Effects of psychopharmacotherapy and patients’ adherence: interdependence within the biopsychosocial paradigm
Background: The expected effects of psychopharmacology in the clinic are mediated by changes in dopamine and serotonin neurotransmission that can determine impaired motivational processes in patients. The aim of the study: To study associations between psychopharmacotherapy and biological, psychological, and social factors of patients` medication adherence. Materials and methods: 83 patients hospitalized due to exacerbation for selection of therapy. Socio-demographic and medical history data were taken from medical records. The original Treatment Motivation Assessment Questionnaire and the Medical Compliance Scale were used. Dispersion analysis with p≤0.05 was performed. Effect sizes (ES) were calculated using Cohen’s d and Cramer’s V. Results: Patients taking atypical antipsychotics were characterized by shorter duration of illness and infrequent hospitalizations (ES=0.68 and 0.47). Only childless and single patients were treated with two antipsychotics (ES=0.32). Past non-compliance varied in subgroups of patients receiving typical and atypical antipsychotics (ES=0.74). The structure of patients' motivation for treatment was objectivized: outpatients treated with typical antipsychotics less often relied on their own knowledge and skills to overcome the disease making a decision about their treatment (ES=0.64) and had lower motivation (ES=0.6). Regardless of their class, the use of antidepressants was associated with better insight. However, unspecific intensification of treatment motivation occurred only when antidepressants were used in combination with mood stabilizers (ES=0.64). Conclusion: Patients' long-term adherence to psychopharmacotherapy is not only a socio-psychological construct, but also a biological process influenced by the neurotropic drugs prescribed in clinical practice.