Factors associated with antipsychotic medication adherence in community-based patients with schizophrenia in Hong Kong: a cross sectional study

Medication non-adherence and associated factors among peoples with schizophrenia: multicenter cross-sectional study in Northwest Ethiopia

BACKGROUND

Schizophrenia is a serious and debilitating psychiatric disorder that is linked to marked social and occupational impairment. Despite the vital relevance of medication, non-adherence with recommended pharmacological treatments has been identified as a worldwide problem and is perhaps the most difficult component of treating schizophrenia. There are limited studies conducted on magnitude and potential factors of medication non-adherence among peoples with schizophrenia in Ethiopia.

OBJECTIVES

This study aimed to assess medication non-adherence and associated factors among peoples with schizophrenia at comprehensive specialized hospitals in Northwest Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted among 387 peoples with schizophrenia at selected hospitals in the Northwest of Ethiopia from June to August 2022. Study participants were enrolled using systematic random sampling. Medication non-adherence was measured using Medication Adherence Rating Scale (MARS). Data entry and analysis were done using Epi-data version 4.6.0 and SPSS version 24, respectively. A multivariable logistic regression model was fitted to identify factors associated with medication non-adherence. Variables with a p-value of < 0.05 at a 95% confidence interval were considered statistically significant.

RESULTS

The prevalence of medication non-adherence was 51.2% (95% CI: 46.3, 56.3). Duration of treatment for more than ten years (AOR = 3.76, 95% CI: 1.43, 9.89), substance use (AOR = 1.92, 95% CI: 1.17, 3.13), antipsychotic polypharmacy, (AOR = 2.01, 95% CI: 1.11, 3.63) and extra-pyramidal side effect (AOR = 2.48, 95% CI: 1.24, 4.94) were significantly associated with medication non-adherence.

CONCLUSION

In this study, half of the participants were found to be medication non-adherent. Respondents with a longer duration of treatment, substance users, those on antipsychotic polypharmacy, and those who develop extra-pyramidal side effect need prompt screening and critical follow-up to improve medication adherence.

Patient and caregivers perspective about clozapine: A systematic review

BACKGROUND

Clozapine is a gold standard treatment for treatment-resistant schizophrenia. However, the patients' and caregivers' perception and their experience with clozapine has remained much less explored.

AIM

To review the available literature on the patients' and caregivers' attitudes, perceptions, and experiences with clozapine.

METHODOLOGY

27 original research and review articles published in PubMed-indexed journals till March 2023 in the English language, exploring the patient and/or caregiver/family member's experience with using clozapine, were included.

RESULTS

30-80 %of patients and 92-100 % of caregivers were found to have a positive attitude towards clozapine in terms of its impact on psychopathology, cognitive and social functioning of the patient, and caregiving needs. Most patients and caregivers also found that the positive effects of clozapine outweighed the side effects and distress related to repeated blood testing. However, a lack of satisfaction was noted among both patients and caregivers regarding the knowledge provided to them regarding clozapine, especially regarding its common adverse effects. Discontinuation of clozapine was found to be more commonly done by the patients' accord rather than clinicians, and the perceived side effects like hypersalivation and excessive sedation emerge as important factors that lead to discontinuation rather than the need for repeated blood testing.

CONCLUSIONS

Overall, patients and their caregivers share a positive attitude towards clozapine and perceive it to be an effective and beneficial drug, but more effort needs to be directed by the clinical teams to educate the users of clozapine regarding its complete side effect profile and provide continuous guidance about dealing with the emerging side effects throughout treatment.

Effectiveness of Providing Information on Antipsychotic Medication to Patients with Psychotic Disorders: An Integrative Review

The aim of this integrative literature review is to describe the information provided to patients with psychotic disorders regarding their medication and to consider the effectiveness of providing such information. Searches of four databases identified 16 articles that met inclusion criteria. Results indicated that patients had relatively poor knowledge about their medications overall. Knowledge about side effects was found to improve significantly following education, with better knowledge leading to positive patient outcomes including increased adherence. Findings offer a comprehensive description of antipsychotic medication information provided to patients and an indication of the positive impact of information provision.

The Effect of Therapeutic Alliance on Attitudes Toward Psychiatric Medications in Schizophrenia

PURPOSE/BACKGROUND

The differential influence of therapeutic alliance with different health care professionals on patients' medication adherence has never been examined.

METHODS/PROCEDURES

Ninety-five stable outpatients (91 patients with schizophrenia and 4 patients with schizoaffective disorder) were recruited. Individual, clinical, and medication factors were assessed, along with drug attitude (10-item Drug Attitude Inventory). Comparison on these factors was made between outpatients who identified psychiatrists as the health care professional most involved in their care, as compared with other health care professionals.

