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The Drug Attitude Inventory (DAI) and the Issue of Subjective Tolerability to Medications

 

Dr. A.G. Awad  


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Professor Emeritus, University of Toronto
Chief of Psychiatry, Humber River Regional Hospital, Toronto, Canada

Keywords: drug attitude inventory (DAI), subjective tolerability, schizophrenia

 

Drug Attitude Inventory (DAI) - A Brief Historical Note of its Development

 

In the 1970s, during my tenure as the director of a large regional service in the largest psychiatric hospital in Toronto, among the several programs we provided, the “Revolving Door Program” was one of the interesting service innovations at that time.  Patients admitted to this specialized program were mostly young persons with the diagnosis of schizophrenia. Such patients are generally younger and require frequent re-hospitalization as a result of their poor compliance with medications.  Within a span of ten months the program tragically lost three young patients to suicide.  A post-mortem clinical review revealed that all three patients were young, suffering from schizophrenia and, in the few weeks prior to their death, extensively complained about how bad they felt on their anti-psychotic medications.  Nurses’ notes documented how the three had complained frequently that medications were making them feel like “zombies”, “unable to think clearly” and generally the “medications were making them worse”.

 

I realized at that point, that it was most likely that these patients’ subjective complaints didn’t receive as much attention as their psychotic symptoms.  Indeed, the clinical impression at that point was that they were not responding adequately to their antipsychotic medications, which frequently led to increasing the dose with the undesired outcome of them complaining more and feeling worse. This clinical observation led me to conduct a retroactive chart review of patients who had the diagnosis of schizophrenia and had committed suicide over the last ten years.  The sample was exhaustingly matched to another sample of patients who did not attempt or commit suicide.  Once more, it was clear that many of the patients who commited suicide had more subjective complaints about their antipsychotic medications, which led to frequent changes of medications. Though there are multiple reasons for people to end their life, it was obvious, then, that these clinical observations about subjective tolerability require a further study.


 


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