`with psychosis as perceived by their family members attending the
`psychiatric outpatient departmentat selected hospital, Mangalore
`
`Bharat Pareek, Raman Kalia
`
`Abstract : Non-compliance or non-adherenceto treatment is the degree to whicha patient does not
`Carry out the clinical recommendation of a treating physician or in other wordsit is failure of the patient to
`follow the prescribed treatment regimen. A descriptive, co-relational study carried out to identify the factors
`affecting non-compliance to psychotropic drugs as perceived by patient'srelativesvisiting outpatient department
`of Father Mullar Mental Hospital Mangalore. A structured interview schedule was prepared and used for data
`collection from 100 subjects thosefulfil the inclusion criteria (relatives of the psychotic patients who are
`visiting to O.PD with the patients & staying with the patient at least last six months) by using purposive
`sampling method after getting their consent. Finding revealed that various factors perceived as contributing to
`non compliance, were disease characteristics related (62%), transportation problems (56%), poor community
`mental health services (55%), drug side effects (52%), cultural myth (49%), socialfactors (48%), psychological
`& motivational factors (47%), economic factors (43%), knowledge & insight (31%), illiteracy (36%), & other
`factors such as misconception about treatment & difficulty in swallowing the tablets contribute to non-
`compliance (17%). Thus,the presentstudy concludedthatthere are many factors which contributing to non-
`compliance among patients with psychotic illness. Therefore,it is recommended that more emphasis must be
`given on deinstitutionalization of mental health services and patient's family education to reduce the burden on
`health care expenditure due to non-adherence
`
`—
`Keywords
`NanCONBNANES. PBYONAIODG Grudge,
`psychoshs, non-adherence
`Correspondance at
`
`Bharat Pareek
`Lecturer & PhD Scholar,
`Saraswati Nursing Institute, Kurali
`Roopnager, Punjab.
`
`Introduction
`Non-compliance is a significant
`problem in all patient population, from
`children to elderly’.
`It applies to nearly ail
`chronic diseases and tend to worsen as longer
`a patient continues on drug therapy. Non-
`compliance is now a days is considered to be
`a major problem in health services of both
`developed and developing nations. Most of
`patients comply with treatment are between
`33% to 94%, with a median of 50% for long
`term therapy?
`NursingandMidwiferyResearch Journal, Vol-9, No.2, April2013
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`56
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`1
`
`Exhibit 2079
`Slayback v. Sumitomo
`IPR2020-01053
`
`
`
`Complianceis important becauseit is
`directly related to the prognosisoftheillness.
`Non-complianceis a serious problem and has
`many serious effects on overall treatment and
`prognosis of theillness. It is dangerous and
`costly, as in manyillnesses noncompliance
`may signal that patient and physician goals
`and priorities differ regarding the treatment
`andits schedule, Non-compliance is a major
`problem with almost all psychotropic drugs.
`The patient who are non-compliant are more
`severely ill at the point of readmission to
`hospital, have more frequent readmission,are
`more likely to be admitted compulsorily and
`have longerin patient stay.2°
`As per the statistics given in health
`information of India that psychosisis the most
`common mental disorder among the patients
`treated in specialized mental hospitalin India’.
`Psychosis is a major mentalillness in which a
`person may distort reality or when people
`demonstrate gross impairment in reality
`testing. It is the problem, which affect both
`male and female but more in male. The
`prognosis in psychotic patient is not very
`good always and recurrenceis very common
`due to non-compliance to medication ’
`Psychotropic drugs are now thefirst
`line treatment for almost every psychiatric
`illness with growingavailability of wide range
`of drugs to treat mental illness®. The patient
`on psychotropic drugs needs to take drug as
`prescribed andregular follow up is necessary
`to regulate long term therapy °. Some patients
`do not follow the prescribed treatment
`becauseof various reasons. Oneof the major
`factors for re-hospitalization is found to be
`
`non-compliance in taking drugs. Non-
`complianceis a personal behavior that deviates
`from health related advice given by health care
`professional" Poor medication complianceis
`found to be almost certainly the single most
`important factor in poor treatment response.
`The consequences of medication non-
`compliance are clinically equivalent to those
`of untreated or inadequately treated psychotic
`iliness.°
`Non-compliance behavior depends on
`specific clinical situation such as nature of
`iliness, treatment program etc.
`In general,
`about onethird of all patients never comply
`with treatment. An overall figure assessed in
`number of studies indicates that 46% of
`patients do not have compliance with
`treatmentat any given time"
`A study in USA found approximately
`50% of2 billion prescriptionsfilled each year
`wasnot taken correctly and resultin increased
`burden on health care expenditure. In India
`clear statistics are not available on non-
`compliance; however the situation is
`quantitatively similar across the globe.'’. The
`problem of non-compliance as significant
`cause of morbidity and mortality’?
