[Disease models and change in attitude of involuntarily admitted schizophrenic patients]

The attitude to illness and therapy of 28 involuntary and 31 voluntary patients admitted to a state psychiatric hospital was investigated by means of a questionnaire at the time of admission and prior to discharge. Involuntary patients have less illness consciousness, and only 17.9% of them but 67.7% of the voluntary patients show insight into their illness; they favour a medical-somatic model of illness and express less positive therapy expectations. Their whole attitude proves to be dysfunctional concerning compliance with medical treatment. Attitudes of involuntary patients changed during the hospital stay and became similar to those of voluntary patients, which hardly changed. This attitudinal change extended to illness consciousness, insight into illness and therapy expectations, whereas models of illness were found to be very stable. One third of the involuntary patients stayed in hospital voluntarily for further treatment. It is discussed that patients attitudes to illness and therapy should be taken more often into consideration and integrated into the planning of therapy.