Stigmatisierung und Medikamenten-Nonadhärenz bei Menschen mit psychotischen Störungen: Schwierigkeiten und Lösungsmöglichkeiten

Stigmatization against persons with schizophrenia poses the first key topic of this dissertation. A second topic was the investigation of nonadherence to antipsychotic medication (i.e. medication intake behavior deviating from the treatment plan). This cumulative dissertation consists of three studies investigating potentially relevant factors and possible solutions for these issues. Stigmatization against persons with schizophrenia is a very frequent problem (Rose et al., 2011) which has even increased over the last 20 years (Angermeyer et al., 2013). So far, the central strategy of larger-scale anti-stigma campaigns was the promotion of biogenetic models on the etiology of the disorder. However, this strategy has been shown to be not very promising and even resulted in an increase of stigmatization (Kvaale, Haslam, et al., 2013; Read et al., 2006). In the first part of this dissertation I investigated the potential of continuum beliefs in reducing stigmatization. Continuum beliefs propose that psychotic symptoms lie on a continuum to normal experiences (McGovern & Turkington, 2001). The first study revealed an association between more endorsement of continuum beliefs and lower stereotype scores in correlation and regression analyses (Wiesjahn, Brabban, et al., 2014). In order to investigate causal effects the second study compared the effects of a continuum intervention with a biogenetic and a control intervention in an experimental design (Wiesjahn, Jung, Kremser, et al., 2014). The results revealed a beneficial effect of the continuum intervention on the perceived incompetence and unpredictability. In contrast, the biogenetic intervention resulted in lower blame scores. The correlation analysis indicated continuum beliefs to be associated with lower scores in all aspects of stigmatization. These findings suggest that continuum beliefs do have the potential to reduce stigmatization. However, further studies are needed using stronger manipulations. Nonadherence to prescribed antipsychotic medication is another frequent challenge for persons with psychotic disorders. Approximately half of the patients with psychotic disorders do not take their medication as prescribed (Lacro et al., 2002), which threatens the outcome of medical treatment (Viguera et al., 1997). The processes that affect the person’s attitudes towards medication and precede the intake behavior have not been investigated sufficiently. In the second part of this dissertation, the third study investigated a process model containing an extensive set of possible predictors for attitudes towards medication in order to predict the intake behavior in a next step (Wiesjahn, Jung, Lamster, et al., 2014). A path analysis revealed five significant predictors for positive attitudes towards medication: Insight into the need for treatment, attribution of symptoms to a mental disorder, presence of biological causal beliefs, less endorsement of psychological causal beliefs, and experience of less negative side effects. In turn, the attitudes towards the medication were associated with adherence. Integrating these factors into a cooperative decision about the treatment poses a possible solution for the problem of nonadherence. These findings need to be cross-validated in future trials. Furthermore longitudinal studies are needed in order to investigate the timeline of the processes in detail.