Greater patient insight and positive attitudes toward medication appear to
be associated with less severe symptoms and better functioning among patients
That's the finding from the latest analysis of the Clinical Antipsychotic
Trials of Intervention Effectiveness (CATIE). The report was posted online
June 26 in the advanced access section of Schizophrenia Bulletin.
Higher levels of insight at baseline were significantly associated with
less severe schizophrenia symptoms at 18-month follow-up, while more positive
medication attitudes were significantly associated with both lower symptom
levels and better community functioning.
(Symptoms of schizophrenia were assessed by the Positive and Negative
Syndrome Scale [PANSS], which yields a total average symptom score, based on
30 items rated from 1 to 7, with higher scores indicating more severe
symptoms, as well as subscales reflecting positive, negative, and general
Change in insight scores over time was associated with declining severity
of schizophrenia symptoms, and change toward more positive medication
attitudes was associated, independently of changes in insight, with
significant decreases in psychopathology, improvement in community
functioning, and greater medication compliance, according to the report.
CATIE was a large, 18-month, randomized, controlled trial that was designed
to compare outcomes of one conventional antipsychotic medication
(perphenazine) and four second-generation antipsychotics (olanzapine,
risperidone, quetiapine, and ziprasidone). It was funded by the National
Institute of Mental Health and conducted from January 2001 through December
2004 at 57 U.S. sites.
Insight was assessed by the Insight and Treatment Attitudes Questionnaire
(ITAQ), which is designed to measure awareness of illness and insight into
need for treatment in patients with schizophrenia. It consists of 11 items
that are phrased as questions to elicit responses on a Likert scale. Attitudes
toward medication were assessed by the Drug Attitude Inventory (DAI).
Psychosocial functioning and quality of life were assessed using the
Heinrichs-Carpenter Quality of Life (HQOL) Scale and a single item from the
Lehman Quality of Life Interview. Medication adherence was evaluated using
monthly pill counts and information from patients, family, and clinicians.
In addition to antipsychotic treatment, participants were offered an
educational plan designed to inform patients and families about diagnosis,
medications, symptom self-monitoring, side effects, and change in
Statistical analyses showed that scores on the ITAQ and DAI were
significantly positively correlated, and both were correlated with lower PANSS
scores and higher HQOL scores—meaning that patients who had greater
insight into their illness also tended to have greater awareness of the
importance of medication. Those patients tended to have fewer symptoms and
higher functioning at follow-up.
Moreover, change in insight scores from baseline to follow-up was
associated with decreased PANSS total scores, improvement in the HQOL total,
and increased medication compliance.
"Taken together, the results suggest that increasing [patients']
insight into their illness and fostering positive attitudes toward medication
may result in improved symptom and [quality of life] outcomes," wrote
Somaia Mohamed, M.D., of the VA Connecticut Health Care System, and
colleagues. "They suggest possible benefits of exploring negative
attitudes toward medication in a client-centered manner. Such an approach
should be based on the development of a supportive therapeutic alliance and a
strong positive practitioner-consumer relationship. The nature of this
relationship has undergone major developments in recent years, shifting from a
hierarchical medical model to a recovery-oriented model that requires new ways
of understanding and approaching the issue of medication choice."
An abstract of "Cross-Sectional and Longitudinal Relationships
Between Insight and Attitudes Toward Medication and Clinical Outcomes in
Chronic Schizophrenia" is posted at<http://schizophreniabulletin.oxfordjournals.org/cgi/content/abstract/sbn067v1>.▪