Attitudes toward Medication and Reasons for Non-Compliance in Patients with Schizophrenia

Non-adherence and predictors in patients with schizophrenia on second generation antipsychotics at Amanuel Mental Specialized Hospital, Ethiopia

BACKGROUND

Schizophrenia is a chronic and profound mental disorder. Non-adherence to prescribed medication regimens is a major concern in the treatment of schizophrenia. This study aimed to investigate the prevalence, factors, and reasons contributing to non-adherence among Ethiopian patients with schizophrenia who are receiving second-generation antipsychotics (SGAs).

METHODS

A hospital-based cross-sectional study was done at Amanuel Mental Specialized Hospital (AMSH) from 03/10/2022 to 31/8/2023. Data were collected using the drug attitude inventory-10 (DAI-10) tool. Analysis was conducted using Statistical Package for Social Sciences (SPSS) version 25. Univariate and multivariate binary logistic regression analyses were conducted.

RESULTS

Most participants were male, (90.0%), and aged 26-40 years, (53.5%). Mean doses for risperidone and olanzapine prescribed were 4.9mg (±2.4) and 13.5mg (±5.0), respectively. Close to 40% of patients were khat (Catha edulis) users. The mean Positive and Negative Syndrome Scale (PANSS) total score was 71.1 ± 35.9 and the Clinical Global Impression-Severity (CGI-S) score was 3.42 ± 1.21. Around 31.4% of participants were non-adherent. Forgetfulness (31.73%) and stigma (27.31%) were the primary reasons cited for non-adherence. The multivariate binary logistic regression analysis revealed a significant association between non-adherence and several key factors. Patients with a PANS score equal to or greater than 71 (95% CI: 1.04, 3.80; p = 0.02), Patients categorized as having a moderate to markedly severe illness (95% CI: 1.1, 3.1; p = 0.024), duration of follow-up (DUP) (6-10) years (95% CI: 1.4, 129; p = 0.02), and age (26-40) years (95% CI: 0.3, 0.9; p = 0.04) were found to be statistically significant predictors of non-adherence.

CONCLUSION

The investigators recommended that counseling of the patients to highlight the importance of adherence, instituting regular and comprehensive symptom monitoring, tailoring interventions to address reasons for non-adherence, promoting early intervention and treatment initiation to reduce the DUP, and customizing interventions based on age-specific needs.

From Pills to Practices: Interpretative Phenomenological Analysis of Medication Experience and Self-Management in Schizophrenia

Schizophrenia, a mental disorder characterized by delayed onset, high relapse rates, and significant disability, ranks among the top 20 contributors to the global burden of disease and poses a substantial public health challenge. Effective self-management is crucial for the recovery of individuals with schizophrenia, with medication experience playing a vital role. However, the underlying mechanisms and logical relationships remain elusive, hindering the development of effective self-management and enhancement strategies from the perspective of medication experience. This research aimed to illuminate these aspects by conducting semi-structured interviews to delve into the impacts of medication experience on self-management behaviors among individuals with schizophrenia. The goal was to elucidate the role of medication in self-management and to identify potential barriers and facilitators via patient narratives. We employed interpretive phenomenological analysis to examine interview transcripts from 12 participants diagnosed with schizophrenia. This analysis yielded three superordinate themes: "Medicine isn't just medicine," "Experience is a catalyst for action," and "Action shaped by experience." We discuss these themes in the context of existing literature and theoretical frameworks and propose specific recommendations, such as motivational interviewing for clinicians, tailored psycho-educational programs, and supportive systems respecting patient autonomy. This study offers a contextual understanding of the medication experience for individuals with schizophrenia, enhancing our knowledge of self-management behaviors and how they can be promoted in this population.

Predictive factors and symptom severity spectrum in adult schizophrenia: Potential insights for improved management and adequate care

Schizophrenia is one of the most disabling psychiatric disorders characterized by positive (hallucinations, delusions, formal thinking disorder) and negative symptoms (anhedonia, lack of speech and motivation). The present study aimed to identify the predictive factors of schizophrenia in adults, and potential differences in the environment of origin, sex, levels of occupational stress, intellectual level, marital status and age of onset of the disease depending on the severity of symptoms using analysis of data collected from 120 patients with a diagnosis of schizophrenia. The study was conducted at the 'Prof. Dr. Alexandru Obregia' Clinical Psychiatric Hospital in Bucharest and included adult patients hospitalized between March 2018 and January 2021 diagnosed with schizophrenia and evaluated by general clinical examination, psychiatric, neurological and psychological evaluation. Results revealed that robust predictors of mild and moderate symptoms were affective symptoms, heredo-collateral history of schizophrenia, late onset, the presence of positive and negative symptoms, substance abuse, stress and marital status, unmarried, lower IQ and mental deficiency. For moderate-severe and severe symptoms, predictors were affective symptoms, heredo-collateral history of schizophrenia and affective disorders, substance abuse, stress, borderline IQ and mild mental deficiency. The present results can be used for further development of psychopharmacological management of schizophrenia.

