Neurocognition, Insight and Medication Nonadherence in Schizophrenia: A Structural Equation Modeling Approach

作者：Boyer Laurent^*; Cermolacce Michel; Dassa Daniel; Fernandez Jessica; Boucekine Mohamed; Richieri Raphaelle; Vaillant Florence; Dumas Remy; Auquier Pascal; Lancon Christophe

来源：PLos One, 2012, 7(10): e47655.

DOI：10.1371/journal.pone.0047655

Objective: The aim of this study was to examine the complex relationships among neurocognition, insight and nonadherence in patients with schizophrenia. %26lt;br%26gt;Methods: Design: Cross-sectional study. Inclusion criteria: Diagnosis of schizophrenia according to the DSM-IV-TR criteria. Data collection: Neurocognition was assessed using a global approach that addressed memory, attention, and executive functions; insight was analyzed using the multidimensional %26apos;Scale to assess Unawareness of Mental Disorder;%26apos; and nonadherence was measured using the multidimensional %26apos;Medication Adherence Rating Scale.%26apos; Analysis: Structural equation modeling (SEM) was applied to examine the non-straightforward relationships among the following latent variables: neurocognition, %26apos;awareness of positive symptoms%26apos; and %26apos;negative symptoms%26apos;, %26apos;awareness of mental disorder%26apos; and nonadherence. %26lt;br%26gt;Results: One hundred and sixty-nine patients were enrolled. The final testing model showed good fit, with normed chi(2) = 1.67, RMSEA = 0.063, CFI = 0.94, and SRMR = 0.092. The SEM revealed significant associations between (1) neurocognition and %26apos;awareness of symptoms,%26apos; (2) %26apos;awareness of symptoms%26apos; and %26apos;awareness of mental disorder%26apos; and (3) %26apos;awareness of mental disorder%26apos; and nonadherence, mainly in the %26apos;attitude toward taking medication%26apos; dimension. In contrast, there were no significant links between neurocognition and nonadherence, neurocognition and %26apos;awareness of mental disorder,%26apos; and %26apos;awareness of symptoms%26apos; and nonadherence. %26lt;br%26gt;Conclusions: Our findings support the hypothesis that neurocognition influences %26apos;awareness of symptoms,%26apos; which must be integrated into a higher level of insight (i.e., the %26apos;awareness of mental disorder%26apos;) to have an impact on nonadherence. These findings have important implications for the development of effective strategies to enhance medication adherence.

• 出版日期2012-10-29