Motivation for adherence to treatment in chronic psychotic disorders: Interventions strategies and social cognitive factors

by E. Barkhof

Institution: Universiteit van Amsterdam
Year: 2015
Record ID: 1257560
Full text PDF: http://hdl.handle.net/11245/1.444375


Nonadherence to antipsychotic medication is highly prevalent in patients with schizophrenia and leads to unfavorable outcomes, such as a five-fold risk of hospitalization, elevated risks for suicide and aggressive incidents and increased overall costs. In this thesis we have reviewed the effects of existing interventions to improve adherence rates and we examined in more detail the effects of a specific intervention, Motivational Interviewing (MI), on treatment adherence and its consequences in patients with schizophrenia. In a randomized trial with 114 patients we found that MI did not produce a significant improvement in adherence rates and hospitalization, compared to a control intervention. However the results provide indications that MI may yet be effective to ameliorate adherence in certain subgroups of patients (females, non-cannabis users, younger patients and patients with a short duration of illness). In the second part of the thesis we examined social cognitive problems in this group, because these may limit the effectiveness of psychological interventions for this group. We found that patients displayed more difficulties in processing social information compared to nonsocial information, which supports the hypothesis that social cognitive disturbances constitute a relative distinct entity within the domain of cognitive functioning in patients with schizophrenia. Furthermore we found a specific association between social cognitive disturbances and disorganization symptoms, which may have clinical implications for the administration of psychological interventions in patients with schizophrenia.