DENIAL OF ILLNESS IN RELATION TO DIFFERENTIAL DRUG RESPONSE

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Abstract
The relation of attitude toward illness and response to psychopharmacologic treatment was studied in 170 chronic schizophrenic outpatients. The patient''s attitude toward his illness was rated by the interviewing psychiatrist at the initiation of treatment in terms of the patient''s acceptance or denial of the signs and symptoms of mental illness. The acceptance-denial attitude was seen to be part of a general illness-treatment orientation. The outcome measures used included the psychiatrist''s judgement of global change and 3 quantitative measures: anxiety level, thought disorder, and social pathology. The only variable showing significant trends in relation to the patient''s attitude was thought disorder although the global results showed similar, but insignificant trends. With placebo usage a gradient of improvement rates for thought disorder by attitude group was seen: denial group, 12.5%; intermediate group, 20.6%; and acceptance group, 53.9%. Using the placebo results as a model for comparison, a significant drug effect was seen for the intermediate group, chlorpromazine showing an improvement rate of 63.2%. For the acceptance group, all agents were closely matched, about half of these patients showing improvement. For the denial group, promazine had the highest improvement rate, 46.7%. The findings are interpreted in the context of a disturbance of communication between doctor and patient. The influence of the illness-treatment orientation lies in its effect on communication. The psychiatrist''s rating of thought disorder is a measure of the disturbance of communication between doctor and patient. The effect of chlorpromazine on the intermediate group may lie in the ability of chlorpromazine to alter some aspect of the patient''s manner of communication which in turn is subject to the patient''s attitude in manifesting its final clinical result.

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