Sociodemographic and Clinical Factors Affecting Treatment Adherence in Adults with Attention Deficit and Hyperactivity Disorder.

Background: This study aims to explore sociodemographic and clinical factors affecting medication adherence in adults with attention deficit and hyperactivity disorder and elicit dysfunctional domains and comorbidities with a focus on gender differences. Methods: Patients were recruited from 2 specialty clinics using chart records in a natural treatment design. Adult attention deficit and hyperactivity disorder self-report scale, Diagnostic Interview for attention deficit and hyperactivity disorder in adults, was applied. Adherence is defined if the patient declared ≥80% adherence to medication throughout the last 8-12 weeks. Results: From 205 attention deficit and hyperactivity disorder patients (male = 112 female = 93 (age (median) min-max = 29 (18-56)), 29% were non-adherent to attention deficit and hyperactivity disorder medication. In the multivariate analysis, having 2 or more comorbid disorders (P = .009), dysfunctions in academic/work (P = .049), and dysfunctions in family and other relationships (P = .047) increased the likelihood of adherence. Adherence rates did not significantly differ between methylphenidate and atomoxetine (P = .405). Women were more likely to have 2 or more comorbid psychiatric disorders (P = .004) and dysfunctions in social relationships (P = .001), free time activities, hobbies (P < .001), self-confidence, and self-image (P < .001). Results: Nearly one-third of adult patients with attention deficit and hyperactivity disorder did not adhere to medication treatment. Comorbid psychiatric disorders and dysfunctions in life domains appear to increase the likelihood of adherence to attention deficit and hyperactivity disorder medications, possibly through increasing motivation for treatment. The effect of cognitive-behavioral therapy on compliance with attention deficit and hyperactivity disorder medication should further be explored with prospective controlled studies. Conclusion: We suggest that future longitudinal studies use objective measures of adherence and confirm the role of dysfunctional life domains and comorbid psychiatric disorders as correlates of medication adherence.

Cognitive insight and acute psychosis in schizophrenia.

Cognitive insight is a new concept. There are very few data regarding the relationship between cognitive insight and positive symptoms. The goal of the present study was to investigate the impact of acute psychosis (delusions and hallucinations) on overconfidence in judgments and self-reflectiveness of patients with schizophrenia. The Beck Cognitive Insight Scale was used to compare the cognitive insight of schizophrenia patients with (n = 93) and without (n = 45) current psychotic symptoms. Clinical symptoms and clinical insight of the patients were also assessed. The present findings suggest that both overconfidence in judgments and impaired self-reflectiveness are associated with acute psychosis. Only diminished self-reflectiveness seem to be improved following hospitalization. Although overconfidence of schizophrenia patients in their judgments was more severe in schizophrenia patients with psychotic symptoms, self-certainty of schizophrenia patients may be a relatively persistent characteristic that is also present after recovery of psychosis. Studies with larger samples involving follow up for longer periods will be valuable to understand the nature of the relationship between cognitive insight and clinical symptoms of schizophrenia.