Patients' attitudes towards antipsychotic drugs probed

The attitudes of schizophrenia patients toward their antipsychotic medications are often surprising and counterintuitive, US researchers report in the Journal of Clinical Psychiatry.

Oliver Freudenreich (Massachusetts General Hospital and Harvard Medical School, Boston) and co-workers studied 81 outpatients with schizophrenia. Each individual's attitude toward their medication was assessed using the 10-item Drug Attitude Inventory (DAI). Current insight and clinical variables were also measured.

On average, patients were receiving 2.25 different drugs (range 1-6). DAI scores ranged from -10 to +10, and positive attitudes outweighed negative attitudes.

More than two-thirds of the group were receiving an antipsychotic drug. Of these patients, attitudes did not differ among those receiving a first-generation drug, second-generation drug, or clozapine.

Freudenreich et al identified several factors that were associated with drug attitudes, many of which overlapped with measures of insight. These included greater awareness of mental disorder, the belief that medication lessens symptoms, and greater awareness of the consequences of mental illness.

Negative attitudes toward medication were more likely among patients with more severe psychopathology, more negative symptoms, more depressive symptoms, and more positive symptoms.

Interestingly, employment was associated with more negative attitudes.

"Contrary to our expectations, we did not find greater extrapyramidal side effects to be predictive of better drug attitude," the authors write. "Our results rather suggest that better occupational and role functioning might serve as clinical 'red flags' for a negative attitude toward psychiatric medications."

They conclude that there is no substitute for enquiring directly about a patient's drug attitude "since it can be only partially predicted from demographic and clinical variables".

J Clin Psychiatry 2004; 65: 1372-1376