Le traitement psychopharmacologique des jeunes en centre jeunesse : observance, croyances relatives au traitement et alliance de travail avec le médecin

This thesis aims to determine the contribution of the beliefs about medication and the working alliance with the doctor with adherence in youth in residential care center receiving a psychotropic medication. More specifically, the first article is a quantitative study verifying the predictive value of the beliefs and the alliance on non-adherence as well as the eventuality of the beliefs mediating the relationship between alliance and non-adherence of 89 teenagers in residential care centers in different regions in Québec. Results show that non-adherence can be conceptualized as two distinct constructs whether the health behavior is intentional or not. Beliefs about psychotropic medication, more precisely the differential between the perceived necessity of the prescription and the worries related to it, as well as the quality of the working alliance with the young patient are predictors of global non-adherence of the participants. The working alliance with the clinician predict the unintentional adherence when the conviction that psychotropic medication are overused predict intentional adherence. Mediation analysis determines that the differential between perceived necessity and worries relative to treatment is a mediator of the relationship between the working alliance with the doctor and global non-adherence. The conviction that psychotropic medications are overused mediate the link between the working alliance and the intentional non respect of the prescription. Results correspond with the theory relative to the Health Belief Model and the emphasis on the alliance with the prescriber in the monitoring of the treatment reveal its role in the attitudes of teenagers towards psychotropic medication. The second article consists in a qualitative exploration of the relationships between adherence and non-adherence behavior types, positive and negative beliefs of the youths towards their psychopharmacological treatment and their relation with their doctor. The interviews were conducted with 33 teenagers living in a rehabilitation center or in a group home and taking a psychotropic medication. They reveal the importance of the perception of secondary benefits and adverse effects of the mediation in the adoption of adherence or non-adherence behaviors. Also, analyses demonstrate that the more the doctor is empathic, the more he encourages exchanges by listening, transmitting information, investigating the youth’s experience towards his difficulties and the treatment, offering choices and the more he accepts the youth opinions, the greater are the chances that this one is going to take his medication as prescribed. The less the carer presents theses aptitudes, the more the adolescent is at risk to not respect his prescription and this, from an unintentional way to an intentional one.  Results of the two articles are reinterpreted with elements of self-determination theory highlighting the role of the motivation type implicated in the application of a behavior as adherence and the importance of autonomy support by the doctor. In light of this integration, a conceptual model of adherence of the psychopharmacological treatment by youths in residential centers is proposed, clinical implications are discussed and further research directions are suggested.

Keyphrases: Adherence, Psychotropic medication, Youth, Residential care center, Beliefs