Schizophrenia and medication adherence among the population in Morocco: a cross-sectional study at the University Psychiatric Center of Casablanca

Introduction

schizophrenia is a chronic, disabling, and serious disease. It represents a challenge because of its prevalence and its consequences in terms of morbidity and mortality for patients, but also for their families and society. Patients often fail to adhere to their treatment, and this has a severe negative effect on the prognosis of the disease. Thus, the identification of the predictive factors influencing this compliance is very important for adequate management and a favorable evolution. The aim of the study is to assess the predictive factors of non-adherence in patients with schizophrenia.

Methods

a cross-sectional study of 320 patients diagnosed with schizophrenia according to the DSM-5 criteria, was conducted at the University Psychiatric Centre of Casablanca, Morocco. Epidemiological, clinical, and therapeutic data were collected using a hetero-questionnaire, while medication adherence was assessed using the Medication Adherence Rating Scale (MARS). The positive and negative symptoms scale (PANSS) was used to assess the severity of symptoms in patients with schizophrenia.

Results

in our study, the total sample comprised 320 (100%) patients, classified into two groups: 82 (25.62%) were categorized as adherent, while 238 (74.38%) were non-adherent, and 72% were male. The non-adherent group was young (p=0.003), and a significant proportion had no educational background (p=0.015), lived alone (p=0,001), in urban areas (p=0.031), non-regular follow-up (p=0.045) and had a toxic history (p=0.0001), early age of onset of the disease (p=0.002). Moreover, this group exhibited more severe schizophrenic symptoms (p=0.02), lacked insight into their condition (p=0.046), and predominantly used typical antipsychotics (p=0.019) with a high frequency of intake (p=0.0001). Sedation emerged as a predominant side effect (p=0.036) of treatment. Notably, a high frequency of hospitalizations (p=0.005) exhibited a strong association with medication non-adherence. The mean age of the sample was 32.9 years (standard deviation: 10.8), with a mean age of disease onset reported at 25.5 years (standard deviation=4.9).

Conclusion

this study highlights the prevalence of non-adherence among patients with schizophrenia, with significant associations observed with demographic factors, the severity of symptoms, treatment patterns, and hospitalization frequency, emphasizing the urgent need for tailored interventions to enhance medication adherence and improve patient outcomes in managing schizophrenia.

Treatment Non-adherence Patterns Among Patients With Mental Illness: A Study From the District Mental Health Care Center in India

INTRODUCTION

The success of any medical intervention, including mental health treatment, depends largely on patient adherence to the prescribed regimen. In psychiatric illnesses, one of the biggest problems is getting people to adhere to their treatment schedule, representing a treatment gap that increases the burdens of patients, families, communities, and countries. Globally, it has become necessary for community health organizations to actively work towards reducing this gap and treatment non-adherence. Therefore, in this study, we aimed to examine treatment non-adherence patterns among patients with mental illness.

MATERIALS AND METHODS

This work used a retrospective study design and consecutive sampling. The data source was secondary data obtained from the healthcare records of patients registered in the outpatient department of the District Mental Health Care Center, India, from January 2022 to December 2022.

RESULTS

Out of a total of 883 patients recruited for the study, 35.7% (n=315) were on regular follow-up over a duration of more than one year. Among patients with severe mental illness, 46% (n=46) had regular follow-ups and were compliant with therapy. About 49% of patients (n=433) discontinued their treatment after the initial contact with the therapist, with the highest rate among those with substance use disorders (77.0%; n=57). The remaining 15.3% (n=135) of recruited patients discontinued their follow-up appointments over a duration of 1 week to 12 months. Overall, 64.3% (n=568) of the recruited patients discontinued their treatment within one year.

CONCLUSION

There was considerable early treatment dropout among patients with mental illness. However, this treatment discontinuation can be avoided because the individual identities of these patients are well-known to the therapist or facility, as they have had at least one interaction with the therapist. In order to improve treatment adherence, patients with mental illnesses must receive consistent support through community outreach programs, home visits, and new strategies to promote treatment compliance.

Medication nonadherence and its associated factors in psychiatric patients in India: A systematic review and meta-analysis

