The Role of Treatment Motivation Subsystems in the Overall Structure of Compliance in Patients Undergoing Psychopharmacotherapy

Abstract

Objective. To identify interactions in the structure of treatment motivation and compliance in patients in a psychiatric clinic. Materials and methods. A questionnaire and compliance scales were used to assess treatment motivation in 104 patients in the Department of Integrative Pharmaco- and Psychotherapy. These included 67 patients with schizophrenia and schizoaffective spectrum disorders, 15 with affective disorders, 13 with personality disorders and neurotic disorders, and nine with organic lesions. Results and conclusions. The key role in forming the overall level of treatment compliance is played by the motivation mechanism based on subjective experience of suffering from the disorder. Occurrence of amotivation syndrome has disastrous effects on the formation of compliance. Passive agreement by the patient to accept treatment leads to a degradation in the treatment alliance, which is worsened by cognitive deficit in patients and reduced insight into the condition. Predominance of external motivation to receive treatment, determined by the pressure of the patient’s immediate environment, also had adverse impact on the compliance subsystem linked with the surroundings. Pressure from relatives was often not transformed into adequate social support. Extremely low levels of internal motivation based on an understanding of the nature of the disorder, led to decreases in compliance associated with attitudes to treatment with medication.