Open Journal of Psychiatry, 2011, 1, 115-121
doi:10.4236/ojpsych.2011.13017 Published Online October 2011 (
Published Online October 2011 in SciRes. http://www.scirp. org/journal/OJPsych
Attitudes towards prescribing psychiatric medicines: do the
views of psychology and medical students differ?
Carlos De las Cuevas1,2*, Wenceslao Peñate3, Lilisbeth Perestelo2,4, Amado Rivero5, Jeanette Pérez5,
Marien González5, Alia Pérez-W ehbe5
1Department of Psychiatry, University of La Laguna, San Cristóbal de La Laguna, Canary Islands, Spain;
2CIBER en Epidemiología y Salud Pública (CIBERESP), Santa Cruz de Tenerife, Spain;
3Department of Personality, Assessment and Psychological Treatments, University of La Laguna, Canary Islands, Spain;
4Evaluation Unit of the Canary Islands Health Service (SESCS), Santa Cruz de Tenerife, Spain;
5Fundación Canaria de Investigación y Salud (FUNCIS), Santa Cruz de Tenerife, Spain.
Email: *
Received 1 July 2011; revised 12 August 2011; accepted 22 August 2011.
Concordance has been suggested as a process of the
consultation in which prescribing process is based on
partnership. The aim of this cross-sectional study was
to compare attitudes towards psychiatric medication
and concordance in medicine taking between medical
and psychology students, as they represent future
members of mental health teams. Two hundred and
sixteen medical students and 222 psychology students
completed the Leeds Attitudes toward Concordance
scale (LATCon) and the Beliefs about Medication
Questionnaire (BMQ) (both adapted for psychiatric
medication). Psychology students saw psychiatric
medicines as more harmful and were also most likely
to believe that psychiatrists overprescribed these
medicines. They also scored higher than medical stu-
dents on attitudes towards concordance, although
this difference remained at the limit of statistical sig-
Keywords: Leeds Attitude toward Concordance Scale
(LATCon); Beliefs about Medication Questionnaire
(BMQ); Medical Students; Psychology Students
Although there are slight variations in the structure and
composition, multidisciplinary Community Mental Health
Teams are considered to provide the core of Specialist
Mental Health Services in Spain. They are responsible for
delivering and for coordinating a specialized level of
community-based care for defined populations [1]. In this
context, psychiatrists and psychologists have to work
together sharing approaches and objectives although they
have obvious different skills arising from different pro-
fessional backgrounds and different basic training.
Even though psychological treatments of proven effi-
cacy are available for the management of many psycho-
pathological disorders, the prescription of psychoactive
medication is one of the most common interventions in
mental healthcare. However, the gap between best care
and usual care is large for psychiatric disorders. In parti-
cular, poor adherence to treatment of psychiatric disor-
ders is a worldwide problem of striking magnitude that
contributes to the gap care [2]. Poor adherence to long-
term therapies compromises severely the effectiveness of
treatment, making this a critical issue in population
health from the perspective of both quality of life and
health economics [3]. This lack of adherence is not only
a problem of pharmacotherapy, but also a problem in
psychological treatments [4].
The ability of patients to follow treatment plans in an
optimal manner is frequently compromised by diverse
barriers, usually related to different aspects of the
problem that include: social and economic factors, the
health care team/system, the characteristics of the dis-
ease, disease therapies and patient-related factors. Sol-
ving the problems related to each of these factors is
necessary if patients’ adherence to therapies is to be im-
proved. In this sense, experts recommended, especially,
to devote time in treatment specifically in addressing
medication adherence, assess patients’ motivation to take
prescribed medications, and to focus on strengthening
the therapeutic alliance [2]. This implies some changes
in the traditional model of the health service delivery.
The traditional model of the practitioner-patient inter-
action incorporates a practitioner-centred approach, foc-
using on the disease rather than on the patient. The “the-
C. De las Cuevas et al. / Open Journal of Psychiatry 1 (2011) 115-121
rapeutic alliance” represents another point of view, and it
is based on the philosophy of “concordance” (or “par-
tnership in medicine-taking”). Concordance is a psych-
ological interaction process that puts the patient at the
centre of the relationship, interacting reciprocally with
the practitioner. In the concordance model, patients are
viewed as active participants who manage their own
health care. Practitioners and patients are encouraged to
forge partnerships to work together as equals. Practi-
tioners bring their professional expertise to the table,
whilst patients draw on their own experiences, beliefs
and wishes [5]. Concordance is viewed as a strategy to
improve medication adherence, among other complex
interventions [6].