Medication nonadherence (MNA) poses a significant challenge in the management of major psychiatric disorders. The present study was undertaken to determine the prevalence of MNA among patients with psychiatric disorders in India and to identify the factors associated with MNA. The following databases were searched systematically: PubMed, Directory of Open Access Journals, and Google scholar. Articles originating from India published in peer reviewed English language journals before May 15, 2021 reporting the prevalence of MNA and associated factors among patients with psychiatric disorders were retrieved and the relevant data were abstracted. The pooled prevalence of MNA was calculated using the inverse variance method. Factors associated with MNA were synthesized and described. A total of 42 studies (pooled N = 6,268) were included in the systematic review. Among these, 32 studies (pooled N = 4,964) reported the prevalence of MNA and hence were eligible for meta analysis. The pooled prevalence of MNA was 0.44 (95% confidence interval [CI] 0.37-0.52). The pooled prevalence of MNA for psychotic disorders, bipolar disorders, and depressive disorders were 0.37 (95% CI, 0.28-0.46), 0.47 (95% CI, 0.23-0.72), and 0.70 (95% CI 0.60-0.78), respectively. Negative attitude toward medications, polypharmacy, greater severity of illness, lack of insight, and cost of medications were associated with MNA. Quality appraisal of the included studies revealed that most studies did not categorize and address nonresponders and did not provide any information on nonresponders. To conclude, about half of the patients with psychiatric disorders in India are nonadherent to their psychotropic medications. Evidence based interventions to improve medication adherence in these patients need to be developed and implemented proactively keeping in mind the factors associated with MNA.

Differential Treatment Responses in Pakistani Schizophrenia Samples: Correlation with Sociodemographic Parameters, Drug Addiction, Attitude to the Treatment and Antipsychotic Agents

Schizophrenia patients demonstrate variations in response to different therapies that are currently being used for the treatment of disorders, such as augmentation therapy (ECT or mood stabilizer) and combination therapy (with antipsychotics). These therapies are also used to treat schizophrenia patients in Pakistan; however, patients show poor overall response. Therefore, this study was conducted to investigate the association between the patients’ response to treatment and the use of antipsychotic agents, with variability in overall response, within different groups of patients. Methods: We conducted a retrospective study that included schizophrenia subjects (N = 200) belonging to different age groups, ethnicities, and regions from different outpatient and inpatient departments in psychiatric institutes located in different cities of Pakistan. These patients were assessed for their response to treatment therapies and categorized into four groups (non-responders (N-R), slow response (S-R), patients with relapse, and completely recovered patients (C-R)) according to their responses. Results: The final analysis included 200 subjects, of which 73.5% were males. Mean age was 34 ± 10 years. Percentage of N-R was 5%, S-R was 42%, patients with relapse were 24%, and C-R was 1.5%. The generalized linear regression model shows a significant association between medication response and age (p = 0.0231), age of onset (p = 0.0086), gender (p = 0.005), and marital status (p = 0.00169). Variability within the medication responses was a result of the treatment regime followed. Antipsychotic agents were significantly associated with the treatment response (p = 0.00258, F = 4.981) of the patients. Significant variation was also observed in the treatment response (p = 0.00128) of the patients that were given augmentation therapy as well as combination therapy. Conclusion: The data suggests proper monitoring of patients’ behavior in response to treatment therapies to implement tailored interventions. Despite several genetic studies supporting the heritability of schizophrenia, an insignificant association between characteristic features and family history might have been due to the limited sample size, suggesting collaborative work with massive sample sizes.

Adherence to Typical Antipsychotics among Patients with Schizophrenia in Uganda: A Cross-Sectional Study

Background

There has been a recent transition from typical to atypical antipsychotics in managing schizophrenia. This has been attributed to the acute side effects experienced by patients on typical antipsychotics that lead to nonadherence. However, the treatment cost with typical antipsychotics is cheaper (preferred in low-income settings), and there is no difference in the effectiveness, efficacy, discontinuation rate, or side effect symptom burden with atypical antipsychotics. This study is aimed at determining the prevalence of nonadherence and the associated factors to typical antipsychotics among patients with schizophrenia attending a psychiatric outpatient clinic at a rural tertiary facility in Uganda.

Method

A cross-sectional study among 135 patients with schizophrenia for at least six months on typical antipsychotics (mean age of 39.7 (±11.9) and 55.6% were female) from a rural tertiary facility in Uganda. Data were collected regarding sociodemographics, adherence, insight for psychosis, attitude towards typical antipsychotics, side effects, satisfaction with medications, and explanations from health workers about medications and side effects. Logistic regression was used to determine the factors associated with nonadherence.

Results

The prevalence of nonadherence was 16.3%, and the likelihood of being nonadherent was more among the poor (monthly earning below the poverty line). However, having reduced energy was associated with reducing the likelihood of having nonadherence.

Conclusion

The prevalence of nonadherence was lower than many previously obtained prevalence and was comparable to nonadherence for atypical antipsychotics. However, to reduce nonadherence, we need all stakeholders (such as the government, insurance companies, and caregivers) to assist patients living in poverty with access to medication.

Comparison of the retention rate, safety, and efficacy of two different titration protocols for lamotrigine in newly diagnosed epilepsy patients

OBJECTIVES

To evaluate and compare the retention rate, safety, and efficacy of two different lamotrigine (LTG) titration protocols for newly diagnosed epilepsy patients.

METHODS

We retrospectively evaluated newly diagnosed epilepsy patients taking LTG from January 2012 to December 2021. In one titration protocol, LTG was taken once daily; in the other, LTG was taken twice daily. Clinical characteristics, seizure outcomes, adverse effects and patient retention rates were evaluated.

