a cross - sectional , observational study was conducted in the department of psychiatry at a tertiary care hospital in south india over a period of 2 months . an institutional human ethics committee 's approval was obtained before the commencement of the study . patients above 18 years of age with a psychiatric diagnosis as per the international classification of diseases 10 and receiving at least one psychotropic medication ( any medication capable of affecting the mind , emotions , and behavior ) for > 1 month were enrolled in the study . patients who were critically ill , on magico - religious treatment ( beliefs prevalent in a particular culture concerning various supernatural influences operating in the environment ) , diagnosis of dementia , or mental retardation and patients from whom reliable history of illness can not be obtained were excluded from the study . all the patients who met the study criteria were enrolled in the study after getting informed consent either from the patients or first - degree relatives . relevant data such as demographic details , past and current medical / psychiatric illness , and medication history were collected and documented using suitably designed data collection form . we grouped patients into pharmacophobic and pharmacophilic group based on the positive or negative scores on the drug attitude inventory ( dai ) scale which allocates scores of + 1 ( positive view of medications ) and 1 ( negative view of medications ) to ten selected items , allowing total scores from 10 to + 10 . this scale has been proven to be suitable for grouping patients according to their attitude toward medication as pharmacophilic and pharmacophobic . scores classified as pharmacophobic ranged from 10 to 2 scale points and that of pharmacophilic attitudes are ranged from 2 to 10 scale points . we grouped patients into adherent and nonadherent based on the score obtained from medication adherence rating scale ( mars ) , which is a ten - item questionnaire that assigns a score of + 1 ( positive view of medication usage ) and 0 ( negative view of medication usage ) , allowing total scores ranging between 0 and 10 . scores classified as adherent ranging from 6 to 10 scale points and as nonadherent ranging from 0 to 5 scale points . the continuous variables presented as mean ( standard deviation [ sd ] ) and difference between these variables identified using student 's t - test . categorical variables presented as number ( % ) and difference between these variables identified using chi - square test . the impact of pharmacophilia and pharmacophobia on medication adherence was identified using multivariate logistic regression analysis . all the statistical analyses were carried out using spss ( ibm corp . released 2012 . a cross - sectional , observational study was conducted in the department of psychiatry at a tertiary care hospital in south india over a period of 2 months . an institutional human ethics committee 's approval was obtained before the commencement of the study . patients above 18 years of age with a psychiatric diagnosis as per the international classification of diseases 10 and receiving at least one psychotropic medication ( any medication capable of affecting the mind , emotions , and behavior ) for > 1 month were enrolled in the study . patients who were critically ill , on magico - religious treatment ( beliefs prevalent in a particular culture concerning various supernatural influences operating in the environment ) , diagnosis of dementia , or mental retardation and patients from whom reliable history of illness can not be obtained were excluded from the study . all the patients who met the study criteria were enrolled in the study after getting informed consent either from the patients or first - degree relatives . relevant data such as demographic details , past and current medical / psychiatric illness , and medication history were collected and documented using suitably designed data collection form . we grouped patients into pharmacophobic and pharmacophilic group based on the positive or negative scores on the drug attitude inventory ( dai ) scale which allocates scores of + 1 ( positive view of medications ) and 1 ( negative view of medications ) to ten selected items , allowing total scores from 10 to + 10 . this scale has been proven to be suitable for grouping patients according to their attitude toward medication as pharmacophilic and pharmacophobic . scores classified as pharmacophobic ranged from 10 to 2 scale points and that of pharmacophilic attitudes are ranged from 2 to 10 scale points . scores from 1 to we grouped patients into adherent and nonadherent based on the score obtained from medication adherence rating scale ( mars ) , which is a ten - item questionnaire that assigns a score of + 1 ( positive view of medication usage ) and 0 ( negative view of medication usage ) , allowing total scores ranging between 0 and 10 . scores classified as adherent ranging from 6 to 10 scale points and as nonadherent ranging from 0 to 5 scale points . the continuous variables presented as mean ( standard deviation [ sd ] ) and difference between these variables identified using student 's t - test . categorical variables presented as number ( % ) and difference between these variables identified using chi - square test . the impact of pharmacophilia and pharmacophobia on medication adherence was identified using multivariate logistic regression analysis . all the statistical analyses were carried out using spss ( ibm corp . released 2012 . a total of 176 patients were enrolled in the study , of which 110 patients were found to be pharmacophilic and 54 patients were pharmacophobic based on the scores obtained from the dai scale and the remaining 12 patients with dai scale score of 0 were excluded from the analysis . sociodemographic characteristics of the study population receiving psychotropic drugs clinical characteristics of the patients such as diagnosis , comorbidities , and common class of drugs prescribed are depicted in table 2 . in this study , bipolar affective disorder ( bpad ) , schizophrenia , and alcohol dependence syndrome ( ads ) were found to be the most common diagnoses in pharmacophobic patients and anxiety in pharmacophilic patients . antipsychotics were found to be the most commonly prescribed class of drugs in the pharmacophobic group , and the other classes of medications were found to be higher in pharmacophilic group . a comparison of clinical characteristics of patients with pharmacophilia