The problem of treatment adherence is especially
relevant in mental health services, since psychiatric
patients are more likely than others to refuse medication
[7], and are more likely to participate in therapeutic
decisions [8]. The importance of (non)adherence in men-
tal health practice has dealed to the creation of a expert
panel to afford potential solutions for adherence [9]. A
prior consensus among healthcare practitioners is the
basic target to get those potential solutions.
Psychiatrists and clinical psychologists are part of the
healthcare team that has daily contact with patients to
discuss medication. If they have different respective
beliefs about psychoactive medication, what treatment a
patient should receive and the consequent provision of
different information to the patient about the treatment,
the patient could then have difficulties evaluating the
treatment [10]. Thus, agreement between mental health
professionals is a pre-requisite in treatment election and
patient’s commitment. This includes agreement in psy-
chiatric medication and concordance. This is a relevant
aim, since there are different perceptions about medicine
depending on the different educational background of
practitioners [11]. Psychiatrists and clinical psycholo-
gists have different formative curricula in both their
theoretical and practical formation, and it can be part of
a lack of consensus about mental health intervention.
The objective of the present paper is to investigate the
beliefs of medical and psychology students about psych-
iatric medication and their attitudes towards concordance
in medicine taking, as they potentially represent future
mental health care providers. Potential differences in at-
titudes towards prescribing psychiatric medicines bet-
ween psychiatrists and clinical psychologists could ori-
ginate from their different academic formation which
could favor a biological perspective in the case of medical
students and a more psychosocial view for psychology
students. Therefore, we assume that medical students will
show more positive beliefs about psychiatric medicines,
while psychology student will show a better attitude
towards concordance.
2.1. Participants
216 medical students and 222 psychology students parti-
cipated in the study. According to their level degrees,
medicine students were 63 third degree, 57 fourth degree,
56 fifth degree, and 40 sixth degree. Psychology students:
85 third degree, 69 fourth degree, 46 fifth degree, and 22
master degree. Medicine students mean age was 22,62;
psychology students mean age was 22.2. Based on sex,
medical students: 64 were males, and 152 females; psy-
chology students: 41 males, and 181 females.
Students were recruited during class lessons. They were
asked whether they want to voluntarily participate in a
study about mental health treatment. There was not any
credit nor specific remuneration for their participation.
2.2. Instruments and Measures
In order to measure students’ beliefs about psychiatric
medication, the Spanish version of BMQ-General ques-
tionnaire was used. The scale assesses general beliefs or
social representations of pharmaceuticals as a type of
treatment: beliefs that medicines in general are overused
by doctors and beliefs that medicines in general are
harmful, addictive, poisons that should not be taken con-
tinuously. BMQ have shown to be a valid and reliable
measure [12-14] and it is able to discriminate between
different groups of patients and students [11-14]. The
BMQ-General scale includes eight items in two sub-
scales, the Overuse subscale and the Harm subscale. The
degree of agreement with each statement is indicated on
a five point Likert scale, ranging from (1) strongly dis-
agree to (5) strongly agree. For this study, items were
modified to specifically refer to psychiatric medication.
In order to investigate the attitudes of medical and
psychology students towards concordance, the Leeds
Attitude toward Concordance Scale (LATCon) was used
[15,16]. It consists of a 12-item scale. The respondent
scores each item on a four point Likert scale: (0)
strongly disagree, (1) disagree, (2) agree, (3) strongly
agree. The total maximum score is therefore 36. An av-
erage item score between 2 and 3 indicates that the re-
spondent tends to ‘agree’ with the concept of concor-
dance, while an average score below 2 suggests that he/
she does not.
The original English version of the questionnaire was
translated into Spanish by two members of the research
team and then translated back into English by a native
English speaker to check whether or not the Spanish
translations conveyed the original meaning intended by
the authors. As with the BMQ, items were modified to
specifically refer to psychiatric medication.
