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The influence of life quality insight on treatment adherence of major depressive patients on Quetiapine.


Depressive disorder is a multidimensional disease, with many therapeutic goals, including the management of profound sadness, psychotic features, anxiety and diminished quality of life. For a person with a depressive condition, understanding and having the ability to recognize the disease relapses are vital to a successful treatment. This applies to both the patient and family members. Recurrent depressive disorder is regarded as an episodic disease with sometimes chronic evolution, a disorder that develops for a long time period and is exacerbated by inadequate therapy. Choosing the right medication for depressive disorder is made a complicated choice by the nature of the disease and the effectiveness and tolerability profile of the various therapies available. [1] Maintenance treatment in depressive disorder should be based on a good quality therapeutic alliance between the patient and the medical team, high compliance and adherence, maintaining cognitive skills and social functioning in terms of treatment. Depressive disorder faces a range of difficulties regarding the therapeutic compliance. A common problem in treating patients with depressive disorder is that they are not given their regular treatment. [3] Evolution of poor quality is significantly associated with social dysfunction, severe impaired interpersonal and family relationships, negatively affecting the patient's quality of life, family and careers. [6] High frequency of hospital admissions occurs on a background of non-compliance to the treatment administered over time. [3, 5]

Visiting the doctor regularly, daily administration of prescribed medication, psychotherapy and following a balanced lifestyle often succeed in keeping under control the depressive disorder and providing a normal life to the patient.

Helping the patient to comply with these standards, to create a rigorous discipline regarding treatment aspects and developing the therapeutic relationship appear to be related to the presence of a clear conscious about their health and social situations [5]. However, this insight on the present quality of life and patient compliance has been less discussed in the specialized literature.


To assess the relationship between the patient's insight on their life quality and compliance to treatment in major depression treated with Quetiapine.


1. There is a significant correlation between the discrepancy value at SF36 tests and the patient's treatment adherence.

2. The variable Discrepancy is a significant factor in the level of compliance at the group of the patients involved in the study, having a predictive significance for the later values.


Trial description: the group of subjects was formed of 38 patients (22 inpatients, 16 outpatients).

The criteria to admission in this study were:

--patients hospitalised with depressive affective disorder [2];

--patients that have been treated with Quetiapine, doses between 200 mg and 400 mg;

--age between 18 and 80 years old;

--no major psychiatric comorbidity associated.

In this study, we used two inventories:

--one quality of life inventory, SF-36;

--one treatment adherence inventory, TAT treatment adherence test.

The Short Form 36 Inventory (SF-36) is an instrument of generic health measurement, that has been developed by New England Medical Center in Medical Outcomes Study which uses 8 scales: somatic state, social state, role limitations in somatic and emotion states, mental health, vitality, somatic pain, general state of health.

This model has 3 levels:

--36 items;

--8 scales that summarised the items;

--2 generic concepts that summarized the scales.

The compliance inventory is formed by 10 items with possible valuables ranged between 1 to 5, the high scores showing good adherence to treatment.

Eight investigator specialists were asked to participate to this trial and clinically interview and assist the patients. They also filled the SF-36 according to their opinion on the patient's status. They also considered interviews with the family, close contacts, social inquiry, educational and cultural level. After analysing the 2 inventories filled in parallel by both the patients and their attending psychiatrists, we noticed an important discrepancy between the scores. This discrepancy is the expression of the difference between patient's subjective view and his real status. This is an inverted measure of the insight the patient has regarding his life quality. We have correlated the value of the discrepancy with the adherence.

The data has been statistically processed in SPSS.17.



Scatter Plot shows a negative linear correlation between discrepancy and treatment compliance which means that high values of discrepancy are correlated with low values of adherence.

In order to quantify the value of discrepancy and treatment adherence correlation we used the Pearson test. The test highlighted a significant strong correlation (p < 0,01; 2-tailed) and revelled a value of correlation factor of r = -0,772.

The Pearson correlation test confirms and objectifies the value of negative linear correlation and highlights that it is highly significant.

The ANOVA test was used in order to validate the model that evaluates in which way the improvement of insight could influence the compliance to treatment.

The hypothesis that there are differences in the way that the discrepancy variable influences the adherence level at the patients under study was verified with the help of a linear regression analysis that compared in which way the improvement on insight modified the adherence to treatment.

The independent variable was the discrepancy; the dependent variable was the treatment adherence.

In order to predict the evolution of adherence factor, we used the prediction equation with the next elements:

--Adjusted [R.sup.2] is 0,585 which means that the model explains 58.5 % of cases.

--The values of F test (Anova) and the factors of significance have values of p < 0.01, which confirms that the model is valid.

