The two Sides of the Coin: The Form to Assess Risk Perception of Antipsychotics (FRA) among Patients with Schizophrenia – A Study on Construct Validity

Background: How patients perceive the risks related to their antipsychotic treatment (e.g. unwanted side effects) is a crucial factor for adherence; however, our current understanding of cognitive constructs underlying antipsychotic adherence is scarce. Recently, the self-report questionnaire Form to Assess Risk Perception of Antipsychotics (FRA) was introduced. The instrument measures the patients’ subjective perspective of two antithetical aspects of the perceived risks related to antipsychotic medication: risks attributed (1) to continuously taking the prescribed antipsychotics (e.g. probably causing unwanted effects) and (2) to stopping them (e.g. probably causing relapse of psychosis). Based on the two subscales the Difference Score is calculated, indicating which of the two risk perception views is stronger. This paper aims to further validate the FAR and introduces an additional method to calculate a composite Ambivalence Score. Methods: Fourty-one inpatients with schizophrenia-spectrum disorders (ICD-10; F-2) completed the FRA and further questionnaires during inpatient treatment. Convergent and discriminant validity of previously reported and new scoring methods were examined via correlations with theoretically related and unrelated constructs. Results: Our data show the hypothesized contrastive correlations of the two risk perception subscales and the two composite scores with instruments measuring related constructs, i.e. medication adherence, insight into the disorder, beliefs about needing medication or concerns about taking these drugs, distress and tension-relieving impulsive behavior patterns, confirming convergent validity. Lack of correlations with non-related constructs, e.g. emotion regulation and social support, supporting discriminant validity. The combined scores of both contrasting dimensions of risks perception are not related. Conclusion: Our study lends further support to the validity of the FRA and sheds new light on cognitive processes underlying non-adherence. Since both risk perception subscales and the two composite scores correlate antithetically with different related constructs, this supports that it is promising to consider perceived risks of medication adherence and of medication non-adherence in the assessment of antipsychotic risk perception. Risk perception might be a factor, which can shed new light on the understanding of medication adherence and, thus, might provide new impulses in therapeutic treatment of patients with psychosis.