Copyright © 2011 SciRes. OJPsych
C. De las Cuevas et al. / Open Journal of Psychiatry 1 (2011) 115-121
Copyright © 2011 SciRes.
The questionnaire that the medical and psychology un-
dergraduate students completed also included some so-
ciodemographic variables and information about present
or past use of psychoactive drugs by the interviewee or
their relatives.
2.3. Study Design
According to Montero and León [17], a post-facto design
was used. This was a cross-sectional, self-administered
questionnaire survey of an opportunistic sample of medi-
cal and psychology students registered in the last courses
of their respective degrees as undergraduates at the Uni-
versity of La Laguna, in the Canary Islands, Spain.
2.4. Data Collection
The data collection for this cross-sectional study was
performed in May 2010, during class lessons. At the
time of the data collection students were informed both
orally and in writing about the aim of the study and that
participation was voluntary and anonymous. They also
received information on how to complete the question-
2.5. Data Analysis
Mean differences between medical and psychology stu-
dents were calculated using one way MANOVA (BMQ
subscales) and t-test (LATCon). For BMQ subscales, the
effect of having personal or vicarious experience with
psychiatric drugs, as well as its interaction with type of
studies, were analyzed.
Apart from total and factor-scores comparisons, an
item-level analysis was also carried out, by means of two
additional MANOVAs with BMQ and LATCon items,
respectively, as dependent variables. Finally, a forward
stepwise logistic regression was conducted with both the
BMQ-General and LATCon items as independent vari-
ables, and type of studies as dependent variable.
3.1. Sample
There was no significant difference in both age and level
degree between student groups. Psychology students
included significantly more women (81.5% vs. 70.4%;
2 = 7.483, p < 0.006).
3.2. Beliefs about Medications
Scores for the BMQ Overuse and Harm subscales were
normally distributed in both samples. No significant
differences in general beliefs about medication were
found due to age or sex for any student category consid-
ered. According to BMQ subscales scores, psychology
students saw psychiatric medicines as more harmful
compared to medical students (BMQ-Harm: 2.68 ± 0.58
vs. 2.38 ± 0.62; p < 0.001) and were also most likely to
believe that psychiatrists overprescribed these medicines
(BMQ-Overuse: 3.67 ± 0.66 vs. 3.18 ± 0.7; p < 0.001).
Table 1 shows the mean scores in the BMQ items for
medical and psychology students. Taking as a criterion a
theoretical intermediate score of 3 for each item (neither
agree nor disagree), both medical and psychology stu-
dents surpassed this score on items related to the addic-
tive nature of the psychiatric medication and the con-
sid-eration that spending more time with patients would
result in less prescribed medication. There are two other
Table 1. Differences in BMQ items for medical and psychology students (MANOVA).
Beliefs About Medicines Questionnaire—General Items
Overuse subscale Medicine Mean
(SD) Psychology
Mean (SD) F p η2
1. Psychiatrists use too many medicines 2.98 (0.85) 3.67 (0.85) 70.635 0.0000.139
7. Psychiatrists place too much trust on medicines 2.98 (1.01) 3.70 (0.75) 71.132 0.0000.140
8. If psychiatrists had more time with patients they would prescribe fewer medicines 3.61 (1.09) 3.65 (0.98) 0.181 0.6700.000
Harm subscale
2. People who take psychiatric medicines should stop their treatment for a while every
now and again 2.64 (1.12) 2.95 (1.02) 9.473 0.0020.021
3. Most psychiatric medicines are addictive 3.15 (1.13) 3.47 (0.98) 9.804 0.0020.022
4. Natural remedies are safer than psychotropic medicines* 2.36 (1.02) 2.72 (0.99) 13.650 0.0000.030
5. Psychiatric medicines do more harm than good 1.96 (0.79) 2.30 (0.77) 20.695 0.0000.045
6. All psychiatric medicines are poisons 1.81 (0.98) 1.96 (0.96) 2.601 0.1080.006
*In the Spanish validation of BMQ, item 4 loads on Harm subscale, contrary to the original questionnaire.
