Attitude and preferences towards oral and long-acting injectable antipsychotics in patients with psychosis in KwaZulu-Natal, South Africa

BACKGROUND: Patient attitudes to and satisfaction with their treatment are associated with improved adherence. There is a paucity of data on patient drug attitudes and preference to oral compared to long-acting injectable (LAI) antipsychotic treatment. AIM: To describe patients attitudes and preferences towards oral versus LAI antipsychotic formulations and explore factors associated with their drug attitudes. SETTING: Two psychiatric hospitals in KwaZulu-Natal, South Africa. METHOD: A cross–sectional survey of 140 adult outpatients with schizophrenia spectrum disorders receiving LAI with or without oral antipsychotics (a total of 70) were compared to patients receiving oral antipsychotics only (N = 70). A sociodemographic-clinical questionnaire, chart review and the Drug Attitude Inventory scale (DAI–30) were used. RESULTS: Of the 140 participants, 98 (70%) preferred the medication formulation currently prescribed, and 132 (94.3%) reported a positive drug attitude towards their antipsychotic medication. The adjusted regression analysis indicated that study participants who were currently on a formulation that matched their preference scored better on the DAI-30 than individuals with a mismatch in use and preference (p < 0.04). In terms of covariates, we found, on one hand, that study participants who are divorced (compared to single) with schizophrenia diagnosis (compared to other psychotic or schizoaffective disorder) are more likely to have lower score on DAI-30. On the other hand, we found that study participants with a higher household income and longer duration of the psychotic illness were associated with greater DAI-30 score. CONCLUSION: The majority of participants preferred their current oral and LAI formulation. Drug attitude was influenced by several factors, including matched medication use. Focused psychoeducation should be considered for newly diagnosed, lower socio-economic groups and patients with non-affective psychosis to improve drug attitude.