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Stigma negatively impacts adherence to psychosis treatment

Jackey Suen
19 Jan 2017
Prof Eric Chen (middle), Nicole Lau (right)

Stigma negatively impacts treatment adherence among psychosis patients in Hong Kong, a recent survey has shown.

Among 300 patients with psychotic disorders who responded to the survey, 30 percent admitted lying about the reason for taking antipsychotic medications, while 19 percent felt ashamed of taking antipsychotics.

“Surprisingly, the stigma towards antipsychotic treatment existed even among a significant proportion of respondents with a high level of insight about their disease,” reported Professor Eric Chen of the Department of Psychiatry, The University of Hong Kong, who is Chairman of the Early Psychosis Foundation.

“Forty percent of the respondents were nonadherent to their medications. Another 40 percent expressed concerns about disclosing their illness and treatment,” he continued.

The survey, conducted by the Early Psychosis Foundation between June and October 2016 in patients with psychotic disorders from Queen Mary Hospital, Baptist Oi Kwan Social Service, Alliance of Ex-mentally Ill of Hong Kong and New Life Psychiatric Rehabilitation Association, also established an association between medication nonadherence and stigma. Significantly more respondents who did not adhere to antipsychotics believed that people on antipsychotics are useless and dangerous (17 percent vs 8–9 percent in patients who adhered to antipsychotics).

“Clinicians have attributed the high medication nonadherence rate of psychosis patients to lack of knowledge and insight about the disease,” noted Chen. “However, the corresponding psychoeducation approach has achieved only limited success in improving adherence as it focuses on brain abnormality, which is considered unchangeable and aggravates stigma. It fails to acknowledge the effect of stigmatization as a factor behind its ineffectiveness in improving patients’ attitude and behaviour towards treatment.”

In the survey, patients with high levels of brain and mind attributions of psychosis were found to have more positive attitudes towards antipsychotic treatment and medical professionals, while positive attitudes in the patients’ close social circles were helpful in reducing stigma and improving treatment adherence.

“A three-pronged approach is needed to help patients understand the brain and mind attributions of the disease, guide them to appreciate the interaction between the two, and encourage support from their families and partners. This can assist patients in building a positive attitude towards antipsychotic treatment and effectively support their recovery,” he suggested.

“In response to the survey’s findings, the Early Psychosis Foundation will launch the iPAT project to encourage communication between patients and their families about the illness and its treatment. This will help strengthen mutual support between patients and their families, thereby eliminating self-stigmatization,” explained Nicole Lau, Senior Project Manager of Early Psychosis Foundation. “In the project, a series of promotional activities will be rolled out to educate patients on assessing their status of recovery, and to raise their awareness of the interaction between the brain and the mind.”

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