Improving treatment adherence among patients with chronic psychoses

Refusal of prescribed drugs in a psychiatric hospital

Aims and methods

A survey of recorded refusal of drug administration to patients in a psychiatric hospital over a six-month period in 1996 was made using drug administration records. For comparison 150 patients were randomly selected from the 1975 drug sheets and instances of drug refusal noted.

Results

Eighteen per cent of patients refused drugs on at least one occasion, and of those over 65 years of age 26.2% refused drugs. All the main diagnostic categories and groups of drugs were involved. of the 150 patients studied from 1975 only four refused drugs.

Clinical implications

Doctors should be alert to the possibility of refusal of drug treatment in a wide range of psychiatric conditions. When refusal occurs interventions are likely to be necessary, including a review of drug treatment.

Attitude to medication of parents/primary carers of people with intellectual disability

OBJECTIVE

To investigate the influence of attitudes of carers of people with intellectual disability (ID) towards giving medication.

METHOD

Ninety-three carers of service users who are currently attending outpatients clinic (Harrow Learning Disability service) were interviewed, using the RAMS (Rating of Attitude to Medication Scale) interview schedule.

RESULTS

A significant association was found between relationship of the carer to the service user and overall positive or negative attitude towards medication, with a disproportionate number of parents expressing a negative attitude in comparison with professional carers (46% vs. 11%).

CONCLUSION

This study suggests more work needs to be done with family carers than with professional carers to improve compliance with medication. Stigma is still associated with ID and psychiatric disorders. The family carers responses may be projecting their feelings related to the impact of having a child not only with ID, but also with additional psychiatric problems. The implication of the study for psychiatrists is the identification of a number of areas that could be usefully explored before writing a prescription.

Effects of involuntary outpatient commitment and depot antipsychotics on treatment adherence in persons with severe mental illness

This study examines potential improvement in treatment adherence during a study of involuntary outpatient commitment among individuals with severe mental illnesses. Involuntarily hospitalized subjects, awaiting discharge under outpatient commitment, were randomly assigned to be released or continue under outpatient commitment after hospital discharge. A nonrandomized group with a recent history of serious violence was also studied under outpatient commitment. Randomized control and outpatient commitment groups did not differ significantly in group comparisons of treatment adherence. However, analyses of all subjects, including nonrandomized violent subjects, showed that those who underwent sustained periods of outpatient commitment (6 months or more) were significantly more likely to remain adherent with medication and other treatment, compared with those who underwent only brief outpatient commitment or none. Administration of depot antipsychotics also significantly improved treatment adherence independently of the effect of sustained outpatient commitment. Sustained periods of outpatient commitment may significantly improve adherence with community-based mental health treatment for persons with severe mental illness and thus may help improve other clinical outcomes affected by adherence.