Coarctation of thoracic aorta, with thrombosis of arch, treated by homograft.

Abstract

A patient who is prescribed drugs may take none of them, or he may take them for a short time and then stop, or he may take them irregularly. The answer to the question, " Is this patient taking his drugs ? " will depend on the criterion used. A verbal inquiry can compass some or all of the various ways in which a patient may not take his drugs. Urine tests for drug excretion give restricted answers, but have the advantage of objectivity, an advantage of particular importance in this context. In the present study a negative urine test for amphetamine-like substances (including a negative chromatogram where low dosage of chlorpromazine made the first test unsatisfactory) indicates that the patient had not been taking the drug during the previous 24 hours (or longer for imipramine patients according to dose). This might mean only a temporary and isolated lapse in taking his tablets, though sometimes of significant duration. The findings, however, that a second urine test usually gave the same result as the initial one, and that in multiple tests the results from any patient were usually consistent, suggest that a single negative test may generally be taken to indicate that the patient had not been taking his drug at all, or not with any regularity, for many days or weeks.The use of this criterion has demonstrated a failure rate of 48% in the whole series. This may be compared with failure rates of over 20% (Haler, 1962) and 33-40% (Benstead and Theobald, 1952) Our findings do little to elucidate the reasons why patients omit their drugs. Age, sex, intelligence, and side-effects had no apparent influence. The fact that men living alone defaulted more often than those living with their wives suggests a beneficial influence of supervision. The failure rate varied with diagnosis and with the drug, but our observations suggest no simple explanation.While the causes may remain obscure, the fact seems to be established that a very large proportion of psychiatric outpatients fail to take their drugs. Some consequences of the extent of this failure may be mentioned. There is a considerable waste of drugs and money. The accumulation of unused drugs in the homes of patients is a source of danger. Drug trials in which there is no reliable check on whether the patients are taking the drugs as prescribed can be seriously misleading. SummaryTests were made of 125 psychiatric out-patients to ascertain whether they were taking the chlorpromazine or imipramine that had been prescribed.Criteria of failure to take the drugs were based on information of the drugs' excretion by in-patients, and included both a quantitative test and sensitive and specific chromatographic tests.The results indicate that the failure rate for the whole series was 48 %. The rate for patients prescribed chlorpromazine was slightly higher than that for those prescribed imipramine, and was also higher for depressives than for schizophrenics within the chlorpromazine group.Failure rate was not associated with age, sex, intelligence, or drug side-effects.The...