Physician patient relationship and medication compliance in the mentally ill

physician patient relationship and medication compliance in the mentally ill

Mental health medication compliance can be determined by questioning patients, counting is a direct reflection of the quality of the doctor-patient relationship. Many mental disorders require more than just a brief medication intervention. patient characteristics (e.g., attitudes toward illness and medication, ); and 8) emphasizing the doctor/patient relationship (Salzman, ). Nonadherence to mental health treatment incurs clinical and economic burdens. fully understand the role of the clinician-patient relationship, or 'alliance' or communication and treatment adherence in mental health care.

physician patient relationship and medication compliance in the mentally ill

It has been argued that patient participation in shared decision making improves adherence to treatment plans. To assess to what extent treatment adherence of psychiatric patients is influenced by the concordance between their preferred participation and their actual participation in decision making.

A total of consecutive psychiatric outpatients completed the Control Preference Scale twice consecutively before consultation, one for their preferences of participation, and the other for the style they had usually experienced until then, and the eight-item self-report Morisky Medication Adherence Scale 8. Most psychiatric outpatients preferred a collaborative role in decision making.

Self-reported adherence was significantly higher in those patients in whom there was concordance between their preferences and their experiences of participation in decision making, regardless of the type of participation preferred. Poor adherence to pharmacologic treatment of psychiatric disorders is a worldwide problem of striking magnitude that contributes to the gap in care between best care, defined as the optimal use of proven efficacious pharmacologic therapies in psychiatric disorders, and usual care, the actual level of efficacious care being provided to psychiatric patients.

In these cases, treatment effectiveness, crucial in severe mental illness and limited in minor psychiatric disorders, is hampered by the lack of adherence to the prescribed regimen. Half of patients with major depression for whom antidepressants are prescribed will not be taking the drugs 3 months after the initiation of therapy.

physician patient relationship and medication compliance in the mentally ill

This definition of adherence presumes that the patient has reached some agreement with the health care professional about the prescribed medicine. Review of the literature on predictors of compliance with psychiatric treatment prescribed has shown the inconsistency of sociodemographic and clinical variables. Materials and methods Sample From October to May1, consecutive psychiatric outpatients seen in the Community Mental Health Services on Tenerife Island Canary Islands, Spain were invited to participate in a cross-sectional study; a total of accepted.

Patients were eligible for inclusion in the study if they were aged 18 years and over and were diagnosed by their psychiatrists using the International Classification of Diseases ICD as F20 schizophreniaF31 bipolar affective disorderF32—33 depressive disorderF40—48 anxiety disorderand F60—69 disorders of adult personality and behavior.

Each participant then filled out a brief sociodemographic survey and the remaining questionnaires. Measures Sociodemographic characteristics and clinical variables Age, sex, educational level no formal education, primary studies, secondary studies, and university degreehistory as psychiatric patient in yearsand type of psychoactive drugs currently taken were assessed.

For assessment purposes, the drugs were divided into the common groups of psychotropic drugs: For statistical analysis purposes, a new variable number of different drugs was drawn up as an indirect measure of treatment complexity.

We also recorded how long patients had been under psychiatric treatment in monthsthe number of different psychiatrists treating them during that time, and the number of psychiatric admissions specifying their voluntary or involuntary character.

Each no response is rated as 1 and each yes rated as 0, except for item 5, in which each yes response is rated as 1 and each no is rated as 0. For item 8, it is necessary to standardize the code 0—4by dividing by four when calculating a summated score. Permission to use the scale was granted by Donald Morisky, the copyright holder of the instrument.

A secondary hand search was performed in relevant journals, grey literature and reference. Results 23 studies met the inclusion criteria for the review. The methodological quality overall was moderate. Subjective ratings of clinical communication styles and messages were assessed in 12 studies.

physician patient relationship and medication compliance in the mentally ill

Meta-analysis was not possible due to heterogeneity of methods. Findings were presented as a narrative synthesis. Conclusions Clinician-patient alliance and communication are associated with more favourable patient adherence. Further research of observer rated communication would better facilitate the application of findings in clinical practice.

physician patient relationship and medication compliance in the mentally ill

Establishing agreement on the tasks of treatment, utilising collaborative styles of communication and discussion of treatment specifics may be important for clinicians in promoting cooperation with regimens. These findings align with those in health communication. However, the benefits of shared decision making for adherence in mental health are less conclusive than in general medicine.

Communication, Alliance, Adherence, Mental health Background Clinical practice in mental health has transformed in recent decades, principally fuelled by pharmacological advances.


Consequently, the composition and objectives of psychiatric encounters have changed and in turn the roles of clinicians. The development of atypical antipsychotics and successful use of Selective Serotonin Reuptake Inhibitors render psychopharmacology an increasingly primary task [ 1 ]: A central function of consultations is medication management via regular review and regime modification [ 2 ]. Since noncompliant consumers are less likely to continue in care, they are also less likely to find helpful providers or successful treatments.

Thus, noncompliance with treatment may become a self-fulfilling cycle.

[Full text] To what extent is treatment adherence of psychiatric patients influenc | PPA

Compliance is higher when treatments, including medications, help consumers feel better, when a family supports the treatment, and when taking medication prevents relapse of symptoms.

However, as mentioned, people may be distressed by potential side effects of any medication, including those psychiatric medications that limit functioning. Limited functioning through drowsiness, also a problem of the older generation of antihistamines, is the best example. It is an effect of many medicines, particularly those for mental disorders.

physician patient relationship and medication compliance in the mentally ill

Other unwelcome side effects of various psychiatric medications include weight gain, involuntary movements such as muscle twitching, and impaired coordination. Consumers may feel embarrassed about taking medication, may have difficulty getting a prescription for medication, and may have financial problems paying for treatment or medication.

In some cases, when a patient is non-compliant or perceived to be at odds with treatment recommendations, they may risk losing autonomy over medical decisions. When at risk to self or others, people who are medication noncompliant may be pressured or forced to take medication at the risk of being involuntarily hospitalized.

Multiple challenges in mental health care Compliance rates reflect the proportion of individuals in treatment who have the highest possibility of successful treatment. Noncompliance rates reflect those individuals who have either discontinued or avoided treatment, and thus have lower probabilities of treatment success.

[Full text] Why do psychiatric patients stop antipsychotic medication? A systemati | PPA

Sometimes patients do not want to get rid of their symptoms mania, for exampleor patients may not consider their experiences called symptoms to be indicative of a disorder.

In addition, successful mental health care is hampered by the fact that many people with mental health problems either do not use or lack access to mental health care. Therefore, compliance with treatment is part of a larger national challenge to provide quality mental health care and to use it well. University of Chicago Press,