FINDINGS/RESULTS

Older age, longer duration of illness, presence of medical comorbidities, lower levels of internalized stigma, higher levels of insight, higher levels of functioning, lesser severity of depressive symptoms, and positive symptoms were found to be significantly associated with greater levels of drug attitude (small to moderate associations). Only therapeutic alliance had a large correlation with drug attitude (ρ = 0.503, P < 0.001). The therapeutic alliance scores between the 2 health care professionals groups are not significantly different. However, participants who have identified psychiatrists as the health care professional that contributed the most to their recovery reported a significantly more positive attitude (μ = 6.18, SD = 3.42) toward psychiatric medication as compared with the other health care professionals group (μ = 3.11, SD = 5.32, P = 0.004). Only 2 factors, the Revised Helping Alliance Questionnaire (β = 0.424, P < 0.001) and Personal and Social Performance scale (β = 0.272, P = 0.006), were statistically significant predictors of drug attitude.

IMPLICATIONS/CONCLUSIONS

Therapeutic alliance is found to be the lead factor associated with drug attitude in patients with schizophrenia. Identifying psychiatrists as the health care professional most involved in the patients' recovery can greatly increase patients' drug attitudes. Maintaining individuals' functioning also contributes to drug attitude.

Impact of adverse reactions to first-generation antipsychotics on treatment adherence in outpatients with schizophrenia: a cross-sectional study

BACKGROUND

Antipsychotics are well-known to cause potentially serious and life-threatening adverse drug reactions (ADRs) that have been reported to be also one of the major reasons for non-adherence. In Eritrea, shortage of psychiatrists and physicians, inadequacy of laboratory setups and unavailability of second-generation antipsychotics in the national list of medicines would seem to amplify the problem. This study's objective is to determine the impact of adverse effects of first-generation antipsychotics on treatment adherence in outpatients with schizophrenia at Saint Mary Neuro-Psychiatric National Referral Hospital.

METHODS

A cross-sectional study design was employed. All eligible adult patients with diagnosed schizophrenia (n = 242) who visited the hospital during the study period were enrolled. Data on ADRs, adherence and other variables were collected from patients using a self-administered questionnaire, interview and through medical cards review. The collected variables were analyzed using SPSS 22.0 with descriptive and multivariable logistic regression analysis. Statistical significance was tested at p value < 0.05.

RESULTS

Greater than one-third (35.5%) of the patients with schizophrenia were non-adherent to treatment. The odds of non-adherence increased 1.06 times for each unit increase in the total ADR score (AOR = 1.06, 95% CI 1.04, 1.09). Patients with extrapyramidal (AOR = 44.69, 95% CI 5.98, 334.30), psychic (AOR = 14.90, 95% CI 1.90, 116.86), hormonal (AOR = 2.60, 95% CI 1.41, 4.80), autonomic (AOR = 3.23, 95% CI 1.37, 7.57) and miscellaneous reactions (AOR = 2.16, 95% CI 1.13, 4.13) were more likely to be non-adherent compared to their counterparts.

CONCLUSION

Poor treatment adherence was found to be substantial which was attributed to total ADR score, extrapyramidal, hormonal, psychic, autonomic and miscellaneous categories of reactions of the LUNSERS. To improve treatment adherence, early detection and management of adverse effects and inclusion of second-generation antipsychotics are recommended.

Effect of Group Psychoeducation on Treatment Adherence, Quality of Life and Well-Being of Patients Diagnosed with Schizophrenia

Psychoeducation offers a holistic approach that focuses on the philosophy of health, cooperation, coping and empowerment, but it is known that experimental studies used in psychoeducation in schizophrenia are insufficient. The study was conducted with 42 schizophrenia patients using a quasi-experimental research design. Patients were evaluated using a pretest, post-test, follow-up test, "Medication Adherence Rating Scale", "Quality of Life Scale for Schizophrenia" and "Flourishing Scale". There was a significant difference between the experimental group and the control group in terms of pretest and post-test, pretest and follow-up test scores (p < 0.05). The post-test and follow-up test scores of the patients in the experimental group were determined to increase their quality of life and well-being score (p < 0.05). This study is an important contribution to the literature due to its assessment of the relationship between psychoeducation and change in treatment adherence, quality of life and levels of well-being.

Check the effects: systematic assessment of antipsychotic side-effects in an inpatient cohort

BACKGROUND

Antipsychotics are associated with a range of side-effects that can influence patients' subjective well-being negatively resulting in poor adherence. In order to limit the negative consequences of side-effects, they should be regularly systematically assessed. The aim of this study was to systematically assess antipsychotic side-effects in an inpatient cohort using validated rating scales.