`Non-compliance is
`the problem
`encountered by the all health professionals
`and it is not only the responsibility of nurses
`but also the responsibility of other health
`professionals to makethe patient and relatives
`aware about the importance of being
`compliant to their medication, since non-
`compliance delays the patient's restoration to
`full health.°
`
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`Psychiatric nurse spend the largest
`amount of time in direct patient contact &
`work with the long term management of
`psychiatric patients, the role of nurses become
`even more critical, particularly regarding
`psycho pharmacological treatment and the
`education of the patient and their families
`regarding compliance of these treatment
`agents"?
`The investigator while working with
`psychiatric patients noticed that manypatients
`with psychiatric illness get admitted with
`relapse. Keepingit in mind the present study
`conductedto identify the factors affecting Non-
`compliance to psychotropic drugs.
`Objectives
`To identify the factors affecting non-
`compliance to psychotropic medication as
`perceived by the family membersof patients
`with psychosis.
`Methodology
`This descriptive study was conducted
`on relatives of psychotic patients who were
`non-compliant to psychotropic medication at
`Father Muller Medical College & Hospital,
`Mangalore. Sample of 100 attendants who
`were visiting psychiatric outpatient
`departmentalong with patients were selected
`using purposive sampling technique.
`Interview schedule was prepared that
`composedof two parts. Part 1 consisted of
`10 socio-demographic variables of psychotic
`patient; part-Il: contained 40 questionsrelated
`to various factors affecting non-compliance.
`
`Eight experts of whom six from the field of
`psychiatric nursing and two from psychiatric
`medicine checked validity of the tool. Tool was
`translated into Kannada and Malayalam then
`again from Kannada and Malayalam to English
`and pre-tested on 10 subjects to check its
`Clarity, feasibility, and practicality.
`It took
`around thirty minutes on an average to
`complete the interview schedule. The
`respondedclearly and easily understood the
`language and no change made in final
`tool.The reliability of the tool was tested
`through split half method and reliability
`coefficient was found to be statically
`significant (p=0.78). The permission for data
`collection obtained from the concern authority,
`the investigator assured the anonymity to the
`subjects, and their consent obtained. The
`psychotic patients those were irregular on
`their follow up OPD visits were screened by
`evaluating their case files with the help of
`consultant psychiatrist and their relatives (who
`are visiting to O.PD with the patients & staying
`with the patient at least last six months)
`wereinterviewedby using interview schedule.
`Data was analyzed using descriptive statistics.
`
`Results
`Tables 1 represent the data regarding
`socio demographic characteristics of
`psychotic patients. 29% of the patients were
`in the age group of 36 to 45 years followed
`by 45 or above years (28%) whereas 25%
`were under age group of 18-25 years and
`restof the patients (18%) belonged to the age
`group of 26 to 35 years
`
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`Table 1: socio-demographic profile of psychotic patients
`N=100
`
`Age (in years)
`18-25
`
`26-35
`36-45
`
`Above 45
`
`Gender
`Male
`
`Female
`
`Joint Furthermore, it was observed that more
`
`than half of the patients (60%) were male
`whereas 40% were female. One third of
`patients (32%) studied up to primary school,
`23% up to PUC, 19% up to secondary school,
`10% wereilliterate whereas the equal numbers
`(10%) of patients were educated up to the
`graduation. Nearly half of the patients (46%)
`were having the total family income up to
`Rs.2000 per month, 22% were having income
`between Rs.2001 to 3000 per month, 13%
`between Rs.3001 to 4000 followed by 19%
`patients having family income above Rs. 4000
`per month. Most of patients (83%) were
`suffering from illness for more than 4 years,
`whereas few (13%) were suffering from
`illness with the duration of less than 4 years.
`Fourty percent patients were rural dwellers,
`32% were semi-urban (block level) dwellers
`and rest (26%)belonged to the urban area
`(district level & above). Two third of the
`patients (67%) were from nuclear family and
`rest (33%)lived in joint family.
