Does religiosity in persons with schizophrenia influence medication adherence

Relationships between neuropsychological performance, insight, medication adherence, and social metacognition in schizophrenia

BACKGROUND

Social metacognition is still poorly understood in schizophrenia, particularly its neuropsychological basis and its impact on insight and medication adherence. We therefore quantified social metacognition as the agreement between objective and subjective mentalization and assessed its correlates in a sample of individuals with schizophrenia spectrum disorders.

METHODS

Participants consisted of 143 patients with schizophrenia or schizoaffective disorders who underwent a metacognitive version of a mentalization task, an extensive neuropsychological battery, and a clinical evaluation to assess their insight into illness and medication adherence. We studied potential interactions between confidence judgments and several neuropsychological and clinical variables on mentalization accuracy with mixed-effects multiple logistic regressions.

RESULTS

Confidence judgments were closely associated with mentalization accuracy, indicative of good social metacognition in this task. Working memory, visual memory, and reasoning and problem-solving were the three neuropsychological dimensions positively associated with metacognition. By contrast, the two measures of medication adherence were associated with poorer metacognition, whereas no association was found between metacognition and clinical insight. The multiple regression model showed a significant positive impact of better working memory, older age at onset, longer duration of hospitalization, and worse medication adherence on social metacognition.

CONCLUSIONS

We discuss possible mechanisms underlying the apparent association between social metacognition and working memory. Adherence should be monitored when remediating social metacognition, and psychoeducation should be given to patients with a high level of awareness of their capacity to mentalize.

Association of Coping Strategies and Medication Adherence: A Systematic Review

Background: Medication adherence is difficult for most patients who take at least one medication. Poor drug adherence is a developing problem since it contributes to negative outcomes, prescription waste, increased healthcare expenses, and disease progression. Coping strategies are an important tool for managing a patient's condition because a patient's coping method influences how he or she perceives the situation and deals with the stress that comes with it, which can eventually affect adherence. Coping strategies are classified into five categories: problem-focused, emotion-focused, seeking understanding, support seeking, and problem avoidance. Objective: The goal of this study is to examine and illustrate the association of coping strategies on medication adherence. Method: A systematic review of PubMed/MEDLINE database was conducted in order to screen and select articles. A total of 15 studies were included where they were classified by endpoints. Endpoints that were considered are medication adherence, problem-solving/active coping strategy, emotion-focused coping strategy, seeking understanding coping strategy, support seeking coping strategy and problem avoidance coping strategy. The association of each coping strategy on medication adherence was then evaluated from each article assigned to every category of coping strategies to determine if it had a favorable, negative, or no impact on medication adherence. Results: Most studies which measured problem-solving/active coping strategy (78%) had a positive association on medication adherence, followed by studies which measured emotion-focused coping strategy (69%). Majority of the studies that evaluated for problem avoidance coping strategy (50%) showed a negative association on medication adherence and a small proportion of studies (30%) showed a positive association. Four(4) of the 5 coping strategies (problem-solving/active, emotion-focused, seeking understanding and support seeking) were found to have a greater number of studies showing positive association to medication adherence as opposed to problem avoidance. Conclusion: The findings may suggest that problem-solving and emotion-focused coping strategies can be useful to help people with chronic conditions improve their medication adherence. More study is needed to establish a link between coping strategies and medication adherence in patients, which will allow pharmacists and other healthcare professionals to deliver better interventions to patients and assess for medication nonadherence due to poor coping skills.