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

An intercultural perspective toward supporting antipsychotic medication adherence in clinical practice

In the UK, the incidence of schizophrenia appears highest in Black Caribbean and Black African communities (four- to six-fold that of the White British population). The incidence of psychosis in other minority ethnic groups is also raised, but to a lesser magnitude. Although there are numerous environmental confounding factors, the data stresses the importance of optimising treatment in high-risk (minority) groups. Antipsychotic nonadherence is the most common reason for schizophrenia relapse, and is associated with increased rates of relapse, readmission to hospital and suicide. This article examines available literature to discover how culture can affect antipsychotic nonadherence, and considers culture-based solutions that could enhance antipsychotic adherence. Acknowledging the importance of the therapeutic alliance and sociocultural aspects in antipsychotic adherence, I argue that current cultural competence training provided to clinicians is inadequate. Organisational- and system-level approaches are required to reduce oppressive practise and promote culturally competent, person-centred care.

Uncertainty in illness among individuals with schizophrenia: a phenomenology study in Indonesia

Purpose

Individuals with schizophrenia experience uncertainty due to the unpredictable symptoms, the course of the illness and poor knowledge about the disease, treatment and prognosis. Uncertainty in illness is linked with poor treatment outcomes, coping strategies, check-up decisions and psychological distress. This study aims to explore the uncertainty in illness among individuals with schizophrenia.

Design/methodology/approach

Eight individuals with schizophrenia living in the community were interviewed regarding their illness. The phenomenology approach was used to collect and analyze the data.

Findings

Three themes emerged from the findings of the study; the unpredictable course of the illness, compliance amid uncertainty and uncertainty of information about their illness. This study provides an essential overview of how patients with schizophrenia live in uncertain conditions.

Originality/value

It should be considered by various parties, particularly the community mental health nurses working with individuals with schizophrenia. Considering the uncertainty of illness while looking after or interacting with patients and their family is significant in improving adequate mental health-care delivery.

Lifetime relapse and its associated factors among people with schizophrenia spectrum disorders who are on follow up at Comprehensive Specialized Hospitals in Amhara region, Ethiopia: a cross-sectional study

BACKGROUND

Relapse in psychiatric disorders is highly distressing that posed a huge burden to the patients, family, and society. It interrupts the process of recovery and may increase the risk of resistance to treatment. Relapse detection and taking preventive measures against its possible factors are crucial for a better prognosis.

OBJECTIVE

To assess lifetime relapse and its associated factors among people with schizophrenia spectrum disorders who are on follow-up at Comprehensive Specialized Hospitals in Amhara region, Ethiopia.

METHOD

An institution-based cross-sectional study was conducted from July 13-August 13, at Comprehensive Specialized Hospitals in Amhara region, Ethiopia, 2020. Data were collected from 415 randomly selected participants using an interviewer administered questionnaire. Relapse was determined using participants' medical records and a semi-structured questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 25. Logistic regression analysis was done to identify the explanatory variables of relapse. Variables with P-value < 0.05 were considered significantly associated with relapse.

RESULT

The magnitude of lifetime relapse was 57.4% (95% CI = 53-62%). Relapse was significantly associated with comorbidity of another mental illness (AOR = 1.84, 95% CI = 1.06, 3.18), non-adherence to medication (AOR = 2.23, 95% CI = 1.22, 4.07), shorter duration on treatment (AOR = 1.71, 95% CI = 1.05, 2.81), and experiencing stressful life events (AOR = 2.42, CI = 1.2, 4.66).

CONCLUSION

In the current study, more than half of the participants had lifetime relapses. Comorbid mental illnesses, non-adherence, duration of treatment ≤ 5 years, and experiencing stressful life events were factors associated with relapse. This requires each stakeholder to give concern and work collaboratively on the respective factors that lead to relapse.

