Non-Compliance In Schizophrenia From Socio-Cultural, Familial And Environmental Perspective

Abstract

Introduction: Non-compliance significantly influences the course and outcome of treatment. Non-compliance in Schizophrenia is common and a major challenge globally due to need of long duration of treatment and other related factors. The objective of study was to identify patients with treatment non-compliance and associated factors in schizophrenia from socio-cultural, familial and environmental perspective.Material and Method: This study identified non-compliance in schizophrenia among 80 patients attending outpatient department at department of psychiatry, Devdaha Medical College, Rupandehi, Nepal. The study was a descriptive cross section study and purposive sampling, a type of non-random sampling technique was utilized for study. Ethical consideration was done throughout the study and informed consent was taken prior to the study. The questionnaire was given to those patients who had insight into the illness and who were able to understand the questions in the pro forma. Informants of patients with poor insight were given questionnaire to complete.Results: Out of 80 participants, majorities (57.5%) were male and 42.5% were female in the ratio 1.35:1. The mean age of respondent was 30.2±11.6. Approximately one seventh (13.75%) of them were illiterate, more than half (61.25%) had family income less than Nepalese rupees 10,000 a month. A significant proportion (15%) of family members did not know the role of them and relatives, and majority (76.25%) said that people contribute negatively. The different factors contributing to non-compliance were belief as non treatable illness (20%), significant life events (2.5%), migration (3.75%), lack of access of treatment nearby (72.5%), forget doctor appointment (11.25%), cessation of medication as per advise of faith healer (10%), stop medicine due to social stigma (15%), not monitoring patient on medication (15%) and discontinuation of treatment on refusal (11.25%).Conclusion: The study explored noncompliance in Schizophrenia from socio-cultural, familial and environmental perspectives. Multiple factors were identified that contributed for non-compliance directly or indirectly. The non-compliance is a preventable condition that needs an emphasis from different perspectives.J Psychiatrists’ Association of Nepal Vol. 6, No. 2, 2017, Page: 22-27

A cross-sectional, non-interventional study of the correlation between insight and adherence in schizophrenia in Nepal

“…Adherence to medication is affected by many factors, in Nepalese study populations it is recognised that availability and affordability of healthcare, alongside culture and beliefs of the patients can greatly affect compliance to medication [9,10]. This study found no significant variance in adherence between demographic groups, irrelevant of employment status, education or living arrangements.…”

“…This study substantiates this hypothesis, analysis found that insight positively correlated with adherence, also finding that awareness of need for treatment correlated with adherence. Although there is a clear association between insight and adherence, it would be an assumption to say that lack of insight is causative of non-adherence in these patients, as there are many other factors that could be contributing to the outcome of non-adherence [9,10,31].…”

“…This data was collected to explore the correlation between insight and adherence in schizophrenia; demographic data will be used for a variance analysis to observe for the effect of demographics on adherence. Potential confounders of adherence in this population include consulting a faith healer, complexity of drug regime, side effects, duration of illness and drug and alcohol misuse [9,10].…”

“…Non-compliance to medication is a huge challenge facing Nepalese healthcare, especially when treating psychiatric illness. Non-compliance in the Nepalese population has many contributing factors, including beliefs regarding psychiatric illness, migration, lack of access to nearby treatment, forgetting doctor's appointments, use of faith healers, social stigma, substance misuse, insight, unaffordability and more [9,10]. A study by Dhungana et al found that out of 80 cases of noncompliant patients with schizophrenia, 72.5% had lack of access to nearby treatment [9].…”

“…Non-compliance in the Nepalese population has many contributing factors, including beliefs regarding psychiatric illness, migration, lack of access to nearby treatment, forgetting doctor's appointments, use of faith healers, social stigma, substance misuse, insight, unaffordability and more [9,10]. A study by Dhungana et al found that out of 80 cases of noncompliant patients with schizophrenia, 72.5% had lack of access to nearby treatment [9]. In a study by Ghimire, unaffordability was found to be a factor in 68% of cases of poor compliance, whereas poor insight was only found to be a factor in 2% of cases [10].…”