Treatment noncompliance among hospitalized forensic patients

Abstract

Noncompliance with treatment is a major challenge facing medical and psychiatric health care. Over the past few decades, numerous studies have investigated a wide range of behavioral, demographic, sociocultural, and treatment-related variables as they may influence patient compliance with treatment regimens. Most such attempts have demonstrated inconsistent associations across the diverse conditions represented. Nevertheless, within particular subgroups of psychiatric patients, characteristic symptoms such as suspiciousness, anxiety, persecutory delusions, and grandiosity have been shown to predispose affected individuals to resist or refuse prescribed drug treatment and psychosocial interventions.;The purpose of the present study was to examine the association of various characteristics of a forensic psychiatric population with resistance to or refusal of drug and psychosocial treatment recommendations. Using archival data, variables relating to aggressive behavior, demographics, diagnosis, cognitive functioning, legal status, and treatment history were examined in a group of 145 male forensic patients admitted to a maximum security psychiatric hospital. Compliance behavior was evaluated retrospectively using hospital records, case reports, and treatment summaries. Correlational analysis, multivariate analysis of variance, factor analysis, and structural equation modeling were employed to examine the association of compliance with the variables of investigation. Treatment history and diagnosis variables demonstrated the most significant associations with compliance behavior. Results indicated that patients who were older, more frequently admitted for psychiatric treatment, with greater lengths of time hospitalized, received higher daily dosages of antipsychotic drugs, and lacked a history of drug or alcohol abuse tended to be more compliant with treatment regimens. It was also shown that patients more likely to be diagnosed with bipolar disorder, paranoid schizophrenia, and antisocial personality disorder were significantly less compliant with all forms of treatment. The findings of this study suggest the need to further consider the role of population-specific characteristics and subjective experience of illness when evaluating the effectiveness of treatment and ways of improving patient compliance.