Patients Accounts And Rational Considerations
Studies of medication noncompliance in schizophreniaTheapproach with the longest history in the study of medicationnonadherence among people with schizophrenia attributes this responseto their very psychopathology. Poor insight and hallucinations areamong the main factors regarded as precluding their understanding oftheir condition and its treatment.Given this focus on patients cognitive deficits, it is not surprisingthat it downplays or even denies the importance of studying their ownexplanations for their nonadherence. Such an attitude to patientsâ??accounts has recently gained much popularity, following theaccumulation of data suggesting that biologically determined processesproduce their false beliefs. Anapproach diametrically opposite to the one discussed thus far claims,however, that the reasons why patients with schizophrenia object totheir medication do not differ from those commonly found among otherpatients. These reasons include rational considerations, such as theirwish to avoid adverse drug effects, to regulate their own medication,and to gain control over their own lives. Likewise, their medicationnonadherence has been attributed to their skepticism about thetreatments efficacy or their deliberate preference to cling to theirdelusions. Albeit reflecting modern treatments contribution toward diminishingdifferences between the conventional and the schizophrenic ways ofthinking, by focusing solely on patients rational considerations, thisapproach overlooks the potential of their unordinary beliefs forinfluencing medication adherence. In this regard, state, in their comprehensive review article on patients noncompliance, that both inpatient drug refusal and outpatientnoncompliance are consistently associated with more severe ratings ofpsychopathology p.. This implies that, rather than concentratingon patients ordinary motivations, efforts to reduce noncomplianceshould attend to the peculiarities of schizophrenic thinking.Suchan acknowledgment of the uniqueness of patients cognitive assessmentscharacterizes a third approach, which is inspired by theanthropological view of meaning construction and by Europeanpsychiatric phenomenological descriptions of forms of being-in-the-world.â? This approach treats patientsâ?? accounts as beinglay theories that people normally develop for making sense of theircondition see [ and ].Unlike the first perspective discussed in this section, it presupposesthat qualitative analyses of patientsâ?? narratives illuminate themeaning of their responses from their own point of view and offer anopportunity for their accurate understanding. Yet, contrary to thesecond perspectiveâ??s emphasis on the conventionally logical content ofpatientsâ?? accounts, it maintains that the common logic underlying theway they structure their experiences enables comprehension of theirunconventional explanations [ and ].Despite being an accepted practice in medical anthropology see [], and although it has been applied in studies on schizophrenia that focus on such other issues as patientsâ?? distresses [ and ],this approach has been the least exploited one in the investigation oftheir medication adherence. Among the few who have applied it in thiscontext are [],who have found that psychiatric patients endorsing more nonmedicalbeliefs are less compliant than those holding more medical views, and [],who claims that medication nonadherence among patients with paranoidschizophrenia can be explained by their subjective experience of beingcontrolled, poisoned, or invaded by the drugs. The paucity of thisapproach becomes especially salient in light of recent calls onresearchers to systematically investigate the subjective explanationsof medication use [].This article seeks to respond to this call by showing the contributionof this approach toward understanding the attitudes of patients withschizophrenia to their medical treatment.Methods