Consortium PSYCHIATRICUMConsortium PSYCHIATRICUMConsortium PSYCHIATRICUM2712-76722713-2919Eco-Vector9310.17816/CP93RESEARCHИССЛЕДОВАНИЕResearch ArticleRevisiting Drug Compliance: The Need for a Holistic Approach in the Treatment of Severe Mental DisordersК проблеме медикаментозного комплайенса: необходимость целостного подхода в терапии тяжёлых психических расстройствhttps://orcid.org/0000-0003-2502-636557191369987AAN-5757-20207807-4497SorokinMikhail Yu.СорокинМихаил Юрьевич
Russian Federation

M.D., Ph.D., academic secretary, research assistant of The Integrative Pharmaco-psychotherapy of Patients with Mental Disorders Department, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology

m.sorokin@list.ruhttps://orcid.org/0000-0001-5618-420635593613200U-1562-20179772-0024NeznanovNikolay G.НезнановНиколай Григорьевич
Russian Federation

M.D., Ph.D., Dr.Med.Sc., professor, director, head of The Geriatric Psychiatry Department, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology; head of The Psychiatry and Addictions Department

spbinstb@bekhterev.ruhttps://orcid.org/0000-0002-9481-74116506495244AAN-6629-20201890-9182LutovaNatalia B.ЛутоваНаталия Борисовна
Russian Federation

Ph.D., Dr.Med.Sc., chief researcher, head of The Integrative Pharmaco-psychotherapy of Patients with Mental Disorders Department, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology

lutova@mail.ruhttps://orcid.org/0000-0001-7334-21656603072792AAB-2930-2021WiedViktor D.ВидВиктор Давыдович
Russian Federation

Ph.D., Dr.Med.Sc., professor, chief researcher, The Integrative Pharmaco-psychotherapy of Patients with Mental Disorders Department, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology

wied@mail.ruV.M. Bekhterev National Medical Research Center of Psychiatry and NeurologyНМИЦ ПН им. В.М. БехтереваI.P. Pavlov First Saint-Petersburg State Medical UniversityПСПбГМУ им. И.В. Павлова30092021051120212317251807202103082021Copyright ©; 2021, Sorokin M.Y., Neznanov N.G., Lutova N.B., Wied V.D.Copyright ©; 2021, Сорокин М.Ю., Незнанов Н.Г., Лутова Н.Б., Вид В.Д.2021Sorokin M.Y., Neznanov N.G., Lutova N.B., Wied V.D.Сорокин М.Ю., Незнанов Н.Г., Лутова Н.Б., Вид В.Д.https://creativecommons.org/licenses/by/4.0https://consortium-psy.com/jour/article/view/93

INTRODUCTION: The limited practice of depot antipsychotics and psychoeducation use, recommended for overcoming the noncompliance of patients with severe mental disorders, is linked to a high incidence of treatment violation. Therefore, the development of personalized mental healthcare approaches is a crucial healthcare task.

AIM: To describe and differentiate the role of clinical, social and psychological factors that lead to different level of treatment engagement of psychiatric inpatients.

METHODS: Secondary analysis of findings from 91 inpatients, based on the Treatment Motivation Assessment Questionnaire and Medication Compliance Scale, as well as the Scale of Internalized Stigma of Mental Illness and Perceived Discrimination and Devaluation Scale. Factorial analysis, cluster analysis and analysis of variance with p-level=0.05 and the calculation of the effect size (ES) according to Cohen’s d and Cramer’s V were used.

RESULTS: The nature of therapy compliance in various categories of patients is mediated differentially, including: the severity of negative symptoms (ES=0.29), the global level of functioning and work maladjustment (ES=0.23–0.26), various motivational and behavioral styles (ES≥0.74) and the intensity of psychiatric stigmatization (ES≥0.88).

CONCLUSIONS: Consideration of the clinical, social and psychological factors should empirically determine the strategies for the personalized use of prolonged antipsychotics and socio-psychotherapeutic interventions when developing an individual treatment plan for psychiatric in-patients.

АКТУАЛЬНОСТЬ: Ограниченная практика применения депо-антипсихотиков и психообразования, рекомендуемых для преодоления нонкомплайенса пациентов с тяжелыми психическими расстройствами, сочетается с сохраняющейся высокой частотой нарушений режима лечения. Это определяет разработку персонализованных подходов психиатрической помощи в качестве актуальной задачи здравоохранения.

ЦЕЛЬ: Дифференцированное описание роли клинических и социально-психологических факторов, соучаствующих в формировании разной включенности пациентов психиатрического стационара в терапию.

МАТЕРИАЛ И МЕТОДЫ: Вторичный анализ данных 91 пациента психиатрического стационара с верификацией оригинальной кластерной модели включенности в лечебный процесс на основании данных Treatment Motivation Assessment Questionnaire, Medication Compliance Scale, а также Scale of Internalized Stigma of Mental Illness и Perceived Discrimination and Devaluation Scale. Использованы факторный, кластерный и дисперсионный анализы с p-level=0.05 и расчетом размера эффектов (ES) по Cohen’s d и Cramer’s V.

РЕЗУЛЬТАТЫ: Характер сотрудничества в терапии у разных категорий пациентов опосредован дифференцированно: выраженностью негативной симптоматики (ES=0.29), глобальным уровнем функционирования и трудовой дезадаптацией (ES=0.23-0.26), различными мотивационно-поведенческими стилями (ES≥0,74) и интенсивностью психиатрической стигматизации (ES≥0.88).

ВЫВОДЫ: Учет комплекса клинических и социально-психологических факторов эмпирически обуславливает стратегии персонализированного применения пролонгированных форм антипсихотиков и социо-психотерапевтических интервенций при разработке индивидуального плана лечения пациентов психиатрического стационара.

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