SUMD item 1, unawareness of mental disorder, mean (SD) of 2.5 (1.3) in schizophrenia versus 1.9 (1.2) in bipolar, p < 0.001). Better insight was associated with higher adherence (Spearman Correlation Coefficient, SCC, ranging from 0.39 to 0.49 for the three SUMD general items, p < 0.0001 in all cases). Higher insight was related to a stronger therapeutic alliance (SCC ranging from 0.38 to 0.48, p < 0.0001). A path analysis revealed a positive impact of insight on adherence and alliance and that stronger alliance was related to lower clinical severity (lower CGI score).

Conclusion

Insight and adherence were found to be closely related. Insight impacts on the therapeutic alliance with mental health professionals. These factors are associated to treatment outcomes.
Literature
1.
Oehl M, Hummer M, Fleischhacker WW. Compliance with antipsychotic treatment. Acta Psychiatr Scand Suppl. 2000;407:83–6.CrossRefPubMed
2.
Young JL, Zonana HV, Shepler L. Medication noncompliance in schizophrenia: codification and update. Bull Am Acad Psychiatry Law. 1986;14:105–22.PubMed
3.
Haddad PM, Brain C, Scott J. Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies. Patient Relat Outcome Meas. 2014;5:43–62.CrossRefPubMedPubMedCentral
4.
Montes JM, Maurino J, de Dios C, Medina E. Suboptimal treatment adherence in bipolar disorder: impact on clinical outcomes and functioning. Patient Prefer Adherence. 2013;7:89–94.PubMedPubMedCentral
5.
Leclerc E, Mansur RB, Brietzke E. Determinants of adherence to treatment in bipolar disorder: a comprehensive review. J Affect Disord. 2013;149:247–52.CrossRefPubMed
6.
American Psychiatric A. Practice guideline for the treatment of patients with schizophrenia, 2nd ed. Am J Psychiatry. 2004;161(2 Suppl):1–56.
7.
Higashi K, Medic G, Littlewood KJ, Diez T, Granström O, De Hert. Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Ther Adv Psychopharmacol. 2013;3:200–18.CrossRefPubMedPubMedCentral
8.
Sendt KV, Tracy DK, Bhattacharyya S. A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders. Psychiatry Res. 2014;S0165–1781:854–3.
9.
10.
Schennach R, Meyer S, Seemüller F, Jäger M, Schmauss M, Laux G, et al. Insight in schizophrenia-course and predictors during the acute treatment phase of patients suffering from a schizophrenia spectrum disorder. Eur Psychiatry. 2012;27:625–33.CrossRefPubMed
11.
Comparelli A, Savoja V, De Carolis A, Di Pietro S, Kotzalidis GD, Corigliano V, et al. Relationships between psychopathological variables and insight in psychosis risk syndrome and first-episode and multiepisodeschizophrenia. J Nerv Ment Dis. 2013;201:229–33.CrossRefPubMed
12.
Kutzelnigg A, Kopeinig M, Chen CK, Fábián A, Pujol-Luna MG, Shin YC, et al. Compliance as a stable function in the treatment course of bipolar disorder in patients stabilized on olanzapine: results from a 24-month observational study. Int JBipolar Disord. 2014;2:13.CrossRef
13.
Misdrahi D, Petit M, Blanc O, Bayle F, Llorca PM. The influence of therapeutic alliance and insight on medication adherence in schizophrenia. Nord J Psychiatry. 2012;66:49–54.CrossRefPubMed
14.
Beck EM, Cavelti M, Kvrgic S, Kleim B, Vauth R. Are we addressing the ‘right stuff’ to enhance adherence in schizophrenia? Understanding the role of insight and attitudes towards medication. Schizophr Res. 2011;132:42–9.CrossRefPubMed
15.
Pijnenborg GH, van Donkersgoed RJ, David AS, Aleman A. Changes in insight during treatment for psychotic disorders: a meta-analysis. Schizophr Res. 2013;144:109–17.CrossRefPubMed
16.
Charkraborty K, Basu D. Insight in schizophrenia — a comprehensive update. Ger J Psychiatry. 2010;13:17–30.
17.
Kraemer S, Chartier F, Augendre-Ferrante B, Psarra V, D’yachkova Y, Beselin A, et al. Effectiveness of two formulations of oral olanzapine in patients with schizophrenia or bipolar disorder in a natural setting: results from a 1-year European observational study. Hum Psychopharmacol. 2012;27:284–94.CrossRefPubMed
18.
Spearing MK, Post RM, Leverich GS, Brandt D, Nolen W. Modification of the Clinical Global Impressions (CGI) Scale for use in bipolar illness (BP): the CGI-BP. Psychiatry Res. 1997;73:159–71.CrossRefPubMed