--The discrepancy factor is p < 0.01, therefore SF36 discrepancy tests is a significant predictor of adherence.


These results show that the adherence level depends largely on the discrepancy level. The same analysis reveal that the model is not complete, that there are some other factors that influence the adherence.

In other words, building a proper insight, matching the reality of one's quality of live, will help the patient in becoming more compliant to treatment and, as a result, more satisfied and more integrated in the micro and macro-social environment. The insight is a mendable factor which is in direct correlation to a proper information, the quality of therapeutic relationship, the psychological support and the quality of remission under the treatment. It's in our power to make use of this weapon in the battle with therapeutic abandon. Family counselling could be extremely important since mental instability changes in attitude affect the entire family. [4] For the psychiatrist working with depressive patients the knowledge of these variables can be a starting point in determine possible causes of an unrealistic vision of one's own quality of life. By these means, establishment of prompt and accurate treatment could mend or prevent these situations.


Affective instability could make patients feel in a wrong or unrealistic way about the consequences of their mental suffering on some aspects of their quality of life. This aspect is revealed from scores on SF-36 tests. This study demonstrates not only an important link between the way that the patients relate to their quality of life and their compliance to treatment, but highlights that obtaining a higher insight on the quality of live predicts better compliance to treatment, which, in turn, will further improve the quality of life, thus closing a perpetuum mobile. Preventing and improving the perception of quality of life, the patients with depressive disorder will be more likely to make the most of the treatment they are taking. The research confirms our hypothesis only partially, due to the small group of patients on whom this study was done, not allowing generalization of our results. However we believe that the premises for further deeper research on this sensitive issue in the management of depressive patient have been created.

Maria R. RADU--M. D., Ph. D. Student, "Grigore T. Popa" University of Medicine and Pharmacy Iasi; Junior Psychiatrist at "Socola" Institute of Psychiatry Iasi, Romania

Lucian C. PAZIUC--M. D., Ph. D. Student, "Grigore T. Popa" University of Medicine and Pharmacy Iasi; Junior Psychiatrist at Psychiatry Hospital Campulung, Romania

Roxana CHIRITA--Professor, M. D., Ph. D., Senior Psychiatrist, "Socola" Institute of Psychiatry Iasi, Romania


The authors have no potential conflict of interests to disclose.


[1.] Berk, L., Hallam, K. T., Colom, F., Hasty, M. Enhancing medication adherence in patients with bipolar disorder. Hum Psycopharmacol. 2010 Jan; 25(1):1-16.

[2.] Hamilton, M. A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23:56-62, 1960.

[3.] Hirschfeld, R., Martin, B., Panico, S., et al. The national depressive and manic-depressive association consensus statement on the under treatment of depression. JAMA 277:333-340, 1997.

[4.] Kahn, A., Kolts, R. L., Rapaport, M. H., et al. Magnitude of placebo response and drug-placebo differences across psychiatric disorders. Psychol Med. 2005;35:743-9.

[5.] Lingam, R., Scott, J. Treatment non-adherence in affective disorders. Acta Psychiatrica Scandinavica, Vol. 105, Issue 3, 164-172, March 2002.

[6.] Ramana, R., Paykel, E., Cooper, Z., et al. Remission and relapse in major depression. Psychol Med. 1995; 251161-1170.


Maria R. RADU

No. 23 str. Anastasie Panu

Bd. Muntenia, Sc. A, ap. 10, Iasi, Romania


Submission: October, 13th, 2015

Acceptance: November, 3rd, 2015
Table I. Pearson correlation

                                    discrepancy   adherence

discrepancy   Pearson Correlation   1             -.772 **
              Sig. (2-tailed)                     .000
              N                     38            38

adherence     Pearson Correlation   -.772 **      1
              Sig. (2-tailed)       .000
              N                     38            38

**. Correlation is significant at the 0.01 level (2-tailed).

Table II. The Anova test


Model             Sum of    df   Mean     F        Sig.
                  Squares        Square

1   Regression    40.147    1    40.147   53.093   .000 (a)
    Residual      27.222    36   .756
    Total         67.368    37

a. Predictors: (Constant), discrepancy

b. Dependent Variable: adherence

Coefficients (a)

Model             Unstandardized   Standardized
                  Coefficients     Coefficients

                  B       Std.     Beta           t        Sig.

1   (Constant)    4.600   .184                    24.972   .000

    discrepancy   -.084   .012     -.772          -7.286   .000

a. Dependent Variable: adherence
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Author:Radu, Maria R.; Paziuc, Lucian C.; Chirita, Roxana
Publication:Bulletin of Integrative Psychiatry
Article Type:Report
Date:Dec 1, 2015
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