RESULTS

A total of 193 patients were included. There was no significant difference in seizure outcomes or adverse effects between patients treated with LTG once daily and twice daily. However, the retention rates were significantly higher in the once-daily group than in the twice-daily group (73.03% and 55.77%, respectively).

CONCLUSION

The effectiveness and safety of LTG were not significantly different between the two different LTG titration protocols groups. However, the retention rate of the patients treated with LTG once daily was higher than that of the patients treated with LTG twice daily.

Effectiveness of Artificial Intelligence Methods in Personalized Aggression Risk Prediction within Inpatient Psychiatric Treatment Settings—A Systematic Review

Aggression risk assessments are vital to prevent injuries and morbidities amongst patients and staff in psychiatric settings. More recent studies have harnessed artificial intelligence (AI) methods such as machine learning algorithms to determine factors associated with aggression in psychiatric treatment settings. In this review, using Cooper’s five-stage review framework, we aimed to evaluate the: (1) predictive accuracy, and (2) clinical variables associated with AI-based aggression risk prediction amongst psychiatric inpatients. Databases including PubMed, Cochrane, Scopus, PsycINFO, CINAHL were searched for relevant articles until April 2022. The eight included studies were independently evaluated using critical appraisal tools for systematic review developed by Joanna Briggs Institute. Most of the studies (87.5%) examined health records in predicting aggression and reported acceptable to excellent accuracy with specific machine learning algorithms employed (area under curve range 0.75–0.87). No particular machine learning algorithm outperformed the others consistently across studies (area under curve range 0.61–0.87). Relevant factors identified with aggression related to demographic and social profile, past aggression, forensic history, other psychiatric history, psychopathology, challenging behaviors and management domains. The limited extant studies have highlighted a potential role for the use of AI methods to clarify factors associated with aggression in psychiatric inpatient treatment settings.

Medication Adherence and Drug Attitude Amongst Male Patients with the Methamphetamine-Induced Psychotic Disorder After Discharge: A Three Months Follow Up Study

Medication adherence and attitudes toward psychiatric medication affect treatment outcome. The objective of this study was to evaluate the effect and interaction of psychotic symptoms, sociodemographic factors, and attitudes concerning medication use with a three-month follow-up among methamphetamine-induced psychotic male patients. In this prospective, descriptive study, 42 male patients diagnosed with a methamphetamine-induced psychotic disorder were selected on the last day of their admission period in Iran Psychiatry Hospital, Tehran, Iran. Each patient was evaluated using the Persian version of the Drug Attitude Inventory (DAI-10), Medication Possession Ratio (MPR), Positive and Negative Syndrome Scale (PANSS), as well as a sociodemographic questionnaire immediately, one month and three months after discharge. There was a significant difference in MPR between the first and third months. Moreover, the frequency of patients with a positive attitude toward their medications increased over time. Indeed, all participants stated a positive attitude at the last follow-up based on the DAI-10 cutoff. Based on our findings, medication adherence of male patients with methamphetamine-induced psychotic disorder should be an essential aspect of treatment after discharge from psychiatry inpatient wards, more specifically, through the first months.

Psychotropic medicine beliefs, side effects and adherence in schizophrenia: a patient-caregiver dyad perspective

Background Medication adherence is essential in the management of schizophrenia. Yet poor treatment uptake has negative consequences on patients and their primary caregivers. Objective To examine the association among beliefs about psychotropic medications, side effects and adherence from a patient-caregiver dyad perspective. Setting This study was conducted in a public psychiatric hospital setting in Accra, Ghana. Methods A cross-sectional study was conducted among 121 patient-caregiver dyads using an interviewer-administered data collection approach.Main outcome measure Beliefs about medicines, side-effects and medication adherence. Results The patient and caregiver-reported level of medication adherence was 28.1 %. Using the Kappa index, the level of agreement between the responses of patients and their caregivers ranged from slight to moderate. Both patients and caregivers rated necessity higher than concern (patients: 1.67 ± 0.84, caregiver: 1.79 ± 0.96). Significant positive relations between specific-necessity, necessity-concerns differential and medication adherence were recorded while specific-concern, general harm and side-effects correlated negatively with medication adherence from the dyad. The odds of adhering to medications increased by 58 and 64 % for each unit increase in specific-necessity and general overuse scores respectively. However, a unit increase in specific-concern score and high side-effects scores were associated with lower odds of adherence. Conclusions This study highlights the need for patient-caregiver collaborations in decision-making relating to medication adherence in schizophrenia. Thus, in clinical practice, there is the need to recognize that caregivers are essential partners, and patient-caregiver views about psychotropic medications are critical in enhancing adherence for positive mental health outcomes.

Medication Adherence and Influencing Factors Among Patients With Severe Mental Disorders in Low-Income Families During COVID-19 Outbreak

BACKGROUND

The COVID-19 has spread across the globe in a short time and affected people's life, especially patients with severe mental disorders. Poor adherence to antipsychotics was usually associated with an increasing risk of relapse. This study investigated medication adherence status among patients with severe mental disorders in low-income families during COVID-19 outbreak and the influencing factors.

