There is little current interest in research into patients' attitudes toward medications. In the 1960s, psychiatric researchers including Uhlenhuth, Rickels and Covi focused on this area, but this research topic needs to be revived in the 21st century. The Health Belief Model may hold potential for doing this. This model was initially developed by 2 health psychologists, Rosenstock and Becker, to explain why patients did not follow medical interventions. The application of this model to study medication adherence in psychiatric outpatients has provided multiple findings including the conclusions that adherence is associated with: (1) the balance between internal and external health control beliefs, (2) psychological reactance, (3) patients' attitudes toward prescribed drug treatment in general and (4) the balance between the necessity of taking medications versus the concerns derived from adverse drug reactions (ADRs). Poor adherence is associated with several cognitive styles of patients, including: (1) high internal and external health control beliefs (patients who feel that their health is controlled both by external factors and their own beliefs), (2) higher psychological reactance, (3) pharmacophobia (present in 1/6 patients) and (4) skepticism about medications (a high concern for ADRs and a low belief in the necessity of taking medications). All of these findings suggest that shared decision-making is particularly important in fostering adherence in psychiatric patients. Two wider applications of this article can be made: (1) opening psychiatry to advances in clinical psychology and (2) expanding studies on attitudes toward medications to other medical disciplines.

1.
Lipowski ZJ: Psychiatry: mindless or brainless, both or neither? Can J Psychiatry 1989;34:249-254.
2.
de Leon J: The future (or lack of future) of personalized prescription in psychiatry. Pharmacol Res 2009;59:81-89.
3.
Diaz FJ, Yeh HW, de Leon J: Role of statistical random-effects linear models in personalized medicine. Curr Pharmacogenomics Person Med 2012;10:22-32.
4.
Diaz FJ, de Leon J: The mathematics of drug dose individualization should be built with random-effects linear models. Ther Drug Monit 2013;35:276-277.
5.
de Leon J: Pharmacogenetic tests in psychiatry: from fear to failure to hype. J Clin Psychopharmacol 2016;36:299-304.
6.
Dubovsky SL: The limitations of genetic testing in psychiatry. Psychother Psychosom 2016;85:129-135.
7.
Fava GA: The cult of mediocrity. Psychother Psychosom 2005;74:1-2.
8.
Matarazzo JD: Behavioral health and behavioral medicine: frontiers for a new health psychology. Am Psychol 1980;35:807-818.
9.
Rickels K: Non-Specific Factors in Drug Therapy. Springfield, Charles C. Thomas, 1968.
10.
Downing RW, Rickels K: Nonspecific factors and their interaction with psychological treatment in pharmacotherapy; in Lipton MA, DiMascio A, Killam KF (eds): Psychopharmacology: A Generation of Progress. New York, Raven Press, 1978, pp 1419-1428.
11.
Hochbaum GM: Public Participation in Medical Screening Programs: A Socio-Psychological Study (Public Health Service Publication No. 572). Washington, Government Printing Office, 1958.
12.
Rosenstock IM, Strecher VJ, Becker MH: Social learning theory and the Health Belief Model. Health Educ Q 1988;15:175-183.
13.
Rosenstock IM: Why people use health services. Milbank Mem Fund Q 1966;44:94-127.
14.
Becker MH: The health belief model and personal health behaviour. Health Educ Monogr 1974;2:324-508.
15.
Rosenstock IM: Historical origins of the Health Belief Model. Health Educ Monogr 1978;2:328-375.
16.
Janz NK, Becker MH: The Health Belief Model: a decade later. Health Educ Q 1984;11:1-47.
17.
Martin M, Haskard-Zolnierek K, DiMatteo MR: Health Behavior Change and Treatment Adherence. Evidence-Based Guidelines for Improving Healthcare. Oxford, Oxford University Press, 2010.
18.
Wallston KA, Wallston BS, Smith S, Dobbins C: Perceived control and health. Curr Psychol 1987;6:5-25.
19.
De las Cuevas C, Peñate W, Cabrera C: Perceived health control: a promising step forward in our understanding of treatment adherence in psychiatric care. J Clin Psychiatr 2016;77:e1233-e1239.
20.
Wallston KA, Wallston BS: Who is responsible for your health? The construct of health locus of control; in Sanders GS, Suls J (eds): Social Psychology of Health and Illness. Hillsdale, Lawrence Erlbaum Associates Inc, 1989, pp 65-95.
21.
Brehm JW: A Theory of Psychological Reactance. New York, Academic Press, 1966.
22.
Brehm JW: Responses to Loss of Freedom: A Theory of Psychological Reactance. Morristown, General Learning Press, 1972.
23.
DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW: Patient adherence and medical treatment outcomes: a meta-analysis. Med Care 2002;40:794-811.
24.
DiMatteo MR, Haskard KB, Williams SL: Health beliefs, disease severity, and patient adherence: a meta-analysis. Med Care 2007;45:521-528.
25.
Sabaté E: Adherence to Long-Term Therapies: Evidence for Action. Geneva, World Health Organization, 2003.
26.
Cramer JA, Rosenheck R: Compliance with medication regimens for mental and physical disorders. Psychiatr Serv 1998;49:196-201.
27.
Bulloch AM, Patten S: Nonadherence with psychotropic medications in the general population. Soc Psychiatry Psychiatr Epidemiol 2010;45:47-56.
28.
Beutler LE, Moleiro C, Talebi H: Resistance in psychotherapy: what conclusions are supported by research. J Clin Psychol 2002;58:207-217.
29.
Fava GA: Well-being therapy: current indications and emerging perspectives. Psychother Psychosom 2016;85:136-145.
30.
