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| Subscribe to Clinical Compass™ | VOLUME 2, ISSUE 3 - January 30, 2007 | |||||||||||||||||||||||||||
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FROM THE CLINICAL KNOWLEDGE CENTER Does Religious Belief Influence Medication Adherence in People with Schizophrenia? A new study has examined the relationship of religion and spirituality to medication adherence in patients with schizophrenia. There is a growing amount of literature suggesting that religion and spirituality may provide a positive effect on patients with schizophrenia - particularly for those patients whose social life and personal identity have become diminished by the chronic course of the diseases. For other patients, however, religion can have a negative impact on the outcome of mental disorders, particularly when it replaces or delays medical treatment. Some patients may refuse medical care, especially psychiatric care, because of their religious beliefs. Adherence with medication regimens is an important component of the treatment algorithm for any chronic disease, including schizophrenia. It is estimated that at least half of the patients who are prescribed long-term medication for chronic conditions do not fully comply with treatment. In patients with schizophrenia, nonadherence is a common cause of psychotic relapse and hospitalization, with some studies suggesting that at least 50% of patients are nonadherent to their medication regimen at some time during their illness. For these patients, the consequences of poor adherence can lead to demoralization, loss of job, family discord, danger to self or others, and relapse and rehospitalization. The risk of relapse in first-episode patients has been shown to increase almost fivefold when antipsychotic drug treatment was discontinued. Improving adherence with treatment is an important goal in the management of schizophrenia, as poor outcomes could likely be improved if all patients were fully adherent. The objective of this study was to assess the influence of religion on medication adherence. The study included 103 stable patients from a Swiss outpatient public psychiatric facility. Interviews were conducted to investigate spiritual and religious beliefs and religious practices and religious coping. Medication adherence was assessed through questions to patients and to their psychiatrists and by a systematic blood drug monitoring. Sixty-six percent of patients were treated with an atypical antipsychotic only, 5% with a typical antipsychotic only, and 28% with more than one antipsychotic. Results: Thirty-two percent of patients were partially or totally nonadherent to oral medication. Patients on atypical antipsychotic medication and those on monotherapy were more adherent than patients on typical antipsychotics and on more than one antipsychotic, respectively. Sociodemographic and clinical factors significantly associated with good adherence were daily activities, lower substance abuse, comorbid disorders (alcohol dependence and cannabis abuse), less positive symptoms, and a greater rate of symptomatic and functional remission. Fifty-eight percent of patients were Christians, 2% Jewish, 3% Muslim, 4% Buddhist, 14% belonged to various minority religious movements, and 19% had no religious affiliation. Two-thirds of the total sample reported that spirituality was very important or essential in everyday life and one third reported regular religious practices in the community (attending church services, prayer, meditation, worship, or reading religious material with others). Religion played an important role in the daily lives of about 75% of the patients and in coping with difficulties for more than half of them. Adherent patients had more group religious practices (at least once a month) than nonadherent patients, who seemed to have very little contact with a religious community. Moreover, more adherent patients (34%) stressed the importance of the community's support for them compared with nonadherent patients. More than half of the patients had beliefs about their illness and treatment that were directly influenced by their religious convictions - 31% believed that schizophrenia was a "positive" gift sent by God to put them on the right path or God's plan; 26% believed that it was a "negative" punishment from God, a demon, or the devil. The rest of the sample (43%) was more comfortable with a medical model of illness and spoke in terms of fragility and genetic vulnerability rather than religious or spiritual belief. In the group of adherent patients, medical representations of illness were more prominent than spiritual or religious representations; the ratio was reversed for nonadherent patients. Thirty-one percent of nonadherent patients noted an incompatibility between their religious convictions and medication and supportive therapy (medication is not a part of God's plan), versus 8% of adherent patients. The authors note that that religion and spirituality contribute to how patients with schizophrenia feel about their condition and how it shapes their view of medical treatment. They urge clinicians to consider how religious beliefs may impact treatment adherence, and to work alongside patients to build a therapeutic alliance that includes an ongoing review of the way patients view their disease and its treatment. Do you have feedback for the author? Click here to send us an email. References
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