METHODS

Eligible individuals prescribed an antipsychotic for at least 2 weeks were invited to have their side-effects assessed systematically.

RESULTS

A total of 208 individuals were assessed systematically for antipsychotic side-effects; 71.5% (n = 138) stated that they had not reported side-effects to their clinician prior to the assessment. The most commonly reported side-effects were daytime drowsiness (75%), dry mouth (58.2%) and weight gain (50.0%), while the most distressing side-effects reported were erectile dysfunction (35.0%), sexual dysfunction (26.3%) and amenorrhoea (26.3%). There was no evidence of an association between side-effect severity/number of side-effects reported/distress caused by those taking high dose/combination antipsychotics versus standard dose monotherapy.

CONCLUSION

Side-effects must be regularly and systematically assessed using a validated rating scale. As distress caused by side-effects plays a major role in non-adherence, assessment should examine distress and data on distressing side-effects should be available to those choosing an antipsychotic. Given the lack of correlation between high dose/combination antipsychotics and side-effects, treatment should be tailored to the individual based on response/tolerance and dose reduction/avoidance of polypharmacy should not be recommended to minimise side-effects.

Time of Day Matters: An Exploratory Assessment of Chronotype in a Forensic Psychiatric Hospital

A growing body of evidence links the late chronotype to mental illness, aggression, and aversive personality traits. However, much of what we know about these associations is based on healthy cohorts, and it is unclear how individuals with high levels of aggression, including forensic psychiatric populations, but not offenders, are affected. The present study aimed to measure chronotype in a forensic psychiatric inpatient population, evaluate the impact of diagnosis, and identify any interactive relationships between chronotype, diagnosis, aggression, and dark triad traits. Subjects completed the reduced Morningness-Eveningness Questionnaire (rMEQ), Munich ChronoType Questionnaire (MCTQ), Pittsburgh Sleep Quality Index (PSQI), Buss Perry Aggression Questionnaire-Short Form (BPAQ-SF), and Short Dark Triad Questionnaire (SD3). We sampled 55 forensic psychiatric patients (52 males) between the ages of 23 and 73 years (mean ± SD: 39.6 ± 14.3 years). Among the patients sampled, 25% were evening types and 36% were morning types. Eveningness was greater in patients with a personality disorder; however, no chronotype differences were found for psychosis patients. Patients without psychosis had a positive association between anger and eveningness, as well as between hostility and eveningness. For subjects with a substance use disorder, morningness was positively associated with narcissism. Conversely, an association between eveningness and greater narcissism was identified in patients who did not have a substance use disorder. These findings suggest that, compared to the general population, evening types are more prevalent in forensic psychiatric populations, with the strongest preference among patients diagnosed with a personality disorder. No differences in chronotype were identified for psychosis patients, which may be related to anti-psychotic medication dosing. Given the sex distribution of the sample, these findings may be more relevant to male populations.

To explore the efficacy of community rehabilitation for facilitating daily function among patients with mental illness

PURPOSE

To explore the efficacy of community rehabilitation for facilitating daily function among patients with mental illness.

DESIGN AND METHODS

A quasi-experimental design was used. Two hundred and sixty-four participants completed a daily living function scale questionnaire and provided disease-related information.

FINDINGS

Community rehabilitation was shown to be efficient in helping to stabilize mental illness and enhance daily function. Daily function had a significant and positive correlation with disease stability.

PRACTICE IMPLICATIONS

Community rehabilitation for patients with mental illness can effectively stabilize and prevent disability among those with mental illness.

Effectiveness of Adherence Therapy for People With Schizophrenia in Turkey: A Controlled Study

OBJECTIVE

This study used a quasi-experimental design with a pretest-posttest control group and follow-up to determine the efficacy of adherence therapy in patients with schizophrenia in Turkey.

METHODS

The sample of this study consisted of patients with schizophrenia (n=30). The Questionnaire Form, Medication Adherence Rating Scale, Internalized Stigma of Mental Illness Scale, and Beck Cognitive Insight Scale were used. The patients were assigned to experimental (n=15) and control (n=15) groups using the randomization method. The experimental group received adherence therapy in eight sessions.

RESULTS

When the scores of the patients in the experimental and control groups were compared at the pretest, posttest, and 3- and 6-months follow ups, a significant difference was only found in the Medication Adherence Rating Scale posttest scores.

CONCLUSION

Adherence therapy is effective in improving adherence to treatment but is not effective with regard to insight and internalized stigma in patients with schizophrenia.

