정신역동과 약물순응도
Psychodynamics of Medication Adherence in the Treatment of Psychiatric Patients
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Medication adherence is instrumental for better treatment outcomes. However, many patients—especially psychiatric patients— do not stick to their prescription. In this study, we analyzed the factors associated with treatment adherence and improvement using psychodynamic and psychotherapeutic techniques. The psychodynamic formulation in psychopharmacology can be used to improve medication adherence in most treatment settings. The components of the formulation include psychodynamic significance of medication and symptoms, transference, countertransference, and patient’s attachment style. Even though the psychodynamic significance of medication varies with the patient, a few common features include medication as transitional object and self object. Both transference to the medication and the therapist involve adherence. Counter-transference can also alter the therapist’s prescriptions. The psychodynamics of illness and symptoms may hinder the patient from taking medication. For example, the secondary gain of illness and patient’s denial of mental illness complicate the treatment. The attachment style of patients can affect adherence as well. The patient with avoidant attachment style is less likely to follow the prescription. The therapist should deal with negative transferences and counter-transferences, which might hamper treatment. A warm and collaborative approach can help patients with an avoidant attachment style to accept pharmacologic treatment. In conclusion, the capacity of the therapist to assess the therapeutic relationship, determine the psychodynamic significance of the medication, and employ relevant therapeutic interventions is vital for improved medication adherence.
Abstract
Medication adherence is instrumental for better treatment outcomes. However, many patients—especially psychiatric patients— do not stick to their prescription. In this study, we analyzed the factors associated with treatment adherence and improvement using psychodynamic and psychotherapeutic techniques. The psychodynamic formulation in psychopharmacology can be used to improve medication adherence in most treatment settings. The components of the formulation include psychodynamic significance of medication and symptoms, transference, countertransference, and patient’s attachment style. Even though the psychodynamic significance of medication varies with the patient, a few common features include medication as transitional object and self object. Both transference to the medication and the therapist involve adherence. Counter-transference can also alter the therapist’s prescriptions. The psychodynamics of illness and symptoms may hinder the patient from taking medication. For example, the secondary gain of illness and patient’s denial of mental illness complicate the treatment. The attachment style of patients can affect adherence as well. The patient with avoidant attachment style is less likely to follow the prescription. The therapist should deal with negative transferences and counter-transferences, which might hamper treatment. A warm and collaborative approach can help patients with an avoidant attachment style to accept pharmacologic treatment. In conclusion, the capacity of the therapist to assess the therapeutic relationship, determine the psychodynamic significance of the medication, and employ relevant therapeutic interventions is vital for improved medication adherence.
참고문헌 (41)
- Adelman SA, "Pills as transitional objects : a dynamic understanding of the use of medication in psychotherapy", Psychiatry, 48, pp.246~253 (1985)
- Ainsworth MDS, "Patterns of attachment : a psychological study of the strange situation" (1978), Lawrence Erlbaum Associates
- Alfonso CA, "Dynamic psychopharmacology and treatment adherence", J Am Acad Psychoanal Dyn Psychiatry, 37, pp.269~285 (2009)
- Blackwell B, "Drug therapy : patient compliance", N Engl J Med, 289, pp.249~252 (1973)
- Book HE, "Some psychodynamics of non-compliance", Can J Psychiatry, 32, pp.115~117 (1987)
- Bowlby J., "Attachment and Loss. Volume II. Separation, anxiety and anger" (1973), The Hogarth press and the Institute of Psycho-analysis
