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COGNITIVE AND EMOTIONAL ASPECTS OF COMPLIANCE DURING LOW-DOSE ANTIPSYCHOTIC TREATMENT: A PILOT STUDY

Sabine Bossert, Matthias Dose, Hinderk M. Emrich, Diego Garcia, Matthias Junker, Konstantin Raptis and Matthias M. Weber

Max-Planck-Institute of Psychiatry, Kraepelinstrasse 10, 8000 Munich 40, FRG

Since patient compliance with medication is crucial for the success- ful outcome of the treatment of schizophrenic disorders, rather high rates of non-compliance in schizophrenic patients represent a serious therapeutic problem. Research findings reveal no relationship between sociodemographic, personality or illness variables and suggest cognitive attitudes towards illness and treatment as important determinants for compliance. The main purpose of the present pilot study in 18 schizophrenic (DSM III) patients aged 29 + 9 years, was the assessment of attitudes towards illness and treatment, their change and relationship to compliance, treatment satisfaction and outcome during a 35-day low-dose antipsychotic treatment, with/with- out anticonvulsant adjuvant, in a placebo controlled double-blind design. Cognition was measured by questionnaire: compliance was assessed by behavioral observation and by monitoring of drug plasma levels. Treatment outcome was measured by several clinical and self- rating scales. During treatment attitudes towards illness and treatment remained stable and did not differ significantly with respect to the two treatment groups. Previous experience with neuroleptic therapy, however, was predictive of compliant attitudes, treatment satisfaction and reported side effects. Several attitudes towards treatment and the therapist were significantly correlated with treatment dissatisfaction and presence of depressive symptoms. Since all patients were rated as highly compliant, drug-taking behavior was uncorrelated with attitudinal sets, experience of side effects or satisfaction with treatment.

PATIENTS' ATTITUDES TO DEPOT NEUROLEPTICS

Cosmo Hallstrom, Simon Halstead and Helen Hays

Charing Cross Hospital, London W6, UK

Poor compliance with depot medication is a significant problem and there is little in the literature to explain why this is so. We therefore designed a broad questionnaire for a preliminary screening of patients on depot medication to establish their attitudes to their drugs and what the key issues are. We also tested the hypothesis that patients like taking hypnotics, dislike depot neuroleptics and were indifferent to antidepressants.

One hundred and one patients were questioned. All were on maintenance depot therapy. They were served by two health districts with a catchment area of approximately 210,000. They reflect the practices of eight clinical teams. The patients were rated by 11 different raters, hospital doctors and CPNs in hospital and community settings, in order to get a broad spectrum of patients.

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Sixty percent of patients were single and the sexes were evenly distributed. Seventy percent had been ill for over four years and most had had four or more admissions. The modal age group was 35-60.

Seventy percent said they were on depot medication in order to keep well but only 43% expressed a positive attitude to them. Major reasons for dislike were waiting for treatment, and a dislike of the injection. Weight gain was reported as a problem by 42% of women. Drowsiness, movement disorders and anticholinergic effects were also common side effects. There was no obvious patient preference as to depot drug.

Presumably those who do not think the drugs are helping and do not like taking them are unlikely to comply. The patients sampled were of course those who attended for treatment and therefore complied well. A further group of non-compliant patients needs to be studied and their attitudes compared.

Although numbers for drugs other than depot neuroleptics were small, patients have similar attitudes to sleeping pills, antidepressants and depot neuroleptics. Our hypothesis that attitudes will differ is, therefore, no true in this group.

ANTIPSYCHOTICS OF THE FUTURE

R.M. Pinder* and M.J. Mitchell**

*Scientific Development Group, Organon International, oss, The Netherlands; **Astra Pharmaceuticals International, Kings Langley, Herts, UK

Current antipsychotic therapy is based on dopamine (DA) antagonism with its attendant endocrinological and neurological side effects. Although compounds with greater selectivity for DA receptors may eliminate the additional autonomic side effects of current anti- psychotics arising from interactions with other types of receptor, it is likely that the endocrinological and the more serious neurological effects - acute dystonia, akathisia and pseudo-Parkinsonism in the short term and sometimes irreversible abnormal involuntary movements after prolonged treatment - are related to DA antagonism. Attempts to reduce neurological side effects have focussed on compounds that are selective for subtypes of DA receptor: D2-selective antagonists such as remoxipride, amisulpiride and raclopride; Dl-selective antagonists like Sch-23390, clozapine-like drugs with selectivity for mesolimbic DA receptors and D2-agonists selective for presynaptic DA autorecep- tors. It is still too early to judge the success of these attempts, although remoxipride does seem to cause less extrapyramidal effects.

Many neuroleptics are also potent antagonists of central serotonin (5-HT) receptors. Experimental evidence implicating a tonic in- hibitory role for 5-HT mediated via 5-HTz and/or 5-HTI receptors on central DA systems has led to the clinical evaluation of 5-HTz receptor antagonists as antipsychotics or as adjuncts to neuroleptic therapy and to the development of selective antagonists of central 5- HTI receptors. DA antagonists such as tiaspirone and Org 5222 with