METHODS

To select patients with severe mental disorders in low-income families in central China's Henan Province, we used multi-stage stratified random sampling method. Trained interviewers and psychiatrists collected questionnaire responses from the patients through face-to-face interviews or video interviews. Logistic regression models were used to examine factors that influence the status of medication adherence.

RESULTS

A total of 24,763 valid questionnaires were collected between March 10, 2020, and March 31, 2020. The regular medication rate of patients with severe mental disorders in low-income families during the COVID-19 outbreak was 51.46%. Twelve factors were found to influence medication adherence of investigated individuals. Positive factors for regular medication were younger age, higher education level of patients and their guardians, higher medical expenditure, higher level of self-care ability, having subsidies for care and supervision, having disability certificate and personal care, etc.

CONCLUSIONS

The COVID-19 outbreak affected the medication adherence among patients with severe mental disorders in low-income families. The influencing factors are complicated and diverse, including psychological effects, traffic impact, and economy, etc. The government should pay more efforts on social assistance programs and flexibly deal with difficulties during public health emergencies like the COVID-19.

Perspective on medication decisions following remission from first-episode psychosis

While antipsychotics (APs) could provide rapid relief of positive symptoms in psychotic disorders, their usage is often associated with side effects, stigma and inconveniences. For these and other reasons, many psychosis patients, particularly those of first-episode psychosis (FEP) in remission, wish to discontinue maintenance treatment. The current review aims to discuss the strategies of AP treatment following remission from FEP, with particular emphasis on the evaluation of outcomes following AP discontinuation. Upon review of relevant literature, three potential strategies are put forth for treatment-responsive, remitted FEP patients: a) life-long maintenance treatment, b) AP discontinuation during second year of treatment, or c) AP discontinuation after three years of treatment. In theory, the first strategy presents the safest option for maximal symptom control. However, a rigorous RCT indicates that if AP discontinuation is to be attempted, the third strategy best prevents poor long-term clinical outcomes. Further data is needed to address the costs and benefits of each treatment strategy, compare AP-free patients with those on different types of APs, as well as explore even longer-term outcomes.

Attitude and preferences towards oral and long-acting injectable antipsychotics in patients with psychosis in KwaZulu-Natal, South Africa

Background

Patient attitudes to and satisfaction with their treatment are associated with improved adherence. There is a paucity of data on patient drug attitudes and preference to oral compared to long-acting injectable (LAI) antipsychotic treatment.

Aim

To describe patients attitudes and preferences towards oral versus LAI antipsychotic formulations and explore factors associated with their drug attitudes.

Setting

Two psychiatric hospitals in KwaZulu-Natal, South Africa.

Method

A cross–sectional survey of 140 adult outpatients with schizophrenia spectrum disorders receiving LAI with or without oral antipsychotics (a total of 70) were compared to patients receiving oral antipsychotics only (N = 70). A sociodemographic-clinical questionnaire, chart review and the Drug Attitude Inventory scale (DAI–30) were used.

Results

Of the 140 participants, 98 (70%) preferred the medication formulation currently prescribed, and 132 (94.3%) reported a positive drug attitude towards their antipsychotic medication. The adjusted regression analysis indicated that study participants who were currently on a formulation that matched their preference scored better on the DAI-30 than individuals with a mismatch in use and preference (p < 0.04). In terms of covariates, we found, on one hand, that study participants who are divorced (compared to single) with schizophrenia diagnosis (compared to other psychotic or schizoaffective disorder) are more likely to have lower score on DAI-30. On the other hand, we found that study participants with a higher household income and longer duration of the psychotic illness were associated with greater DAI-30 score.

Conclusion

The majority of participants preferred their current oral and LAI formulation. Drug attitude was influenced by several factors, including matched medication use. Focused psychoeducation should be considered for newly diagnosed, lower socio-economic groups and patients with non-affective psychosis to improve drug attitude.

Attitudes to Medication-Treatment Among Patients and Caregivers: A Longitudinal Comparison of Bipolar Disorder and Schizophrenia From India

BACKGROUND

Attitudes toward medication treatment are thought to significantly influence adherence in bipolar disorder (BD) and schizophrenia. However, the actual impact of patients' treatment attitudes on adherence and determinants of attitudes is still uncertain.

METHODS

A longitudinal examination of treatment attitudes and their correlates was conducted among patients with BD and their caregivers compared with those with schizophrenia. Structured assessments of symptom severity, functioning, insight, medication side effects, knowledge of illness, medication adherence, treatment attitudes, and treatment satisfaction were performed among 176 selected patients (106 with BD and 70 with schizophrenia) and their caregivers. Participants were reassessed on these parameters at 3 and 6 months.

