Short-term clinical stability and lack of insight are associated with a negative attitude towards antipsychotic treatment at discharge in patients with schizophrenia and bipolar disorder

Esteban Medina,¹ Joan Salvà,² Rubén Ampudia,³ Jorge Maurino,¹ Juan Larumbe<sup>4

1</sup>AstraZeneca Medical Department, Madrid, Spain; ²Department of Psychiatry, Hospital Universitari Son Espases, Palma de Mallorca, Spain; ³Mediclin, Quintiles, Madrid, Spain; ⁴Hospital Psiquiátrico de Álava, Vitoria, Spain

Purpose: The primary aim of this study was to assess the range of attitudes towards antipsychotic treatment at hospital discharge in patients with schizophrenia and bipolar disorder. The secondary aim was to analyze the relationship between patients' attitudes and sociodemographic and clinical parameters.
Patients and methods: A cross-sectional study with a sample of patients admitted due to acute exacerbation of schizophrenia or a manic episode was conducted. Attitude towards pharmacological treatment at discharge was assessed with the 10-item Drug Attitude Inventory (DAI-10). Logistic regression was used to determine significant variables associated with attitude to medication.
Results: Eighty-six patients were included in the study. The mean age was 43.1 years (standard deviation [SD] 12.1), and 55.8% were males. Twenty-six percent of the patients presented a negative attitude towards antipsychotic treatment (mean DAI-10 score of -4.7, SD 2.7). Most of them had a diagnosis of schizophrenia. Multivariate analysis showed that poor insight into illness and a greater number of previous acute episodes was significantly associated with a negative attitude towards medication at discharge (odds ratio 1.68 and 1.18, respectively).
Conclusion: Insight and clinical stability prior to admission were related to patients' attitude towards antipsychotic treatment at hospital discharge among patients with schizophrenia and bipolar disorder. The identification of factors related to the attitude towards medication would offer an improved opportunity for clinicians to select patients eligible for prophylactic adherence-focused interventions.

Keywords: attitude towards treatment, schizophrenia, bipolar disorder, therapeutic adherence, discharge, insight