In predicting treatment compliance in individuals with severe mental illness, research has focused on variables such as substance abuse, personality, history of child abuse, and symptomatology, although these relationships have not been investigated in great detail in individuals at the onset of mental illness. To better understand these correlates of treatment compliance, two samples were examined: a sample of 117 individuals presenting with a first episode of psychosis and a more chronic forensic sample of 65 participants recruited from a psychiatric hospital. These samples were investigated for service engagement in terms of violence history, substance abuse, symptom severity, psychopathic traits and history of childhood abuse. Linear regressions performed for the first episode sample revealed that childhood physical abuse was the strongest predictor of poor service engagement, followed by problems with alcohol, a history of physical violence, any history of violence and higher psychopathic traits. Linear regression revealed for the forensic group that a lower level of service engagement was most strongly predicted by a history of childhood abuse and a higher score on the Brief Psychiatric Rating Scale (BPRS). Results are presented in light of the existing literature and clinical implications are discussed.
Psychosis is a serious mental illness that can have dramatic consequences to the individual who suffers from it. Although there are many types of treatment, traditional medication remains the most prescribed (Nemade & Dombeck, 2009). Despite recent advances in antipsychotic medications (Rosenheck et al., 2000), they often cause side-effects, causing people suffering from psychosis to often reduce, or stop taking their prescribed antipsychotics. Recent research has found that many factors contribute to failure to take medications as prescribed, called non-compliance or non-adherence (Davis, Chen, & Glick, 2003). In those suffering from psychosis it has been estimated that non-compliance rates are roughly 40% for complete non-compliance and that partial non-compliance rates are around 75% (Fenton et al., 1997, Lacro et al., 2002 and Young et al., 1986). In addition research from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study found that medication non-compliance was due, in most part, to side effects from the medications (Weiden, 2006). Among patients with schizophrenia, non-adherence to maintenance treatment with antipsychotic medication is associated with a greater number of clinic and emergency room visits and more psychiatric hospitalizations (Terkelsen and Menikoff, 1995, Valenstein et al., 2002 and Weiden and Olfson, 1995). Problems with treatment adherence among psychiatric patients can encompass a variety of behaviors, including (1) taking medication regimens incompletely, (2) discontinuing medications altogether, (3) failing to attend the first outpatient appointment after psychiatric hospitalization, (4) missing other scheduled appointments, (5) dropping out of outpatient follow-up altogether, and (6) failing to complete assignments or recommendations related to prescribed psychosocial interventions. In inpatient psychiatric settings, treatment non-adherence may also include failure to follow the structure of the unit and refusal to participate in a group therapy program. As such, improving adherence to treatment with antipsychotic medication in patients with psychotic disorders is a complex task; more information on factors or profiles of individuals affecting adherence is warranted (McDonald et al., 2002 and Zygmunt et al., 2002).
In conclusion the study found that compliance and engagement in services were lower in those that had more symptoms as measured by the BPRS for both samples. In the first episode sample those who were less engaged in services have higher scores of psychopathy and a greater history of violence. This was not found for the more chronic sample. In addition there was no difference in service engagement in those with a history of substance abuse for either sample. The most significant finding in this study was the fact that history of childhood abuse was the strongest predictor of poor engagement in services in both populations. This highlights the need to consider abuse history when working with clients with psychosis to increase service engagement.