RESULTS

Rates of nonadherence at baseline varied widely between self-reports, clinician ratings, and serum levels. Though symptoms and functioning improved with treatment, overall rates of nonadherence increased in the first 3 months because of early dropouts and remained stable thereafter. However, treatment attitudes and treatment satisfaction remained largely unchanged among patients and caregivers. Both positive and negative attitudes were commonly held and patients' attitudes did not differ between BD and schizophrenia. Patients' attitudes were significantly associated with adherence, insight, knowledge about illness, treatment satisfaction, symptom severity, social disadvantage, and side effects together with caregivers' knowledge, attitudes, and satisfaction. Caregivers of patients with schizophrenia were more knowledgeable and had more positive attitudes than patients.

CONCLUSIONS

Patients' attitudes to medication treatment are associated with adherence over time. They are relatively enduring and mainly associated with insight, knowledge of illness, and treatment satisfaction among patients and their caregivers. These findings could inform psychosocial interventions aiming to improve treatment attitudes and adherence in BD and schizophrenia.

Drug Attitude, Insight, and Patient's Knowledge About Prescribed Antipsychotics in Schizophrenia: A Cross-Sectional Survey

INTRODUCTION

While patients' perspectives toward pharmacotherapy are expected to be directly influenced by their motivation and understanding of the treatment that they are currently receiving, no study has comprehensively investigated the impact of insight into illness and knowledge for the ongoing pharmacotherapy on the attitude towards drug treatment among patients with schizophrenia.

MATERIALS AND METHODS

One hundred forty-eight Japanese outpatients diagnosed with schizophrenia, according to the International Classification of Diseases 10th edition, were included (mean±SD age, 47.3±12.4 years; 90 men (60.8%)). Attitudes toward antipsychotic treatment and insight into illness were assessed with the Drug Attitude Inventory-10 (DAI-10) and the VAGUS, respectively. In addition, a multiple-choice questionnaire that was designed to examine patients' knowledge about therapeutic effects, types, and implicated neurotransmitters of antipsychotic drugs they were receiving was utilized.

RESULTS

The mean±SD of DAI-10 score was 4.7±4.2. The multiple regression analysis found that lower Positive and Negative Syndrome Scale (PANSS) scores, higher VAGUS scores, and longer illness duration were significantly associated with higher DAI-10 scores (β=-0.226, P=0.009; β=0.250, P=0.008; β=0.203, P=0.034, respectively). There was a significant difference in the DAI-10 scores between the subjects who gave more accurate answers regarding the effects of their primary antipsychotic and those who did not (mean±SD, 5.57±4.38 vs 4.13±4.04, P=0.043); however, this finding failed to survive the multiple regression analysis.

CONCLUSION

Better insight into illness and treatment, lower illness severity, longer illness duration, and possibly greater knowledge about the therapeutic effects of medications may lead to better attitudes towards pharmacotherapy among patients with schizophrenia, which has an important implication for this typically chronic mental condition requiring long-term antipsychotic treatment to sustain stability.

Metacognitive Deficits Predict Impaired Insight in Schizophrenia Across Symptom Profiles: A Latent Class Analysis

The integrated model of insight in schizophrenia suggests that poor insight is the result of multiple factors which compromise persons' abilities to integrate streams of information into a personal awareness of psychiatric challenges, and make adaptive responses. This model hypothesizes that metacognitive deficits, or difficulties forming a complex and integrated understanding of the self and others, influence insight, regardless of other proximal causes including clinical profile. To explore this possibility, we performed a latent class analysis on 324 adults with schizophrenia or schizoaffective disorder. This analysis produced 4 groups on the basis of assessment of insight and Positive and Negative Syndrome Scale (PANSS) positive, negative, cognitive, and hostility symptoms. The resultant groups were characterized as: Good Insight/Low Symptoms (n = 71), Impaired Insight/High Negative Symptoms, (n = 43), Impaired Insight/High Positive Symptoms (n = 50) and Impaired Insight/Diffuse Symptoms (n = 160). When we compared metacognitive function as assessed with the Metacognition Assessment Scale - Abbreviated (MAS-A) across groups, we found that the good insight group had better overall metacognition as well as higher levels of self-reflectivity, awareness of the other and mastery as compared to all 3 groups with impaired insight. When controlling for total symptoms, all differences in metacognitive function between the good insight and the impaired insight groups remained significant. These results are consistent with the view that, independent of symptoms, impaired metacognition contributes to difficulties integrating information and hence impedes insight, or awareness of psychiatric challenges. Consistent with extant literature, results suggest that interventions focusing on metacognition as the target may lead to improved insight.

Attitude towards Antipsychotic Medications in Patients Diagnosed with Schizophrenia: A Cross-Sectional Study at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

BACKGROUND

Poor attitude towards antipsychotic drugs is high, and it is a factor for non-adherence to treatment. This increases the risk of relapse, associated healthcare utilization, and costs. This study aimed to assess attitude towards antipsychotic medication among patients with schizophrenia.

