Effects of Motivational Interview-Based Cognitive Therapy in Patients With Schizophrenia: A Multicenter Randomized...

Nonadherence to treatment increases relapse and rehospitalization risks and diminishes quality of life in patients with schizophrenia spectrum disorder.

This study was developed to explore the effect of motivational interview-based cognitive therapy (MIBCT) on medication adherence, insight into illness, and psychotic symptom severity in patients with schizophrenia spectrum disorder.

A single-blind, multicenter randomized controlled trial was conducted on 120 participants recruited from outpatient departments and acute psychiatric wards in northern Taiwan. The participants were randomly assigned to either the experimental group (n=61), which received MIBCT consisting of eight sessions every 3-4 weeks over a period of 24-32 weeks, or the control group (n=59), which received routine care and psychoeducation. The outcomes were measured using the Medication Adherence Rating Scale (MARS), the Schedule Assessment of Insight (SAI), and the Positive and Negative Syndrome Scale (PANSS) at three time points: baseline, the fourth session of interim analysis, and postintervention. Differences in between-group outcomes over time after adjusting for 13 covariates were analyzed using generalized estimating equations.

The mean MARS score in the experimental group improved significantly by 2.56 points at postintervention (p<.001), with significantly lower gains reported for the control group. In addition, the SAI outcome measures for the experimental group improved more than for the control group. This was evident both during the interim analysis and postintervention, with results of B=1.85 (p=.003) and B=2.23 (p=.001), respectively. Furthermore, the mean improvements in positive symptoms were significantly greater in the intervention group than the control group at both the interim analysis (B=-2.52, p=.002) and postintervention (B=-1.85, p=.029).

The results of this study indicate the application of MIBCT significantly improves medication adherence, insight into illness, and positive symptoms in patients with schizophrenia spectrum disorders by increasing intrinsic motivation and addressing treatment barriers. The implementation of this integrated therapeutic approach by psychiatric nurses may contribute to improved patient outcomes.