A systematic review of mental health literacy in Pakistan

Individual mental health has become a primary global concern. In Pakistan, the prevalence of mental health issues is still unclear, as not many studies have assessed the level of mental health literacy (MHL) in the country. This systematic review aims to bridge this gap by encouraging the early detection of mental disorders, lessening stigma, and improving help-seeking behavior. Nine electronic databases were searched to identify empirical literature in this area. Only studies that evaluated MHL efficacy and those published in English were selected. Non-peer reviewed articles and gray literature were excluded. From 613 studies retrieved, 59 studies met the inclusion criteria and were reviewed. Forty-three of the included studies mentioned mental health outcome measures (of which only four mentioned reliability indices), 13 discussed stigma, 18 examined help-seeking approaches to mental illness treatments, and 47 discussed mental health knowledge. Additionally, the outcome of the MHL measures had considerable heterogeneity and limited validity. Meta-analysis was not conducted due to a lack of MHL operationalization. Besides, the measurement tools in the studies lacked consistency and standardization. This review compiled the available studies on MHL to assist researchers currently studying the various dimensions of MHL, as well as those designing new studies or investigating effective methods to increase MHL. This review highlights the need for well-designed controlled intervention studies. Further implications for researchers, practitioners, and policymakers are mentioned.

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

Introduction: Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middle-income countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed.Areas covered: Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments.Expert opinion: Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients' rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up.

Randomized controlled trial of the effects of nursing care based on a telephone intervention for medication adherence in schizophrenia

PURPOSE

Our aim was to determine the effects of "Telephone Intervention Problem Solving" (TIPS) on medication adherence among individuals diagnosed with schizophrenia.

DESIGN AND METHODS

This randomized controlled trial was conducted with 45 patients. TIPS was applied to the intervention group for 2 months, whereas the control group received routine care.

FINDINGS

We found that the rate of voluntary continuation of medicine (P < 0.001), belief in the necessity of medication (P = 0.008) and medication adherence scores were higher in the intervention group (P < 0.001).

PRACTICAL IMPLICATIONS

This study may serve as a guide for applying telephone communication to clinical interventions in psychiatric nursing.

Trends in the prescribing of antipsychotic medicines in Pakistan: implications for the future

Introduction and objectives: There is a paucity of antipsychotic prescribing and utilization data in Pakistan that needs addressing, especially with issues of availability, affordability, gender differences, and domestic violence, to develop pertinent strategies. The objective of this study was to address these issues by describing current antipsychotic utilization patterns in Pakistan among adult patients attending tertiary care hospitals and private practitioners.Methods: A three staged approach was used including (1) assessment of total antipsychotic utilization, expenditure, and costs per unit between 2010 and 2015, (2) an in-depth retrospective study of prescribing patterns, including co-morbidities among representative hospital patients in Pakistan, and (3) assessment of the quality of prescribing against WHO targets.Results: Total use of antipsychotics increased 4.3-fold and the cost/unit increased by 13.2% during the study period. Risperidone and olanzapine were the most prescribed antipsychotics with more limited use of other typical and atypical antipsychotics. The number of medicines per encounter was 4.56. Prescription using generic instead of brand names was 21.4%. Seven per cent were prescribed more than one antipsychotic concurrently.Conclusion: There has been an appreciable increase in antipsychotic utilization in recent years in Pakistan, especially atypical antipsychotics, with little polypharmacy. Ongoing utilization of typical antipsychotics may be due to comorbidities such as diabetes and cardiovascular disease. Issues of international non-proprietary name prescribing need investigating along with the high number of medicines per encounter and gender inequality.

Psychological autopsy review on mental health crises and suicide among youth in Pakistan

INTRODUCTION

Ascertaining putative sociodemographic and clinical causes for death by probable suicide can potentially help implement region-specific strategies to reduce suicide rates. In this study, we wanted to investigate methods utilized and the psychosocial and mental health characteristics of youths (aged 12-26 y) who died by probable suicide.

METHOD

We examined data from mental health clinical files and forensic reports and performed qualitative psychological autopsy interview from more than multiple sources for each youth who died by probable suicide between 1 May and 31 December 2015 in the Khyber Pakhtunkhwa Province of Pakistan.