OBJECTIVES

The aim of this institution based cross-sectional study was to assess attitude towards antipsychotic medications and associated factors among patients with schizophrenia who attend the outpatient clinics at Amanuel Mental Specialized Hospital, 2018.

METHODS

In a cross-sectional study, 393 schizophrenic patients from Amanuel Mental Specialized Hospital were recruited by a systematic random sampling technique. Drug Attitude Inventory (DAI-10) was used to assess attitude, experience, and belief about antipsychotics. Glasgow antipsychotic side effect scale modified version, positive and negative syndrome scale, and Birch wood's insight scale for psychosis were the instruments used to assess the associated factors. Simple and multiple linear regression analysis models were fitted, and the adjusted unstandardized beta (β) coefficient at 95% confidence interval was used.

RESULTS

The mean score of attitude towards antipsychotic medications was 6.51 with standard deviation (SD) of 2.22. In multiple linear regression, positive symptoms (β= -0.07, 95% CI: (-0.09, -0.05)), negative symptoms (β= -0.04, 95% CI: (-0.06,-0.02)), shorter (≤5 years) duration of illness (β= -0.39, 95% CI: (-0.63, -0.15)), first generation antipsychotics (β = -0.35, 95% CI: (-0.55,-0.14)), having sedation (β= -0.28, 95% CI: (-0.52, -0.02)), and extra-pyramidal side effects (β= -0.34, 95% CI: (-0.59,-0.09)) were factors negatively associated with attitude towards antipsychotic medication treatment. Insight to illness (β= 0.24, 95% CI: (0.20, 0.27) was a factor positively associated with attitude towards antipsychotic medications.

CONCLUSION

The result suggests that the mean score of participants' attitude towards antipsychotic medications was good. Prevention of side effects particularly due to first generation antipsychotics is necessary.

Genderwise clinical response of antipsychotics among schizophrenic patients: a prospective observational study from Lahore, Pakistan

OBJECTIVE

The study was aimed to evaluate the gender specific response to adherence and occurrence of side effects among schizophrenic patients in Lahore, Pakistan.

METHODS

A prospective study was performed for a period of 1 year among 180 newly diagnosed schizophrenics, aged 20-60 years to observe the symptoms, medication adherence and side effects. Morisky-Green-Levine Scale was used to evaluate medication adherence, LUNSER for side effects and PANSS to measure positive and negative symptoms. Data were analyzed using SPSS.

RESULTS

Positive symptoms (Male: Baseline 36.14 vs. endpoint 23.58, Female: 35.29 vs. 23.74) and negative symptoms (Males 27.9 vs. 20.05, Females 28.41 vs. 20.2) of schizophrenia were equally reduced after a follow up of 1 year in both the genders. Male population suffered more accumulative side effects (11.4 in males vs. 6.40 in females), extrapyramidal symptoms such as tardive dyskinesia and tremors (1.21 in males vs. 0.57 in females) and other side effects as compared to women (p ≤ .005). Males were found poorly adherent to antipsychotic treatment than females (93.3% in males vs. 6.7% in females (p ≤ .005).

CONCLUSIONS

Prescribing practices should not overlook sex specific factors like hormonal changes, altered brain morphology and socioeconomic factors that may be responsible for the difference in the response to the course of schizophrenia.

A Cross-sectional Analysis of Patterns and Predictors of Medication Adherence in Bipolar Disorder: Single Center Experience from South India

Objective

Our objective was to determine patterns and predictors of medication adherence in bipolar disorder.

Methods

Between August 2015 and December 2016, we recruited 160 patients with a diagnosis of bipolar disorder as per International Classification of Diseases-10: Clinical Descriptions and Diagnostic Guidelines. The diagnosis was further confirmed by using the MINI International Neuropsychiatric Inventory. All of them were currently in remission (confirmed by standard measures) and on stable dosing of medication for at least a year. Medication adherence was assessed using Tamil validated version of Morisky Medication Adherence Scale. Patients were dichotomized into low adherence (<6) and high adherence (≥6) groups and compared on various socio-demographic and clinical variables.

Results

Majority of the sample (n=97, 60.6%) demonstrated low adherence to treatment regimen. Being employed and having spent greater number of days in hospital were predictive of higher medication adherence (odds ratio [OR] 2.78, 95% confidence interval [CI] 1.019-7.585; and OR 1.02, 95% CI 1.003-1.037, respectively). Fewer number of lifetime depressive episodes and positive drug attitudes demonstrated trend level positive association with high medication adherence.

Conclusion

Non-adherence to prescribed medications is a common problem in bipolar disorder. Interventions targeting vocation, medication focused psychoeducation and promotion of positive drug attitudes are likely to enhance medication adherence in this group.

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture.

