Subjective illness theory and antipsychotic medication compliance by patients with schizophrenia

This study investigates subjective illness theories of patients with schizophrenia, how they define their health problem, what they assume causes their illness and which course of illness they expect. The predictive value of those theories for patients' compliance with antipsychotic medication is tested. A problem-centered interview was conducted with 77 schizophrenic patients at discharge from inpatient or day hospital treatment. All patients were on clozapine treatment. Interviews were analyzed by means of computer-assisted content analysis. In addition, potential determinants of compliance were assessed using the 9th version of the Present State Examination, the UKU side effect rating scale, a checklist for patients' evaluations of the effect of psychotropic drugs, and a helping alliance scale. Compliance with medication was assessed by interviewing patients at discharge and three months later. Only slightly more than one half of the patients considered themselves mentally ill. They tended to endorse psychosocial causes more frequently as compared with biological causes. Slightly more than 25% of the patients each expected an improvement of the illness, a reoccurrence of the acute psychosis, or a chronic course. Whereas the quality of the helping alliance, delusion of grandiosity, and attitude toward psychotropic drugs proved to have an influence on patients' compliance with antipsychotic treatment, the three components of subjective illness theory (definition as mental illness, assumed etiology, and prognosis) did not have a statistically significant influence. Subjective illness theories vary in patients with schizophrenia. Although they might reflect different styles of coping with the illness, there is no evidence that they directly determine compliance with medication. Patients' views of the helping alliance and attitudes toward drugs should be considered in predicting compliance with antipsychotic medication.