C. De las Cuevas et al. / Open Journal of Psychiatry 1 (2011) 115-121
items in which psychology students scored above this
term: the facts that psychiatrists use too many medicines
and that they place too much trust on their prescriptions.
These data indicate that, overall, the two samples tend to
disagree more than to agree with the contents of the
items of BMQ-General scale.
As shown in Table 1, six out of the eight items Regis-
tered significant differences with the psychology stu-
dents scoring higher than the medical students: they
were most likely to believe that patients should discon-
tinue the use of drug from time to time, that psychiatric
drugs are addictive, and that these compounds do more
harm than good or that natural remedies are more useful.
However, considering the effect size (η2), the differ-
ences are really low. Only the differences found in the
items about overuse and excessive reliance on psychiat-
ric drugs seem to have reached a certain consistency. On
the other hand, no significant differences were registered
in the item that considers psychiatric medications as
poisons and the already mentioned that if psychiatrists
had more time with patients they would prescribe fewer
Having in mind that a greater knowledge of psy-
choactive drugs might influence the student’s beliefs, the
sample was divided into two groups: those who have
been treated with such compounds or that have a relative
or close friend under this treatment (n = 240) and those
who have no experience on these drugs (n = 198). The
only significant item was the one corresponding to “all
psychiatric medications are poisons” (F1, 436 = 5.52; p
2 = 0.013) with the group without experience
about (M = 2.01; SD = 0.95) considering the psychoac-
tive drugs more toxic than the group who knew them (M
= 1.79; SD = 0.97). The interaction between this variable
and the type of studies only found in one item and it was
marginally significant (F1, 434 = 3.83; p 0.051;
2 =
0.01), suggesting that psychology students have a greater
tendency to disregard toxic psychotropic drugs when
they know them.
3.3. Attitude to Concordance
Considering the results of the Leeds Attitude to Concor-
dance Scale (LATCon), the mean item score of the
global sample was 2.00 ± 0.35, median score 2 (Table 2).
These values indicate that the respondents tend to “agree”
with the concept of concordance. There was no difference
in the attitudes towards concordance of the medical and
psychology students (mean item score: medicine = 1.97
± 0.33; psychology = 2.03 ± 0.37; p = 0.07).
In the comparison of items means across the two sam-
ples, five items allow to appreciate differences between
medical and psychology students. In four of the items
Table 2. Differences in LATCon items for medical and psychology students (MANOVA).
Leeds Attitude to Concordance Scale—items Medicine Mean
(SD) Psychology Mean
(SD) F p η2
1. The consultation between the psychiatrist and patient should be viewed as a
negotiation between equals 1.52 (0.71) 1.71 (0.75) 7.631 0.0060.017
2. Psychiatrists should respect their patients’ personal beliefs & how they cope 2.22 (0.61) 2.19 (0.64) 0.228 0.6330.001
3. The best use of medicine is when it is what the patient wants and is able to
achieve 2.13 (0.62) 2.11 (0.65) 0.126 0.7230.000
4. Just as prescribing is an experiment carried out by the psychiatrist, so too is
medication taking an experiment carried out by the patient 1.51 (0.93) 1.42 (0.86) 1.122 0.2900.003
5. Psychiatrists should give patients the opportunity to talk about their thoughts
about their illness and negotiate how it is treated 2.08 (0.72) 2.07 (0.72) 0.052 0.8200.000
6. Better health would follow from co-operation between psychiatrists and patients2.56 (0.58) 2.50 (0.52) 1.323 0.2510.003
7. A high priority in the consultation between psychiatrist and patients is to estab-
lish agreement about the need for medicine 2.18 (0.70) 2.05 (0.67) 4.265 0.0390.010
8. Psychiatrists should be sensitive to patient desires, needs and abilities 2.07 (0.65) 2.23 (0.64) 6.842 0.009 0.015
9. Psychiatrists should try to help patients to make as informed a choice as possible
about benefits and risks of alternative treatments 2.46 (0.60) 2.49 (0.59) 0.244 0.6220.001
10. During the psychiatrist-patient consultation, it is the patient’s decision that is
most important 1.10 (0.76) 1.48 (0.77) 26.605 0.0000.058
11. Psychiatrists should be more sensitive to how patients react to the information
they give 1.89 (0.59) 2.22 (0.54) 36.835 0.0000.078
12. Psychiatrists should try to learn about the beliefs their patients hold about their
meicines d1.94 (0.60) 1.94 (0.68) 0.001 0.9770.000
Copyright © 2011 SciRes. OJPsych
C. De las Cuevas et al. / Open Journal of Psychiatry 1 (2011) 115-121 119
(the consultation is a negotiation between equals; doc-
tors should be sensitive to patients desires, needs, abili-
ties and how patients react to the information they give;
and the patient decision is the most important), psychol-
ogy students scored significantly higher than those of
medicine. However, with regard to the priority to estab-
lish agreement about the need for medicines, the medical
students were the ones who scored higher. In eight out of
12 items composing the scale, both groups scored above
2 (indicating agreement rather than disagreement). In
four of the items both samples disagree with the asser-
tion. They included the consideration that the consulta-
tion between doctor and patient should be viewed as a
negotiation between equals, the fact that the patients’
decision is the most important one, the experimental
nature of prescribing and using psychoactive drugs, and
the need for psychiatrists to learn about the beliefs their
patients hold about their medication.
