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Association between Therapeutic Alliance and Adherence in Outpatient Schizophrenia Patients

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Objective: Although various clinical factors that affect medication adherence in schizophrenia have been studied, the role of the therapeutic alliance has not been studied in detail. Accordingly, we investigated the association between medication adherence and therapeutic alliance in patients with schizophrenia treated in a community outpatient clinic in Korea. Methods: In this cross-sectional study, 81 outpatients who met the DSM-IV-TR criteria for schizophrenia were analyzed. Therapeutic alliance was measured via patient-self-report questionnaires consisting of 12 questions, which evaluate both “affective bond” and “collaborative bond” of alliance. We investigated the relationship between medication adherence and therapeutic alliance through correlation and regression analyses. Results: Overall therapeutic alliance was weakly associated with medication adherence (r=0.268, p<0.05). Among two factors of therapeutic alliance, “affective bond” was associated with adherence (r=0.302, p<0.05), but collaborative was not. Regression analysis showed that therapeutic alliance significantly predicted medication adherence even after adjustment for duration of treatment, insight, and symptom severity. Conclusion: Maintaining a favorable therapeutic alliance is associated with medication adherence in schizophrenia. Further, treating patients in a frank and genuine manner might be important to improve adherence.

Abstract

Objective: Although various clinical factors that affect medication adherence in schizophrenia have been studied, the role of the therapeutic alliance has not been studied in detail. Accordingly, we investigated the association between medication adherence and therapeutic alliance in patients with schizophrenia treated in a community outpatient clinic in Korea. Methods: In this cross-sectional study, 81 outpatients who met the DSM-IV-TR criteria for schizophrenia were analyzed. Therapeutic alliance was measured via patient-self-report questionnaires consisting of 12 questions, which evaluate both “affective bond” and “collaborative bond” of alliance. We investigated the relationship between medication adherence and therapeutic alliance through correlation and regression analyses. Results: Overall therapeutic alliance was weakly associated with medication adherence (r=0.268, p<0.05). Among two factors of therapeutic alliance, “affective bond” was associated with adherence (r=0.302, p<0.05), but collaborative was not. Regression analysis showed that therapeutic alliance significantly predicted medication adherence even after adjustment for duration of treatment, insight, and symptom severity. Conclusion: Maintaining a favorable therapeutic alliance is associated with medication adherence in schizophrenia. Further, treating patients in a frank and genuine manner might be important to improve adherence.

참고문헌 (34)

