A Strong Therapeutic Alliance and High Patient Insight Was Significantly Correlated With Adherence to Medication

38 Inpatients who met International Classification of Diseases, Tenth Revision (ICD-10) criteria for schizophrenia or schizoaffective disorder were recruited and independently interviewed just before discharge.

Various rating scales, including the self-reported 4-Point ordinal Alliance Scale (4PAS), the Scale to Assess Unawareness of Mental Disorder (SUMD), and the Medication Adherence Rating Scale (MARS), were used.

Insight (SUMD subscore) was significantly correlated with the total MARS score (r=−0.664, P<0.0001).

• The SUMD is a 9-item semistructured questionnaire rated on a 5-point scale (1=aware to 5=unaware). This study calculated a subscore of the first 3 items (item 1: awareness of mental disorder; item 2: awareness of the consequences of mental disorder; item 3: awareness of the achieved effects of medication). The authors believed that this would explore the level of general awareness of the disorder, leaving out the other items that measured the awareness of the different symptoms of the illness.

Therapeutic alliance (4PAS score) was significantly correlated with the total MARS score (r=0.663, P<0.0001).

• The 4PAS is an 11-item questionnaire scored using a 4-point Likert scale ranging from 1 (ie, “strongly disagree”) to 4 (ie, “strongly agree”). Higher 4PAS score indicates better therapeutic alliance.

Reference:
Misdrahi D, Petit M, Blanc O, Bayle F, Llorca PM. The influence of therapeutic alliance and insight on medication adherence in schizophrenia. Nord J Psychiatry. 2012; 66(1): 49-54.