Adesão ao tratamento psiquiátrico: análise comportamental de pacientes com diagnóstico de transtornos de ansiedade

• Autor(a) principal: Monteiro, Maria Elisa de Siqueira
• Data de Publicação: 2001
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da PUC_SP
• Texto Completo: https://tede2.pucsp.br/handle/handle/16814
• topic: Ansiedade; Comportamento; Adesao ao tratamento; Transtorno de ansiedade; Ambulatorio; Avaliacao da adesao ao tratamento; Procedimentos de intervencao; Paciente psiquiatrico adulto; CNPQ::CIENCIAS HUMANAS::PSICOLOGIA::PSICOLOGIA EXPERIMENTAL

Poor adherence to treatment among psychiatric patients is an important hea1thCaTe problem. The objectives of the present study were: 1) to assess adherence to treatment among psychiatric patients with anxiety disorders, 2) to identify the relevant variables associated to poor adherence 3) to compare the reasons for poor adherence to treatment described by patients and their doctors 4) to describe an adherence-enhancement intervention and 5) to describe the effects of this intervention. The first three objectives were pursued in study 1 and the other two in study 11.Participants of the study 1were 54 psychiatric outpatients, four psychiatrists and 11 senior medical students. Questionnaires were applied to each patient and to his/her doctor/senior medical student. Data from patient self-reports were checked against medical or office records. The majority of patients (83,3%) failed to present one or more of the assessed adherence behaviors. Rates of adherence varied inversely to the number of prescribed medications, to the number of dosages and to the number of other nonpharmacological assignments.Regimens requiring lifestyle behavior changes showed to be more difficult to follow. Patients said they forget to take the medication, they do not be1ieve in treatment efficacy and they can't afford treatment regimens. Health professionals focused on the severity of the disorder as a possible reason to explain poor adherence. Although twenty seven non-adherent patients with panic disorder were invited to participate in study II, only three of them volunteered. The adherence-enhancement intervention combined educational and behavioral strategies. During the first interview patients were instructed to record the behaviors comprised by their therapeutic regimen for six weeks, in an individualized diary. Once a week, illness- . related issues were discussed in group with the researcher for one hour. Information about panic disorder was provided and patients were asked to describe their daily activities during the former week. Social differential reinforcement to adherence reporting and to adaptive coping was delivered by the researcher.A month after the last group meeting the researcher interviewed each patient and assessed the same adherence behaviors focused on the intervention procedure. Although the intervention was not successful to approach all the adherence difficulties and had differently affected participants' behavior, all patients improved adherence to medication, which was maintained at the follow-up. Furthermore, the present research identified some variables that should be considered in programs designed to improve adherence to psychiatric treatment