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Depot-medication compliance for patients with psychotic disorders: the importance of illness insight and treatment motivation

Authors Noordraven E, Wierdsma A, Blanken P, Bloemendaal A, Mulder C

Received 8 October 2015

Accepted for publication 16 November 2015

Published 3 February 2016 Volume 2016:12 Pages 269—274


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Roger Pinder

Ernst L Noordraven,1,2 André I Wierdsma,2 Peter Blanken,3 Anthony F T Bloemendaal,1 Cornelis L Mulder2,4

1Dual Diagnosis Centre (CDP), Parnassia Psychiatric Institute, the Hague, 2Department of Psychiatry, Erasmus University Medical Center, Rotterdam, 3Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, the Hague, 4Bavo-Europoort Mental Health Care, Parnassia Psychiatric Institute, Rotterdam, the Netherlands

Background: Noncompliance is a major problem for patients with a psychotic disorder. Two important risk factors for noncompliance that have a severe negative impact on treatment outcomes are impaired illness insight and lack of motivation. Our cross-sectional study explored how they are related to each other and their compliance with depot medication.
Methods: Interviews were conducted in 169 outpatients with a psychotic disorder taking depot medication. Four patient groups were defined based on low or high illness insight and on low or high motivation. The associations between depot-medication compliance, motivation, and insight were illustrated using generalized linear models.
Results: Generalized linear model showed a significant interaction effect between motivation and insight. Patients with poor insight and high motivation for treatment were more compliant (94%) (95% confidence interval [CI]: 1.821, 3.489) with their depot medication than patients with poor insight and low motivation (61%) (95% CI: 0.288, 0.615). Patients with both insight and high motivation for treatment were less compliant (73%) (95% CI: 0.719, 1.315) than those with poor insight and high motivation.
Conclusion: Motivation for treatment was more strongly associated with depot-medication compliance than with illness insight. Being motivated to take medication, whether to get better or for other reasons, may be a more important factor than having illness insight in terms of improving depot-medication compliance. Possible implications for clinical practice are discussed.

noncompliance, psychotic disorder, illness insight, motivation, depot medication, schizophrenia

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