Chaudhari Bhushan, Saldanha Daniel, Kadiani Adnan, Shahani Roma
Department of Psychiatry, Dr DY Patil Medical College, Pune, Maharashtra, India.
Dr DY Patil Medical College, Pune, Maharashtra, India.
Ind Psychiatry J. 2017 Jul-Dec;26(2):215-222. doi: 10.4103/ipj.ipj_24_17.
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.
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.
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.
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.
治疗依从性差是精神分裂症成功管理的主要障碍。找出与不依从相关的因素以及不依从的原因对于提高精神分裂症患者的治疗依从性很重要。本研究旨在评估精神分裂症患者的治疗依从性及其相关因素。
借助包含社会人口学细节、疾病和治疗史信息、阳性和阴性症状量表（PANSS）以及莫里isky药物依从性量表-8的半结构式表格，对50例连续的精神分裂症患者进行横断面研究，以评估药物依从性。对不依从的患者进一步评估其不依从的原因。
在这些患者中，52%为低依从者（不依从者）。与不依从相关的因素包括患者年龄较小、男性、家庭收入低、PANSS评分较高（阳性、阴性及总分）、自知力等级较低、无精神疾病家族史、自行服药的责任、第一代抗精神病药物以及处方中的药物数量。患者给出的不依从的主要原因是药物不良反应、认为治疗无效、经济问题、对疾病和治疗感到羞耻和污名化、认为治疗不必要以及难以获得医疗保健机构服务。
我们的研究表明精神分裂症患者中不依从的比例很高，同时也揭示了相关因素和不依从的原因。对患者及其照顾者进行充分的心理教育以及心理社会干预，加强心理健康基础设施和社区心理健康服务将显著提高治疗依从性。