Finally, stepwise logistic regression (Wald forward
method) was carried out to try to identify which items of
the BMQ and LATCon scales differ for medical and
psychology students. The final resulting model included
10 items, with a Nagelkerke R2 = 0.43, highly significant
(x2 = 171.72; p 0.001). The Table 3 summarizes the
model. As it can be seen, the variables that best predict
are the BMQ items pertaining to the Overuse subscale.
Six items about concordance become part of the equa-
tion with secondary importance, with significant coeffi-
cients, but with a low incremental weight (with the ex-
ception of the consideration that psychiatrists should be
more sensitive to information provided by the patient).
The improvement of health services includes the need of
an agreement among health teams about therapeutic
process. Attitudes about medicines, and about the con-
cordance between patients and practitioners, are parts of
that agreement. This is especially relevant in mental
health services, because of there are different practitio-
ners with different curricula (i.e., psychiatrics, psycholo-
gists…), and because mental patients are more sensitive
about their treatments. Additionally, despite some social
changes, a stigma of mental disorders still prevents pa-
tients from seeking help [18].
According to our results, the first consideration to
highlight is that, in general, medical and psychology
students agree in that medication is not always the best
choice and that concordance between patient and thera-
pist is a value to keep in mind within the therapeutic
relationship. Somehow this information indicates that
both groups are more in agreement rather than in dis-
agreement. The necessary coordination between these
two professional groups in the attention they pay to
mental health seems to have certain guarantees, though
some differences persist. The reason for this does not
seem to be justified by the academic curriculum or the
Table 3 . Forward stepwise logistic regression with BMQ and LATCon items as independent variables and type of student as de-
pendent variable (medical students categorized as 0).
Variables B Standard errorWald Sig R2 (Nagelkerke)
(Constant) –5.598 0.840 44.46 0.000
(BMQ-1) Psychiatrists use too many medicines 0.855 0.170 25.38 0.000 0.186
(BMQ-4)Natural remedies are safer than psychotropic medicines 0.339 0.127 7.13 0.008 0.261
(BMQ-7) Psychiatrists place too much trust on medicines 0.696 0.162 18.36 0.000 0.301
(BMQ-8) If psychiatrists had more time with patients they would prescribe
fewer medicines –0.435 0.140 9.64 0.002 0.342
(LAT-1) The consultation between the doctor & patient should be viewed
as a negotiation between equals 0.363 0.168 4.67 0.031 0.365
(LAT-4) Just as prescribing is an experiment carried out by the doctor. so
too is medication taking an experiment carried out by the patient –0.425 0.152 7.80 0.005 0.387
(LAT-7) A high priority in the consultation between doctor and patients is
to establish agreement about the need for medicine –0.550 0.187 8.60 0.003 0.398
(LAT-10) During the doctor-patient consultation. it is the patient’s decision
that is most important 0.441 0.168 6.86 0.009 0.414
(LAT-11) Psychiatrists should be more sensitive to how patients react to
the information they give 1.260 0.243 26.80 0.000 0.423
(LAT-12) Psychiatrists should try to learn about the beliefs their patients
hold about their medicines –0.436 0.205 4.54 0.033 0.432
opyright © 2011 SciRes. OJPsych
C. De las Cuevas et al. / Open Journal of Psychiatry 1 (2011) 115-121
training reasons, as the academic contents of these studies
are uneven. It is possible that other factors are influ-
encing this, such as the social and human values (the less
medication the better, a good patient-therapist relation-
ship is better than a bad relation), or the social desirability
(“politically correct”). This is especially relevant in the
case of the LATCon, provided that both students groups
highly agree in two thirds of the items.
