The effect of caregivers' perfectionism and distress tolerance levels on the treatment adherence and functionality of patients with schizophrenia

Introduction and Aim: Schizophrenia is a chronic and severe mental illness that affects emotion, thought, behavior, and cognitive functions. During the course of the illness, treatment adherence and functional status are critically important for an individual's quality of life and clinical outcome. In this context, the role of caregivers emerges as a decisive factor. This study aims to examine the effects of caregiver distress tolerance and perfectionism levels on patients' treatment adherence and functionality. Materials and Methods: This study was conducted with 80 schizophrenia patients and 80 caregivers who admitted the Van Yüzüncü Yıl University Psychiatry Outpatient Clinic. Data were collected through face-to-face interviews between October 1, 2024, and May 30, 2025. The Sociodemographic Data Form, Positive and Negative Syndrome Scale (PANSS), Morisky Medication Adherence Scale (MMAS-6), and Short Functional Rating Scale (SFRS) were administered the patient while the caregivers were administered the Sociodemographic Data Form, Distress Tolerance Scale (DTS), and Frost Multidimensional Perfectionism Scale (FMPS). (Ethics Committee Decision No: 2024/10-37). Results: We found that 65.5% of patients had high treatment motivation and 71.25% had high knowledge levels regarding treatment adherence. In multivariate analyses, it was determined that an increase in caregiver distress tolerance significantly improved patients' treatment motivation (p=0.013). However, the level of distress tolerance was not found to have a significant effect on patients' functional status. While the level of perfectionism did not have a significant effect on treatment adherence, patients whose caregivers had high perfectionism levels were found to have a significantly lower autonomy sub-dimension of functionality (p<0.001). Conclusion: These findings indicate that in the treatment of schizophrenia, the focus should be not only on the patient but also on the psychological characteristics of the caregiver. The study suggests that supportive interventions for caregivers should be included in the treatment process. Keywords: Schizophrenia, Treatment adherence, Functionality, Caregiver, Perfectionism, Distress tolerance