and pharmacophobia adverse drug reactions ( adrs ) were found to be significantly more in pharmacophobic group as compared to pharmacophilic group , with a p < 0.001 . about 83% of the patients with pharmacophobia experienced either one or more of the adrs during their treatment which is comparatively higher compared to pharmacophilic group . mean ( sd ) number of hospitalizations was found to be significantly higher among patients with pharmacophobia ( 1.45 [ 1.7 ] ) as compared to patients with pharmacophilia ( 0.83 [ 1.3 ] ) . however , we found no significant difference between both the groups with respect to duration of disease and treatment , number of medications received by the study patients , and the cost per prescription [ table 3 ] . a comparison of other characteristics of with pharmacophilia and pharmacophobia of the 110 pharmacophilic patients , 103 patients ( 93.6% ) were found to be adherent and seven patients ( 6.4% ) were found to be non - adherent according to mars questionnaire . among the 54 pharmacophobic patients , only 3 ( 5.6% ) patients were found to be adherent and remaining 51 ( 94.4% ) were found to be nonadherent . the mean ( sd ) adherence score was found to be significantly higher among patients with pharmacophilia ( 6.98 [ 1.9 ] ) as compared to patients with pharmacophobia ( 2.87 [ 1.6 ] ) [ table 3 ] . studies have revealed that patients ' attitude toward medication plays a significant role on medication adherence . as the medication nonadherence among patients with psychiatric illness is reported to be common , the current study has emphasized on the factors influencing the pharmacophilic and pharmacophobic attitude and its impact on medication adherence . no significant difference was observed between pharmacophilic and pharmacophobic patients in terms of most of sociodemographic variables such as age , gender , education , marital status , and family history , which imply that these parameters does not have any role to play in terms of pharmacophilic and pharmacophobic attitude in psychiatric patients . our study clearly indicates that there is no correlation between the education level and the patients attitude toward the medication , whereas in a study conducted in spain shows patients attitude toward medication depends on the educational level of the patient . number of hospitalizations was found to be significantly higher among pharmacophobia group than pharmacophilia group , which resembles the results of other studies which imply that there is a correlation between number of hospitalization and attitude toward medications . however , a study conducted in vienna among the patients with schizophrenia and schizoaffective psychoses and other studies apparently reported there is no correlation between the number of hospitalization with attitude toward the medication . in our study , majority of the patients were primarily diagnosed with depression in both pharmacophilic and pharmacophobic groups which is similar to that of the study conducted in spain . however , patients with a diagnosis of bpad , schizophrenia , and ads were found to be comparatively higher in number among the pharmacophobic group . medication history of the pharmacophobic patients revealed that the most common class of psychotropic agent implicated among this group was antipsychotics and is consistent with the previous findings and antidepressants were found to be higher in number among pharmacophilic group , which is consistent with the results of the survey conducted by husain et al . a significantly higher number of adrs in pharmacophobic group suggest that adrs play a role in developing negative attitude toward psychopharmacological agents , which is similar to the finding from the studies which conclude that patient who feel impaired by medication develops negative attitude toward medication . in our study , patients with pharmacophilia were found to have statistically significant higher adherence score ( more adherence to medications ) than patients with pharmacophobia ( low adherence to medications ) . this result affirms that pharmacophilia or pharmacophobia toward psychopharmacological agents significantly affects medication adherence of the patient , thereby proving the proposed hypothesis . this study also reveals that the dai-10 scores are significantly related with the mars for patients adherence toward their medication and similar relationship was established between the dai-10 scale and the morisky medication adherence scale-8 in the study conducted in spain . pharmacophobia toward psychopharmacological agents can significantly reduce the medication adherence among patients with psychiatric disorders .
aims : to investigate the impact of pharmacophilia and pharmacophobia on medication adherence among patients with psychiatric disorders.materials and methods : a cross - sectional , observational study was conducted in the department of psychiatry over a period of 2 months . 
 patients above 18 years of age with a psychiatric diagnosis as per the international classification of diseases 10 and receiving at least one psychotropic medication ( any medication capable of affecting the mind , emotions , and behavior ) for > 1 month were enrolled in the study . 
 patients who were critically ill , on magico - religious treatment ( beliefs prevalent in a particular culture concerning various supernatural influences operating in the environment ) , diagnosis of dementia , or mental retardation and patients from whom reliable history of illness can not be obtained were excluded from the study . 
 drug attitude inventory scale was used to classify patients into pharmacophilic and pharmacophobic groups . 
 medication adherence rating scale was used to identify the extent of medication adherence.results:among 176 patients included , 110 were found to be pharmacophilic and 54 were pharmacophobic . the number of hospitalizations ( p < 0.03 ) and adverse drug reactions 
 ( p < 0.001 ) were found to be higher in pharmacophobic group as compared to pharmacophilic group . 
 antipsychotics were found to be most commonly prescribed medications among pharmacophobic group ( p < 0.001 ) . in this study , patients who had pharmacophilia were found to be have higher adherence score ( mean score : 6.98 ) than patients with pharmacophobia ( mean score : 2.9 ) , with p < 0.001.conclusions:this study concluded that pharmacophobia toward psychopharmacological agents can significantly reduce the medication adherence among patients with psychiatric disorders .