Analyzing the differences and differential profile
found, it is striking that the major weight rests on medi-
cation rather than on conformity. In this case, it can be
due to the training curriculum, because of the fact that in
psychology the functional factors are accentuated as the
pathology’s determinant elements, opposite to the more
prominent biological component in medicine. On the
other hand, culture favors a vision of the medication as
an unquestionable healer (and as such it is a ‘profes-
sional’ decision). This element would be more deeply
rooted in medicine students that in those of psychology
due to the proximity to this cultural tradition. Our data
point out that the modulating function of knowing the
psychoactive drugs’ effects does not seem to play a
relevant role. Nevertheless, the necessary patient-thera-
pist relationship passes to be of secondary importance,
possibly because both student groups have a similar so-
cial value on mutual commitment, and on the need of
empathy between patient and physician. In any case,
some differences could be observed, showing overall
that psychology students showed a higher agreement on
the importance of concordance.
These differences can be justified by the epistemo-
logical diversity in the medical and psychological treat-
ments’ nature. In psychotherapy there is an assertion
which calls for an active patients’ participation in health
change. On the other hand, in medicine this assertion is
mediated by the intrinsic treatments’ effects (especially
medication taken). In other words, concordance is part of
an active principle of psychological treatments, but in
medicine it is part of a better procedure (better adher-
ence, better commitment). In this sense, psychologists
encourage patient-therapist concordance as an intrinsic
element of treatment efficacy, whereas physicians con-
sider it as a modulator variable, via adherence, of treat-
ment efficacy.
Definitively, medical and psychology students seem to
show a raising agreement in the need of concordance
within the therapist-patient relationship. Taking into ac-
count the training differences [19] the fact that the
agreement is major for both professional groups it might
be indicating the need of new contents that trace these
training differences in relation with concordance. In this
respect, new versions of the LATCon could favor this
point of view [20]. In any case, beyond new versions of
the LATCon could improve its differential and dis-
criminant validity, it might be more appropriate to bear
in mind the major impact that the levels of social desir-
ability have on concordance when it is always seen as
“what it should be”.
The most notable differences were found in the role of
medication and its management. Beyond the modulating
paper of social and personal values of every students
group, the training curriculum could be modulating these
results; for this reason it would be necessary to consider
the role of the curricular development [21] and that of
the professional practice (clinical psychology and psy-
chiatry) as elements that could go eliminating these dif-
ferences. This does not mean that both curricula must
share more equivalent contents between them, and more
equivalent professional responsibilities, as the polemic
of prescription privileges for clinical psychologists
seems to point out [22]. We do not find reasons to con-
fuse both the functional and biological perspectives in
mental health. But we find reasons for a better comple-
mentary formation in clinical practice. As it has been
mentioned, the necessary complementarity and confor-
mity among mental health professionals makes it neces-
sary that the elimination of these differences is tackled
explicitly. The agreement between professionals who
shared a common task is a prerequisite of its efficacy
and efficiency.
It is important to point out, as a main limitation of this
study, that only a small proportion of medical and psy-
chology undergraduates go on to work in the area of
mental health, so these results are not directly gener-
alizable to future psychiatrists and clinical psychologists.
Nevertheless, they offer a general view of differences in
attitude towards psychiatrist medicines and concordance
between these student samples, differences that therefore
could be present independently of the eventual academic
education and training in mental health area.
This work was supported by the Instituto de Salud Carlos III, FEDER
Unión Europea (PI10/00955).
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