Prof. Xenia Gonda, MA (Psychology), PhD (Psychiatry), PharmD, Hungary

Semmelweis University, Budapest, Hungary
International Centre for Education and Research, Samara State Medical University, Russia

A bitter pill to swallow? Affective temperaments are possible predictors of treatment non-adherence: results of a meta-analysis

Abstract:
Therapeutic adherence especially in chronic somatic and psychiatric disorders requiring long term or continuous maintenance therapy is pivotal to controlling the symptoms and preventing recurrence, influencing illness course and outcome. Finding and selecting an efficacious pharmacological treatment is thus only one component of the therapeutic success, while the other, equally important and equally challenging, is the active participation of the patient in the form of adhering to medical recommendations.
Several psychological factors may play a central role in influencing therapeutic adherence via their effect on related emotions, cognitions and behavior. One such psychological construct is the model of affective temperaments which have previously been investigated in a small number of methodologically questionable studies. As these studies reported promising results concerning the predictive efficacy of affective temperaments we carried out a systematic review and metaanalysed the resulting 9 studies. We found strong, adverse associations of cyclothymic, irritable, and depressive affective temperament scores with medication adherence suggesting that these temperamental types may predict decreased adherence and thus treatment outcome, and in the clinical practice may contribute to identifying groups at a high risk for non-adherence, help predict success of treatment, and also help devise personalized treatment plans. In the next step we need to depend our understanding on what mediates the effects of affective temperaments on treatment adherence and how these factors can be influenced by different intervention levels from education through support to psychotherapy, and we also need to find further processes related to the core of personality and understand how they, in constellation, influence medication-related attitudes, beliefs, cognitions, emotions and behaviors.