Reasons associated with treatment non-adherence in schizophrenia in a Pakistan cohort

non-adherence in patients with schizophrenia is the most common reason for a relapse of psychosis. In a cohort of participants in Pakistan who suffered a relapse of psychosis, we aimed to identify the principal factors associated with non-adherence, including any culture specific factors that might not be as significant in other jurisdictions. Semi-structured interviews were undertaken at four psychiatric hospitals in the Peshawar region in Pakistan with 55 participants (44 male and 11 female) diagnosed with schizophrenia, who had suffered a relapse of psychosis subsequent to treatment non-adherence. The five principal documented reasons for treatment non-adherence were: 1) alternative treatment pathway chosen with a traditional faith healers (n=53, 96.4%), 2) lack of insight (n=36, 65.5%), 3) poor economic status (n=33, 60.0%), 4) adverse effects of medications (n=33, 60.0%) and 5) utilising psycho-active substances as an alternative to psychotropic medications (n=27, 41.1%). A number of identified factors associated with a relapse of psychosis are potentially modifiable including the provision of a range of pharmacological options including second generation antipsychotic agents, long acting injectable antipsychotics and psycho-therapeutic interventions including psycho-education. These interventions should prove cost effective and be associated with reduced relapse rates of psychosis.

Attitude toward psychiatrists and psychiatric medication: A survey from five metropolitan cities in India

BACKGROUND

Stigmatization and overall scarcity of psychiatrists and other mental health-care professionals remain a huge public health challenge in low- and middle-income countries, more specifically in India. Most patients seek help from faith healers, and awareness about psychiatrists and treatment methods is often lacking. Our study aims to explore public attitudes toward psychiatrists and psychiatric medication in five Indian metropolitan cities and to identify factors that could influence these attitudes.

MATERIALS AND METHODS

Explorative surveys in the context of public attitudes toward psychiatrists and psychiatric medication were conducted using five convenience samples from the general population in Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). We used a quota sample with respect to age, gender, and religion using the census data from India as a reference.

RESULTS

Mean scores indicate that attitudes toward psychiatrists and psychiatric medication are overall negative in urban India. Negative attitudes toward psychiatrists were associated with lower age, lower education, and strong religious beliefs. Negative attitudes toward psychotropic medication were associated with lower age, male gender, lower education, and religion.

CONCLUSION

In line with the National Mental Health Policy of India, our results support the perception that stigma is widespread. Innovative public health strategies are needed to improve the image of psychiatrists and psychiatric treatment in society and ultimately fill the treatment gap in mental health.

Evaluation of treatment adherence in outpatients with schizophrenia

BACKGROUND

Treatment nonadherence is a major obstacle in the successful management of schizophrenia. Finding out factors associated with nonadherence and the reasons for nonadherence are important to improve treatment adherence in patients with schizophrenia. This study was conceived to evaluate treatment adherence in patients with schizophrenia and the factors associated with it.

MATERIALS AND METHODS

A cross-sectional study was conducted in 50 consecutive patients with schizophrenia with the help of semi-structured pro forma consisting of sociodemographic details, information regarding illness and treatment history, (PANSS), and Morisky Medication Adherence Scale-8 to assess medication adherence. Nonadherent patients were further assessed for their reasons for nonadherence.

RESULTS

Among the patients, 52% were low adherers (nonadherers). Factors associated with nonadherence were younger age of patients, male gender, low household income, higher PANSS score (positive, negative, and total score), lower grades of insight, lack of family history of psychiatric illness, responsibility of taking self-medications, first-generation antipsychotics, and number of drugs in prescription. Major reason for nonadherence given by patients were adverse effects of medications, treatment perceived as ineffective, financial problems, shame and stigma about illness and treatment, regarding treatment unnecessary and difficulty to access health-care facility.

CONCLUSION

Our study established high proportion of nonadherence in patients with schizophrenia and also brought out factors associated and reasons for nonadherence. Adequate psychoeducation of patients and their caretakers as well as psychosocial interventions, strengthening mental health infrastructure, and community mental health services will significantly improve treatment adherence.

Acupuncture in the Treatment of a Female Patient Suffering from Chronic Schizophrenia and Sleep Disorders

Background. The use of acupuncture in the treatment of sleep disorders in patients with chronic schizophrenia is investigated. Case Presentation. We report the case of a 44-year-old female outpatient of German origin who had been suffering from long-term schizophrenia and sleep disorders. The patient was treated with manual acupuncture weekly for 12 weeks, and a psychological assessment was performed before, immediately after, and three months after the acupuncture treatment period. In addition, actiwatch data were collected for 14 days both before and after the acupuncture treatment period. Conclusion. Acupuncture treatment led to a decrease in general psychopathology, less severe sleep problems, and markedly improved cognitive functioning (working memory) in the patient; however, the positive and the negative symptoms remained stable. The actiwatch data revealed a beneficial effect of acupuncture, showing better sleep latency, a trend towards better sleep efficiency, and a decrease in the number of minutes that the patient was awake during the night after acupuncture treatment. In sum, this study showed that acupuncture might be beneficial in the treatment of sleep disorders in patients suffering from chronic schizophrenia, but future, large, randomized (placebo), controlled, clinical trials are needed in order to replicate the present preliminary findings.