Findings of three articles reporting results in 1372 stabilized outpatients taking
2454 medications in Spain, Argentina, and Venezuela were combined. Prevalence of good
adherence was not obviously different across diagnoses: 69.5% (N=212) for schizophrenia,
66.3% (N=142) for bipolar disorder, and 69.8% (N=521) for depression. Besides the
focus on stabilized outpatients, other study biases included use of a research sample;
limited to oral medications, ignoring long-acting injectable antipsychotics; and lack
of data on active substance abuse, clinical severity, and insight. Logistic regression
models explored predictors of good vs. poor adherence. The six self-reported variables
studied were pharmacophobia, pharmacophilia, high psychological reactance, high internal
health locus of control (LOC), high doctor LOC, and skepticism concerning specific
medications. ORs were significant in 56% (47/84) of the statistical tests vs. 24%
(23/98) of ORs significant in case of 7 demographic/clinical variables (p=0.001).
At least 2/3 of the ORs for pharmacophobia, pharmacophilia and skepticism were significantly
associated with adherence in cases and controls, indicating their independence from
diagnoses. In need of replication, three other self-reported measures had differential
effects on adherence across diagnoses. High psychological reactance was associated
with decreased adherence to antidepressant medications in general, or for patients
with mood disorders. High internal LOC as associated with poor adherence may reflect
the distrust patients with schizophrenia or severe bipolar disorder have of other
people. High doctor LOC was significantly associated with increased adherence only
in patients with bipolar disorder, but was significant for all medications, mood stabilizers
and antipsychotics, indicating the relevance of the patient-psychiatrist relationship
in these patients. (Neuropsychopharmacol Hung 2021; 23(4): 363-373).