`non-
`to
`Factors Contributing
`compliance as perceived by family members
`of psychotic patients:
`2 years
`Mostof the subjects (62%) perceived
`3 years
`the following disease characteristics as a
`4 years
`reason for non compliance of diesease such
`More than4years
`as chronic nature ofillness, many numberof
`Area of residence
`tablets need to be taken in a day & require
`City
`following long-term treatment regimen as
`Town
`highest contributing factor
`to non-
`compliance. Furthermore, transportation
`problem perceived as second mostimportant
`(56%) reason for non-compliance. The third
`highest (55%) related factor revealed to
`
`Educational Status
`Cannot read & write
`Can read & write
`
`Primary school(1-7)
`Secondary school(8-10)
`Pre-university (PUC)
`Graduate & above
`
`Total per month family incomeof
`Rs. 1000/- to 2000
`Rs. 2001/- to 3000
`Rs. 3001/- to 4000
`Rs. 4000/- and above
`
`Duration ofillness
`
`Village
`
`Type of family
`Nuclear
`
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`
`noncompliance was poor community mental
`health services whereas almost similar
`number of subjects (62%) perceived drugs
`side effects as contributing to non-adherence
`to treatment.
`Almost half of the study participant
`perceived Cultural (49%), social (48%) and
`psychological (47%) factors as reason for
`non-compliance. Economic factors (like
`shortage of money, cost of medicine etc...)
`perceived by 43% of study participant as
`contributing to non-compliance.The other
`factors related to non compliance were lack
`
`of knowledge, comprehensive and insight of
`iliness as perceived by 31% whereasilliteracy
`perceived by 36% study participant as cause
`of non-compliance. Difficult in swallowing the
`Tablets revealed as contributing factor of non-
`compliance by 23% of patient's relatives
`whereas misconception about psychiatric
`procedures like ECT and other procedures
`perceived by 11% as reason for non-
`compliance. This revealed that there are many
`factors contributing to noncompliance to
`drugs among psychotic patient. (Fig. 1)
`
`Fig.1 Factors Affecting Non-Compliance to Psychotropic Drugs
`
`Discussion
`There is a need for mentallyill patients
`to take the medications regularly especially
`the patients who are on long-term therapy in
`orderto preventrelapse of disease. However,
`it is observed that many patients do not
`comply with their treatment schedule.
`Administration of medication is a responsibility
`
`of the nurse or their relatives (at home)
`because the mentally ill patient (especially
`Psychatic Patient) lacks cognitive skill & insight
`to illness. They may notidentify the need for
`medications. Very few systematic studies had
`been doneonthis issues especially on factor
`associated with non-compliant.
`
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`
`Present study observed that most of
`the patients were male and in age group of
`26-45 years. Maximum numbers ofpatients
`(83%) were chronically suffering from illness
`(more than 4 years) and most of them belong
`to rural area. Two-third of the patients were
`belongs to the nuclear family and were having
`monthly income in between Rs.1000-3000/-
`The present study explored various
`factors as contributing to non-compliance,
`majority of the subjects perceived disease
`characteristics related factors as main reason
`for non-compliance.Transportation problems,
`poor community mental health services, drug
`side effects, cultural myth, social factors,
`psychological & motivational factors,
`economic factors, lack of knowledge & insight
`ofillness,
`illiteracy & other factors such as
`misconception about treatment & difficulty in
`swallowing the tablets were also revealed as
`contributing factors to non-compliance. These
`finding were consistence with finding of the
`study conducted by Taj. R Khan in Pakistan
`and reported commonest reason for non-
`compliance as lack of awarenessof treatment
`benefits, non-affordability of drugs, physical
`side effects.Both the study reported almost
`similar factor but different in magnitude based
`on amount of contributions to non-
`compliance”
`In present study stigma of illness,
`cultural myth,
`lack of knowledge about
`disease & treatment also reported as a
`contributing factor to non-compliance. These
`finding were consistent with the findings of
`Chan DW where the knowledgeof treatment
`and side effects, perceived stigma of the
`
`illness, personalbelief, werelinked to the non-
`compliance’.
`The present study explored many
`factors, which were associated with non-
`compliance, the similar factors were observed
`in many studies across the world’* ".
`In-
`consistency observed only among various
`factors in terms of their proportional
`contribution to non-compliance butthe all
`reported factors consistently found as major
`cause of non-complianceall around the world
`therefore it is recommended that psychiatric
`patients & their family members must be
`motivated to treatment adherence & mass
`level awareness program on mentalillness
`must be planned.
`Based on the finding of the present
`study it
`is recommendedthat a teaching
`program on importance of
`treatment
`compliance could be planned, conducted, and
`evaluated to find out the effectivenessnot only
`for the psychiatric patients but also for all
`patients who are on long-term treatment. A
`similar study can be conducted by
`considering large geographical area to explore
`the variations in the factors contributing non-
`compliances
`The findings of the study have number
`of implications for nursing practice.The
`nurses need to provide psycho-education to
`make patients and most importantly their
`relatives aware about the importance of
`regularly in treatment to prevent relapse.
`Nurses can also teach them about the their
`illness, side effects of the medication etc. The
`role here is educative and supportive to
`increase the self-care potentials of patients
`and their relatives.
`
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`
`
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