Satisfaction with antipsychotics as a medication: the role of therapeutic alliance and patient-perceived participation in decision making in patients with schizophrenia spectrum disorder

Abstract

Objectives

The aim of this study was to identify independent predictors of satisfaction with antipsychotics in patients with schizophrenia spectrum disorders treated in a mental health catchment area.

Methods

Observational analytical study of patients (n = 150) recruited through a convenience sampling method from five mental health units. Satisfaction with the antipsychotic as a medication was evaluated using the Treatment Satisfaction Questionnaire for Medication (TSQM). Therapeutic alliance was assessed by the Working Alliance Inventory Short Form (WAI-S). Patient-perceived participation in decision-making was assessed using COMRADE (Combined Outcome Measure for Risk communication And treatment Decision making Effectiveness). A multiple linear regression analysis was performed to identify variables independently associated with the TSQM ‘Global Satisfaction’ total score.

Results

Two variables – age and higher level of self-perceived participation in treatment decision-making – were directly, significantly, and independently associated (β coefficient values: 0.209 and 0.432, respectively) with a higher TSQM Global satisfaction score. In addition, the severity of psychotic symptoms was inversely associated with satisfaction (β coefficient value: −0.205) (R² = 0.355; R² adj. = 0.291; F(13) = 5.554; p < 0.01).

Conclusions

These findings suggest that involving the patient in treatment decision-making and optimising the treatment to reduce symptoms, especially in younger patients, could increase satisfaction with antipsychotic treatment.

Key Points

• Patient involvement in shared decision-making is relevant for treatment satisfaction.

• Current evidence suggests that improving the doctor–patient relationship optimises antipsychotics outcomes.

• Self-perceived participation in decision-making predicts satisfaction with antipsychotic medication.

• Types of antipsychotics do not determine consistent differences in satisfaction.

Keywords:

• Satisfaction
• antipsychotics
• schizophrenia
• working alliance
• patient participation
• severity

Acknowledgements

We want to thank all of the patients who kindly participated in this study. We thank Quintiles Inc. for the use of the TSQM scale.

Author contributions

RTO and FGS designed the study and analysis plan. FGS undertook the analysis with JPR and JMMS. RTO and FGS wrote the first draft of the manuscript with JMVM. All authors participated in the interpretation of the findings. CRG coordinated clinical interviews created the database and mechanised them with the collaboration of EGS and ALM. All authors contributed to and have approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Financial support for this study was provided entirely by a grant from Consejería de Salud [PI-0309-2013] (Andalusian government agency). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.

This work was supported by a public grant of Consejería de Salud (Regional Government of Andalusia, Spain). Code PI-0309-2013. This funding source had no role in the design or conduct this study, data analysis, or manuscript preparation.