De las Cuevas C, Peñate W, Betancort M, Cabrera C: What do psychiatric patients believe regarding where control over their illness lies? Validation of the Multidimensional Health Locus of Control Scale in psychiatric outpatient care. J Nerv Ment Dis 2015;203:81-86.
31.
De las Cuevas C, Peñate W, Betancort M, De Rivera L: Psychological reactance in psychiatric patients: examining the dimensionality and correlates of the Hong Psychological Reactance Scale in a large clinical sample. Pers Individ Diff 2014;70:85-91.
32.
De las Cuevas C, Peñate W, Sanz EJ: The relationship of psychological reactance, health locus of control and sense of self-efficacy with adherence to treatment in psychiatric outpatients with depression. BMC Psychiatry 2014;14:324.
33.
De las Cuevas C, Peñate W: Psychometric properties of the eight-item Morisky Medication Adherence Scale (MMAS-8) in psychiatric outpatient setting. Int J Clin Hlth Psych 2015;15:121-129.
34.
De las Cuevas C, Peñate W: Perceived self-efficacy and mental illness: validation of the General Self-Efficacy Scale in psychiatric outpatient care. Psicothema 2015;27:410-415.
35.
Bandura A, Adams N: Analysis of self-efficacy theory of behavioral change. Cognitive Ther Res 1997;1:287-310.
36.
Hogan TP, Awad AG, Eastwood R: A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med 1983;13:177-183.
37.
De las Cuevas C, Peñate W: Explaining pharmacophobia and pharmacophilia in psychiatric patients: relationship with treatment adherence. Hum Psychopharmacol Clin Exp 2015;30:377-383.
38.
De las Cuevas C, Peñate W, Cabrera C: Are acceptance and skepticism determinant factors for adherence to drug treatment in psychiatric patients? J Clin Psychopharm 2016, in press.
39.
Joosten EA, DeFuentes-Merillas L, de Weert GH, Sensky T, van der Staak CP, de Jong CA: Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom 2008;77:219-226.
40.
De las Cuevas C, Peñate W, Perestelo-Pérez L, Serrano-Aguilar P: Shared decision making in psychiatric practice and the primary care setting is unique, as measured using a 9-item Shared Decision Making Questionnaire (SDM-Q-9). Neuropsychiatr Dis Treat 2013;9:1045-1052.
41.
De las Cuevas C, Peñate W: To what extent do psychiatric patients perceive involvement in decision-making about their mental health care? Relationships with socio-demographic, clinical and psychological variables. Acta Neurpsychiatr 2014;26:372-381.
42.
De las Cuevas C, Peñate W, De Rivera L: Psychiatric patients' preferences and experiences in clinical decision-making: examining concordance and correlates of patients' preferences. Patient Educ Couns 2014;96:222-228.
43.
De las Cuevas C, Peñate W, De Rivera L: To what extent is treatment adherence of psychiatric patients influenced by their participation in shared decision-making? Patient Prefer Adherence 2014;8:1547-1553.
44.
Slavney PR, McHugh PR: Autonomy and paternalism; in: Psychiatric Polarities. Baltimore, The Johns Hopkins University Press, 1987, pp 98-117.
45.
Department of Health Reference Guide to Consent for Examination or Treatment, ed 2. London, Department of Health, 2009. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/138296/dh_103653__1_.pdf
46.
Chapman SC, Horne R, Chater A, Hukins D, Smithson WH: Patients' perspectives on antiepileptic medication: relationships between beliefs about medicines and adherence among patients with epilepsy in UK primary care. Epilepsy Behav 2014;31:312-320.
47.
Saleem F, Hassali M, Shafie A, Atif M: Drug attitude and adherence: a qualitative insight of patients with hypertension. J Young Pharm 2012;4:101-107.
48.
Hsiao CY, Chang C, Chen CD: An investigation on illness perception and adherence among hypertensive patients. Kaohsiung J Med Sci 2012;28:442-447.
49.
Chee YJ, Chan HH, Tan NC: Understanding patients' perspective of statin therapy: can we design a better approach to the management of dyslipidaemia? A literature review. Singapore Med J 2014;55:416-421.
50.
Ryan RM, Deci EL: Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000;55:68-78.
51.
Salvador-Carulla L, Mezzich JE: Person-centred medicine and mental health. Epidemiol Psychiatr Sci 2012;21:131-137.
52.
Fava GA: The intellectual crisis of psychiatric research. Psychother Psychosom 2006;75:202-208.
53.
Berrios GE, Markova IS: Conceptual issues; in D'haenen H, den Boer JA, Willner P (eds): Biological Psychiatry. Chichester, John Wiley and Sons Ltd, 2002, pp 1-24.
54.
Ghaemi SN: Nosologomania: DSM and Karl Jaspers' critique of Kraepelin. Philos Ethics Humanit Med 2009;4:10.
55.
McHugh PR: Rendering mental disorders intelligible: addressing psychiatry's urgent challenge; in Kendler KS, Parnas J (eds): Philosophical Issues in Psychiatry II. Nosology: International Perspectives in Philosophy and Psychiatry. Oxford, Oxford University Press, 2012, pp 269-280.
56.
de Leon J: One hundred years of limited impact of Jaspers' General Psychopathology on US psychiatry. J Nerv Ment Dis 2014;202:79-87.
57.
Shader RI: Some thoughts about medical caring. J Clin Psychopharmacol 2015;35:115-116.
58.
Fava GA: Modern psychiatric treatment: a tribute to Thomas Detre, MD (1924-2011). Psychother Psychosom 2013;82:1-7.
59.
Guidi J, Fava GA: Emerging trends in clinical psychology. Riv Psichiatr 2014;49:227.
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