19.
Haro JM, Kamath SA, Ochoa S, Novick D, Rele K, Fargas A, et al. The Clinical Global Impression-Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatr Scand Suppl. 2003;416:16–23.CrossRefPubMed
20.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders text revision: DSM-IV-TR. Washington: American Psychiatric Press; 2000.
21.
Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res. 2000;42:241–7.CrossRefPubMed
22.
Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM. Assessment of insight in psychosis. Am J Psychiatry. 1993;150:873–9.CrossRefPubMed
23.
24.
Medina E, Salvà J, Ampudia R, Maurino J, Larumbe J. Short-term clinical stability and lack of insight are associated with a negative attitude towards antipsychotic treatment at discharge in patients with schizophrenia and bipolar disorder. Patient Prefer Adherence. 2012;6:623–9.PubMedPubMedCentral
25.
Baloush-Kleinman V, Levine SZ, Roe D, Shnitt D, Weizman A, Poyurovsky M. Adherence to antipsychotic drug treatment in early-episode schizophrenia: asix-month naturalistic follow-up study. Schizophr Res. 2011;130:176–81.CrossRefPubMed
26.
Gianfrancesco FD, Sajatovic M, Rajagopalan K, Wang RH. The association between treatment adherence and antipsychotic dose among individuals with bipolar disorder. Int Clin Psychopharmacol. 2008;23:305–1.CrossRefPubMed
27.
Wunderink L, Nieboer RM, Wiersma D, Sytema S, Nienhuis FJ. Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry. 2013;70:913–20.CrossRefPubMed
28.
Lysaker PH, Vohs J, Hasson Ohayon I, Kukla M, Wierwille J, Dimaggio G. Depression and insight in schizophrenia: comparisons of levels of deficits in social cognition and metacognition and internalized stigma across three profiles. Schizophr Res. 2013;148:18–23.CrossRefPubMed
29.
Lysaker PH, Dimaggio G, Buck KD, Callaway SS, Salvatore G, Carcione A, et al. Poor insight in schizophrenia: links between different forms of metacognition with awareness of symptoms, treatment need and consequences of illness. Compr Psychiatry. 2011;52:253–60.CrossRefPubMed
30.
Hillis JD, Leonhardt BL, Vohs JL, Buck KD, Salvatore G, Popolo R, et al. Metacognitive reflective and insight therapy for people in early phase of a schizophrenia spectrum disorder. J Clin Psychol. 2015;71(2):125–35.CrossRefPubMed
31.
Van Donkersgoed RJ, De Jong S, Van der Gaag M, Aleman A, Lysaker PH, Wunderink L, et al. A manual-based individual therapy to improve metacognition in schizophrenia: protocol of a multi-center RCT. BMC Psychiatry. 2014;14:27.CrossRefPubMedPubMedCentral
32.
Brent BK. A mentalization-based approach to the development of the therapeutic alliance in the treatment of schizophrenia. J Clin Psychol. 2015;71:146–56.CrossRefPubMed
Metadata
Title
Relationship of insight with medication adherence and the impact on outcomes in patients with schizophrenia and bipolar disorder: results from a 1-year European outpatient observational study
Authors
Diego Novick
William Montgomery
Tamas Treuer
Jaume Aguado
Susanne Kraemer
Josep Maria Haro
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2015
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-015-0560-4

Other articles of this Issue 1/2015

BMC Psychiatry 1/2015 Go to the issue

Commentary

A shared framework for the common mental disorders and Non-Communicable Disease: key considerations for disease prevention and control

Research article

The Early Psychosis Intervention Center (EPICENTER): development and six-month outcomes of an American first-episode psychosis clinical service

Research article

Experienced consequences of being diagnosed with ADHD as an adult – a qualitative study

Case report

Case report: an unexpected link between partial deletion of the SHANK3 gene and Heller’s dementia infantilis, a rare subtype of autism spectrum disorder

Research article

What are the factors associated with depressive symptoms among orphans and vulnerable children in Cambodia?

Research article

A MRS study of metabolic alterations in the frontal white matter of major depressive disorder patients with the treatment of SSRIs