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Pathways to medication adherence: a configurational analysis of psychiatric symptoms and medication attitude in patients with schizophrenia spectrum disorder receiving long-acting injectable antipsychotics
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DOI：10.1186/s12888-026-08475-2.png)
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Abstract
En 中文
Medication non-adherence affects nearly half of patients with schizophrenia spectrum disorder and is associated with relapse and hospitalization. Long-acting injectable (LAI) antipsychotics may improve adherence, but their effectiveness likely depends on interactions between specific psychiatric symptom patterns and medication attitudes. This study, a secondary analysis of published data from the Dryad repository, examined how configurations of psychiatric symptoms factors influence adherence via medication attitude among patients receiving LAI. This secondary analysis included 304 patients with schizophrenia spectrum disorder (mean age 45.64 years; 63.16% male) receiving LAI from Italy. We employed complex mediation qualitative comparative analysis (cmQCA) to examine symptom-adherence pathways. Psychiatric symptoms were assessed using the Brief Psychiatric Rating Scale-18 items (BPRS-18) across five dimensions: affect, positive symptoms, negative symptoms, resistance, and activation. Medication attitudes were evaluated with the Drug Attitude Inventory (DAI-10), and adherence was measured using Kemp’s 7-point scale. Regression models examined direct and mediated relationships, controlling for demographic variables, substance abuse history, LAI generation, and injection interval. Qualitative comparative analysis (QCA) identified six configurations: three promoting positive medication attitudes (46% solution coverage, 82% consistency) and three leading to poor medication attitudes (39.5% coverage, 79.4% consistency) characterized by high Resistance. The absence of Positive Symptoms and Resistance emerged as core conditions for positive medication attitudes. Regression analyses confirmed partial mediation through medication attitudes. Multiple pathways link psychiatric symptom configurations to medication adherence through medication attitude in patients receiving LAI treatment. Clinicians should consider specific symptom patterns for adherence interventions. Targeted approaches addressing both symptom configurations and medication attitudes may optimize outcomes for schizophrenia spectrum disorder. Not applicable.
Keywords:
Long-acting injectable antipsychotics
Medication adherence
Medication attitude
Brief psychiatric rating scale
Qualitative comparative analysis
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