  1. Naber D, "Good tolerability equals good results: the patient’s perspective", Eur Neuropsychopharmacol, 11(Suppl 4), pp.S391~S396 (2001)
  2. Seon-Cheol Park, "Comparative Efficacy and Safety of Long-acting Injectable and Oral Second-generation Antipsychotics for the Treatment of Schizophrenia: A Systematic Review and Meta-analysis", Clinical Psychopharmacology and Neuroscience, 16(4), pp.361~375 (2018), 대한정신약물학회[DOI]
  3. Verdoux H, "Medication adherence in psychosis: predictors and impact on outcome. A 2-year follow-up of first-admitted subjects", Acta Psychiatr Scand, 102, pp.203~210 (2000)
  4. Babiker IE, "Noncompliance in schizophrenia", Psychiatr Dev, 4, pp.329~337 (1986)
  5. Blackwell B, "Drug therapy : patient compliance", N Engl J Med, 289, pp.249~252 (1973)
  6. Ascher-Svanum H, "The cost of relapse and the predictors of relapse in the treatment of schizophrenia", BMC Psychiatry, 10, pp.2~ (2010)
  7. Day JC, "Attitudes toward antipsychotic medication : the impact of clinical variables and relationships with health professionals", Arch Gen Psychiatry, 62, pp.717~724 (2005)
  8. Kao YC, "Compliance and schizophrenia : the predictive potential of insight into illness, symptoms, and side effects", Compr Psychiatry, 51, pp.557~565 (2010)
  9. Murru A, "Rates and clinical correlates of treatment non-adherence in schizoaffective bipolar patients", Acta Psychiatr Scand, 125, pp.412~418 (2012)
  10. Sendt KV, "A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders", Psychiatry Res, 225, pp.14~30 (2015)
  11. Lacro JP, "Prevalence of and risk factors for medication nonadherence in patients with schizophrenia : a comprehensive review of recent literature", J Clin Psychiatry, 63, pp.892~909 (2002)
  12. Misdrahi D, "The influence of therapeutic alliance and insight on medication adherence in schizophrenia", Nord J Psychiatry, 66, pp.49~54 (2012)
  13. Thompson K, "Reliability and validity of a new Medication Adherence Rating Scale(MARS)for the psychoses", Schizophr Res, 42, pp.241~247 (2000)
  14. Svensson B, "Relationships among patient and therapist ratings of therapeutic alliance and patient assessments of therapeutic process : a study of cognitive therapy with long-term mentally ill patients", J Nerv Ment Dis, 187, pp.579~585 (1999)
  15. Bordin ES, "The generalizability of the psychoanalytic concept of the working alliance", Psychother Theory Res Pract, 16, pp.252~260 (1979)
  16. Krupnick JL, "The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome : findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program", J Consult Clin Psychol, 64, pp.532~539 (1996)
  17. Weiss M, "The role of the alliance in the pharmacologic treatment of depression", J Clin Psychiatry, 58, pp.196~204 (1997)
  18. Gaudiano BA, "Patients’ expectancies, the alliance in pharmacotherapy, and treatment outcomes in bipolar disorder", J Consult Clin Psychol, 74, pp.671~676 (2006)
  19. Neale MS, "Therapeutic alliance and outcome in a VA intensive case management program", Psychiatr Serv, 46, pp.719~721 (1995)
  20. Frank AF, "The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome", Arch Gen Psychiatry, 47, pp.228~236 (1990)
  21. McCabe R, "The therapeutic relationship and adherence to antipsychotic medication in schizophrenia", PLoS One, 7, pp.e36080~ (2012)
  22. American Psychiatric Association, "Diagnostic and statistical manual of mental disorders: 4th ed, text revision (DSM-IV-TR)" (2000), American Psychiatric Association
  23. Morisky DE, "Concurrent and predictive validity of a self-reported measure of medication adherence", Med Care, 24, pp.67~74 (1986)
  24. Hogan TP, "A self-report scale predictive of drug compliance in schizophrenics : reliability and discriminative validity", Psychol Med, 13, pp.177~183 (1983)
  25. McGuire-Snieckus R, "A new scale to assess the therapeutic relationship in community mental health care : STAR", Psychol Med, 37, pp.85~95 (2007)
  26. 권자영, "한국어판 치료적관계척도(STAR-K)의 타당화 연구", 정신건강과 사회복지, (35), pp.81~110 (2010), 한국정신건강사회복지학회
  27. Amador XF, "Assessment of insight in psychosis", Am J Psychiatry, 150, pp.873~879 (1993)
  28. Overall JE, "The brief psychiatric rating scales", Psychol Rep, 10, pp.799~812 (1962)
  29. Nelson AA Jr, "Drug default among schizophrenic patients", Am J Hosp Pharm, 32, pp.1237~1242 (1975)
  30. "Involuntary admission in high income country" (2015)[URL]
  31. Fialko L, "A large-scale validation study of the Medication Adherence Rating Scale(MARS)", Schizophr Res, 100, pp.53~59 (2008)
  32. Zemmour K, "Validation of the Medication Adherence Rating Scale in homeless patients with schizophrenia : results from the French housing first experience", Sci Rep, 6, pp.31598~ (2016)
  33. Shattock L, "Therapeutic alliance in psychological therapy for people with schizophrenia and related psychoses : a systematic review", Clin Psychol Psychother, 25, pp.e60~ (2018)[DOI]
  34. Jung E, "Perceived therapist genuineness predicts therapeutic alliance in cognitive behavioural therapy for psychosis", Br J Clin Psychol, 54, pp.34~48 (2015)

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