Clinical improvement in psychosis during home hospitalisation: association with treatment attitude

Background

Poor medication adherence is a well-established challenge in the management of psychotic disorders and has been consistently associated with relapse, rehospitalisation and poorer clinical outcomes [1]. Insight into illness and treatment attitude are key factors influencing adherence, with lower levels of insight predicting reduced adherence to pharmacological treatment [2]. The Drug Attitude Inventory (DAI) is widely used to assess patients’ subjective response and attitude towards medication and has been associated with both adherence and clinical outcomes [2,3]. Patients with more positive attitudes towards medication are more likely to adhere to treatment and achieve better clinical stability [1,3].

Home hospitalisation has emerged as an alternative to conventional inpatient care, providing intensive, multidisciplinary treatment within the patient’s home environment. This model may enhance therapeutic alliance, improve adherence and promote recovery in a less restrictive and more patient-centred setting. It may also reduce the need for prolonged hospital stays, decrease healthcare costs and improve patient and family satisfaction. However, evidence regarding its effectiveness in psychotic disorders, as well as the role of treatment attitude in influencing outcomes, remains limited and requires further investigation.

Aims

To evaluate changes in psychotic symptom severity during home hospitalisation and to explore the association between treatment attitude and clinical improvement.

Methods

A retrospective observational study was conducted including patients with psychotic disorders admitted to a home hospitalisation programme. Sociodemographic and clinical variables were collected from medical records. Psychopathology was assessed at admission and discharge using the Positive and Negative Syndrome Scale (PANSS). Treatment attitude was evaluated at discharge using the Drug Attitude Inventory (DAI).

Symptom improvement was defined as the difference between admission and discharge PANSS scores (ΔPANSS = PANSS_pre − PANSS_post). Changes in symptom severity were analysed using the Wilcoxon signed-rank test due to the small sample size. The association between treatment attitude and clinical improvement was examined using Spearman’s rank correlation coefficient, with statistical significance set at p < 0.05.

Results

Seventeen patients were included in the analysis. A statistically significant reduction in psychotic symptoms was observed between admission and discharge. Mean PANSS total scores decreased from 77.8 (SD 23.2) at baseline to 48.3 (SD 10.9) at discharge (p < 0.001), indicating a marked improvement in symptom severity during the home hospitalisation period.

A positive correlation was found between DAI scores and symptom improvement (Spearman’s rho = 0.31), suggesting that more favourable attitudes towards medication may be associated with greater clinical improvement. However, this association did not reach statistical significance (p = 0.23), possibly due to the limited sample size.

Conclusions

Home hospitalisation was associated with a significant reduction in psychotic symptoms, supporting its role as an effective alternative to inpatient care. Although the association between treatment attitude and clinical improvement did not reach statistical significance, the observed positive trend suggests that patients’ attitudes towards medication may influence outcomes. Further studies with larger samples are needed to confirm these findings and to better understand the factors associated with treatment response.

References

1. Novick, D., Montgomery, W., Treuer, T., Aguado, J., Kraemer, S., Haro, J.M., 2015. Relationship of insight with medication adherence and the impact on outcomes in patients with schizophrenia and bipolar disorder: results from a 1-year European outpatient observational study. BMC Psychiatry 15, 189.
2. Droulout, T., Liraud, F., Verdoux, H., 2003. Relationships between insight and medication adherence in schizophrenia. L’Encéphale 29 (5), 430–436.
3. Kim, J., Ozzoude, M., Nakajima, S., et al., 2020. The relationship between attitude toward medication and clinical outcomes in schizophrenia. Neuropharmacology 168, 107980.