RESULTS

The two most common methods of probable suicide were by firearm use and self-poisoning utilizing pesticides that were significantly associated with male and female gender, respectively. The most common mental health difficulties were major depressive disorder and harmful use of psychoactive substances. Other clinical features particularly evident included thoughts of self-harm, irritability and aggression, low self-esteem, treatment nonadherence, family dispute, and financial distress.

CONCLUSION

Efforts to reduce the ease of access to firearms and pesticides may potentially have a beneficial effect in reducing the suicide rate in this region of Pakistan.

Development and validation of assessment of psycho-education of carers questionnaire: An early experience

Background and Objective

Psycho-education is an intervention integrating psychotherapeutic and educational strategies. Whilst carer psycho-education is known to aid in psychiatric disorders, at present there is no known tool to assess the degree to which this is routinely provided by mental health professionals. Our objective was to develop and validate a tool, in English, which assesses psycho-education of carers of psychiatric patients in Pakistan.

Methods

A questionnaire was generated in English. It was pretested on twenty male and female carers and was refined to attain a more reliable version. Sixty bilingual male and female primary carers, who were fluent in English, and had been in a care-giving role for more than three months were requested to complete the developed Questionnaire for the Assessment of Psycho-Education of Carers (APEC) at Fatima Memorial Hospital Psychiatry Out-patient department within a period of four months from December, 2017 to April, 2018. Carers were identified via patients presenting to a psychiatric OPD. Responses were analyzed for reliability and test retest consistency using Cronbach's alpha analysis, Intraclass correlation coefficients, factor analysis and Paired t-test.

Results

APEC was found to be easily understandable and capable of adequately assessing aspects of psycho-education. A high degree of internal consistency was demonstrated on cronbach's alpha analysis. Cronbach's α coefficient for various domains was sufficiently high ranging from0.76 to 0.960. Similarly, domains of (APEC) were highly correlated. Test-retest reliability was assessed by computing the correlation between Visits 1 and 2 scores.

Conclusion

The developed questionnaire can adequately assess psycho-education of primary carers in mental health settings.

Comparisons of the effects of second-generation antipsychotics long-acting injections on treatment retention according to severity of patient condition

INTRODUCTION

There have been no naturalistic reports in Japan clarifying the difference of second-generation antipsychotics (SGA) long-acting injections (LAIs) on treatment retention according to severity of patient condition.

METHODS

This study aimed to investigate the difference in treatment retention between SGA LAIs according to severity of patient condition.

RESULTS

This study demonstrated that, although AOM patients had better rates of treatment retention compared to PP and RLAI for mild cases, the reverse was true for moderate to severe cases.

CONCLUSION

Because treatment retention rates can differ for each SGA LAI based on the severity of the patient's condition.

A narrative meta-synthesis of how people with schizophrenia experience facilitators and barriers in using antipsychotic medication: Implications for healthcare professionals

BACKGROUND

It is recognized that people who are diagnosed with schizophrenia often do not fully adhere with their antipsychotic prescription. The vast majority of previous research on the topic of medical adherence is limited to quantitative research methods, and in particular, to determining correlations.

OBJECTIVES

The present review was designed to describe how people who are diagnosed with schizophrenia experience and narrate pharmacological treatment with antipsychotic medication.

DESIGN

A narrative meta-synthesis.

DATA SOURCES/REVIEW METHOD

A search was conducted in three databases, PubMed, CINAHL and PsycINFO, to identify qualitative original research. Nine articles met the criteria for inclusion and were subjected to a qualitative interpretive meta-synthesis.

RESULTS

The findings showed that patients were uninformed about medication but valued talks about medication with professionals. The findings also demonstrated that patients are motivated to take medication in order to gain stability in their life and to be able to participate in life activities and in relationships. Good support, both from relatives and professionals, also motivates them to continue taking medication. The obstacles were side-effects, pressure and compulsion, and rigid organizations.

CONCLUSIONS

We advise professionals to adopt a person-centered approach to healthcare when encountering these patients and to transform the language used to describe patients from terms denoting compliance and adherence to terms denoting cooperation and alliance. Labeling patients as compliant or non-adherent may risk fortifying preconception of patients as static beings and obscure the patients' individual recovery process.