Assessing clinicians' perspectives about the identification and management of antipsychotic medication side-effects: Psychometric evaluation of a survey questionnaire

Eliciting clinicians' views about antipsychotic medication side-effects may assist in understanding strategies that could enhance the identification and management of these side-effects. The present paper details the development and psychometric evaluation of a questionnaire that captures clinicians' perceptions about these issues. An initial item set was derived from a literature review, and then refined by an expert content validity panel that assessed the relevance of the items. The online questionnaire was distributed to Australian mental health nurses and 140 fully completed questionnaires were returned. Principal components analysis yielded two robust scales that conceptually tapped "system responsibility" and "personal confidence". These scales may be used to advance knowledge about how mental health nurses' attitudes towards the assessment and management of antipsychotic medication side-effects influences their clinical behaviour.

Exploring the views of nurses on the cardiometabolic health nurse in mental health services in australia

People with serious mental illness experience premature death due to higher rates of cardiometabolic conditions (e.g. cardiovascular disease, diabetes) than the general population. Mental health services often do not provide sufficient cardiometabolic clinical care to address these risks. The cardiometabolic health nurse (CHN) role has been suggested as a strategy for ensuring integrated care is provided and sustained. The views of nurses in mental health would be essential in informing the viability and development for this initiative. This paper presents the findings of open-ended comments from a cross-sectional online survey of nurses working in mental health in Australia (n  =  643) eliciting views about the possible introduction of the cardiometabolic nurse. Thematic analysis was undertaken, of 133 open comments on this topic. The findings suggest that nurses see the specialist role as suitable and valuable for mental health services. Some nurses voiced concern about specialisation leading to fragmentation (e.g. in responsibilities for physical health, division of mental and physical health care, and less emphasis on equipping all nurses with comprehensive care skills), especially for settings where generalist nursing was seen as already available. The findings suggest this role is viewed favourably by nurses, provided that it is consistent with holistic and comprehensive care. Empirical research is needed to see whether this role increases holism (as valued by consumers and nurses) and cardiometabolic outcomes.

Consensus statements on adherence issues in schizophrenia for Hong Kong

AIM

In view of the clinical importance of the adherence issues in schizophrenia management, a consensus group of experienced local psychiatrists and nurse specialists gathered to outline a number of consensus statements for clinicians to consider enhancing adherence in their patients.

PROCESS

Prior to the consensus group meeting, three core members drafted eight statements on the issue of adherence in schizophrenia. Using a modified Delphi method, published literature and published guidelines regarding the management of schizophrenia were reviewed by the full panel during the group meeting. After discussion and reflection from each individual member of the consensus group, the eight statements were reworded and electronically voted on anonymously in two steps: acceptance on quality of evidence and practicability in implementation.

RESULTS

After modifications of the original statements, there was very high overall level of agreement and acceptance (reaching international standard) on all the five areas of adherence within the eight statements of the finalised statement.

CONCLUSIONS

The present consensus statements are the first in Hong Kong to address systematically adherence issues in schizophrenia management. They include areas on adherence assessment and definition, treatment strategies in enhancing adherence, and treatment considerations at specific phases of schizophrenia. They are tailored to be of practical utility in the local Hong Kong setting.

Factors influencing adherence in long-term use of statins

PURPOSE

To assess the factors influencing adherence in long-term medication use as exemplified by statins.

METHODS

Data from an in-depth survey of Australians aged 45 years and over were linked to national prescription reimbursement data to assess medication possession ratio (MPR) for statins for the middle two years of a four-year period of statin possession. Poisson regression was used to calculate the relative risk (RR) for adherence (MPR ≥ 80%) for patient characteristics and factors related to access to and need for health care services. Separate models were fit for patients receiving healthcare concession subsidies and those who do not ('general beneficiaries').

RESULTS

In the analysis, 42 492 concessional and 16 110 general beneficiary patients were included, with 80.1% and 56.7% showing MPR ≥ 80%, respectively. In both models, RR for adherence was significantly elevated for older (age 65+) and less healthy (worse self-rated health, pre-existing heart condition or obese) individuals, and for those who had private health insurance. Significantly lower RR (i.e. more non-adherence) was found for individuals reporting speaking a language other than English at home, who were smokers, were employed, and had higher levels of education, and for those who reported psychological distress. Income had no significant relationship with adherence, and the pattern of adherence by remoteness of area of residence was inconsistent.

CONCLUSIONS

Poor adherence in long-term use of statins is commonplace, but a number of key predictors-including age, language other than English spoken at home, smoking status and psychological distress-are readily assessable by the prescribing practice.