- Busch FN, "Psychotherapy and medication : the challenge of integration" (2016), Routledge
- Jhin Goo Chang, "Association between Therapeutic Alliance and Adherence in Outpatient Schizophrenia Patients", Clinical Psychopharmacology and Neuroscience, 17(2), pp.273~278 (2019), 대한정신약물학회[DOI]
- Ciechanowski P, "Influence of patient attachment style on self-care and outcomes in diabetes", Psychosom Med, 66, pp.720~728 (2004)
- Ciechanowski PS, "The patient-provider relationship : attachment theory and adherence to treatment in diabetes", Am J Psychiatry, 158, pp.29~35 (2001)
- Fishbain DA, "Secondary gain concept : definition problems and its abuse in medical practice", APS J, 3, pp.264~273 (1994)
- Gabbard GO, "Psychodynamic psychiatry in clinical practice" (2014), American Psychiatric Publshing
- Gialamas A, "Does point of care testing lead to the same or better adherence to medication? A randomised controlled trial : the poct in general practice trial", Med J Aust, 191, pp.487~491 (2009)
- Gutheil TG, "The psychology of psychopharmacology", Bull Menninger Clin, 46, pp.321~330 (1982)
- Hausner RS, "Medication and transitional phenomena", Int J Psychoanal Psychother, 11, pp.375~398 (1985)
- Haynes RB, "Compliance in health care" (1979), Johns Hopkins University Press
- Jin J, "Factors affecting therapeutic compliance : a review from the patient’s perspective", Ther Clin Risk Manag, 4, pp.269~286 (2008)
- Kemp R, "Randomised controlled trial of compliance therapy", Br J Psychiatry, 172, pp.413~419 (1998)
- Kohut H, "The analysis of the self : a systematic approach to the psychoanalytic treatment of narcissistic personality disorders" (1971), University of Chicago Press
- Kwan O, "Clinical relevance of the sick role and secondary gain in the treatment of disability syndromes", Medical Hypotheses, 59, pp.129~134 (2002)
- Laplanche J, "The language of psycho-analysis" (1973), W. W. Norton
- 이문수, "항우울제의 복약 순응도", 생물정신의학, 17(1), pp.5~14 (2010), 대한생물정신의학회
- Li TCW, "Psychodynamic aspects of psychopharmacology", J Am Acad Psychoanal Dyn Psychiatry, 38, pp.655~674 (2010)
- McDonald HP, "Interventions to enhance patient adherence to medication prescriptions : scientific review", JAMA, 288, pp.2868~2879 (2002)
- McLaughlin JT, "Clinical and theoretical aspects of enactment", J Am Psychoanal Assoc, 39, pp.595~614 (1991)
- Milrod BL, "Combining psychodynamic psychotherapy with medication in the treatment of panic disorder : exploring the dynamic meaning of medication", Psychoanal Inq, 18, pp.702~715 (1998)
- Mintz DL, "How(not what)to prescribe : nonpharmacologic aspects of psychopharmacology", Psychiatric Clin North Am, 35, pp.143~163 (2012)
- Nieuwlaat R, "Interventions for enhancing medication adherence", Cochrane Database Syst Rev, (11), pp.CD000011~ (2014)
- Pampallona S, "Combined pharmacotherapy and psychological treatment for depression : a systematic review", Arch Gen Psychiatry, 61, pp.714~719 (2004)
- Rubin J, "Countertransference factors in the psychology of psychopharmacology", J Am Acad Psychoanal, 29, pp.565~573 (2001)
- Sackett D, "Compliance in health care", pp.11~22 (1979), Johns Hopkins University Press
- Thase ME., "Handbook of psychological change: psychotherapy processes and practices for the 21st century", pp.474~497 (2000), John Wiley & Sons Inc
- Treloar AJC, "Effectiveness of education programs in changing clinicians’ attitudes toward treating borderline personality disorder", Psychiatr Serv, 60, pp.1128~1131 (2009)
- Tutter A, "Medication as object", J Am Psychoanal Assoc, 54, pp.781~804 (2006)
- van Egmond J, "A blind spot for secondary gain affecting therapy outcomes", Eur Psychiatry, 17, pp.46~54 (2002)
- van Egmond J, "Secondary gain as hidden motive for getting psychiatric treatment", Eur Psychiatry, 20, pp.416~421 (2005)
- Wallin DJ, "Attachment in psychotherapy" (2007), Guilford press
- Warden D, "Identifying risk for attrition during treatment for depression", Psychother Psychosom, 78, pp.372~379 (2009)
- World Health Organization, "Adherence to long-term therapies : evidence for action" (2003), World Health Organization
- Winnicott DW, "Playing and reality" (1971), Tavistock Publications
- Winston A, "Psychotherapy and psychopharmacology : different universes or an integrated future", J Psychother Integr, 15, pp.213~223 (2005)