Adherence, cognition and attitudes to treatment in at-risk mental states and schizophrenia (Manchester-Melbourne Dual Award)

Poor adherence to antipsychotic medication multiplies the risk of relapse and suicide, yet at any time 40% of service users are poorly adherent. Negative attitudes to treatment may also discourage people from seeking help and delay first treatment. Reasons for negative attitudes to medication and poor adherence in psychosis have been much studied but no coherent, overall model has been constructed and tested before. This is a problem because the drivers of poor adherence affect each other: they form a complex system, so studying them together is important to understanding how to intervene. They include forgetting to take medication, particularly in those with cognitive problems caused by the psychosis, distrusting medications, distrusting the prescriber of the medication, and deciding there is little risk of a relapse or one was never ill in order to preserve a sense of self-worth and avoid accepting the stigma of mental illness.

In this PhD the student will survey reasons for poor adherence and negative attitudes in those taking antipsychotics and using mental health services, using well established measures, and model them statistically to test hypotheses about how they interact. They will do this in Manchester and again in Melbourne, to compare results in different groups and make use of the expertise in early intervention in Melbourne. This will enable them to test how far the same is true of those in services for psychosis and those who have not yet developed it but are seeking help for “at-risk” mental states.

In either city they will also examine how those who score positively or negatively in attitudes to medication score on measures of cognition, to test the hypothesis that prospective memory (remembering what you intended to do) predicts adherence rather than other aspects of cognition, and only in those with positive attitudes.

They will also survey staff attitudes to non-adherence and intervening to improve it, in order to develop an intervention in Manchester, based on the survey results, to support staff in intervening to improve adherence or guide help-seekers to more suitable cognitive therapy. They will examine the feasibility and acceptability of such an intervention, and examine whether it shifts staff attitudes and improves their knowledge. In Manchester they will have access to expertise in staff development and training interventions and health psychology expertise to support this.

The student will be able to publish relatively high impact papers based on this work, given the unique expertise behind it and the public health importance of poor adherence and its impact on sufferers, families, services and the economy. This work will support postgraduate development of interventions to help staff improve adherence, something also of direct, substantial public health benefit.


See https://www.manchester.ac.uk/study/postgraduate-research/golden/melbourne/