medication compliance Dr. Mohammad Hussein March 2018

1. Schizophrenia;
from
Resistance to
Concordance
DR. MOHAMMAD HUSSEIN
CONSULTANT PSYCHIATRIST

2. History
1860
Morel
mence précoce
1892
Kraepelin
Dementia praecox
Manic-depressive
psychosis
Kraepelinian
dichotomy
1908
Bleuler
schizophrenia
Schneider
1959
Schneiderian first-
rank symptoms

3. course and outcome
 Kraepelin believed that schizophrenia had a
deteriorating course in which mental
function continuously declines,
 This led Kraepelin to name what we now
know as schizophrenia, dementia praecox
(the dementia part signifying the irreversible
mental decline).
1892
Kraepelin
Dementia praecox

4. Outcome of schizophrenia
22%
One episode only-
no impairment
35%
Several episode with
no or minimal
impairment
8%
35%
Episodic with stable
defect
Episodic with
progressive defect
22 35 8 35

5. medication
Would it help?

6. Different outcomes of never-treated and treated patients
with schizophrenia:
14-year follow-up study in rural China
Mao-Sheng Ran, Xue Weng, Cecilia Lai-Wan Chan, Eric Yu-Hai Chen, Cui-Ping
Tang, Fu-Rong Lin, Wen-Jun Mao, Shi-Hui Hu, Yue-Qin Huang, and Meng-Ze
Xiang
510 pts 123 572 people from 1994 to 2008.
Partial and complete
remission in treated group
never-treated
group
(57.3%) (29.8%)

7. Long term outcome
WITHOUT
TREATMENT
05
02
WITH
TREATMENT
05
02
60 – 80 % will
relapse within 2 years
100 % will
relapse within 5 years
20 – 40 % will
relapse within 2 years
50 % will
relapse within 5 years

8. Antipsychotics

9. CAUSES OF
NON-COMPLIANCE TO MEDICATION

10. CAUSES OF NON-COMPLIANCE TO MEDICATION
drugs
illness
family
pts
system
Family factors
System Factors
Patient factors
illness factors
Medication factors

11. CAUSES OF NON-COMPLIANCE TO MEDICATION
drugs
Medication
factors
 Lack of efficacy
 Side effects
 Cost of medication
 Complexity of regime

12. CAUSES OF NON-COMPLIANCE TO MEDICATION
pts
Patient factors
 Attitudes towards medication
 Education
 Stigma
 Social Isolation
 Personality Style – rebel against authority

13. CAUSES OF NON-COMPLIANCE TO MEDICATION
family
Family factors
 Denial
 Family attitude towards medication
 Stigma
 Alternative healing
 Complexity of therapeutic plan

14. CAUSES OF NON-COMPLIANCE TO MEDICATION
family
Family factors

15. CAUSES OF NON-COMPLIANCE TO MEDICATION
illness
illness factors
 Delusions
 Hallucinations
 Cognitive impairment
 Depression
 Lack of insight

16. CAUSES OF NON-COMPLIANCE TO MEDICATION
system
System Factors
 Cost of medication
 Transport factors – distance to travel to
access mental health services
 Lack of therapeutic alliance
 Inadequate supervision

17. Concordance
agreement between the patient
and healthcare professional,
reached after negotiation that
respects the beliefs and wishes
of the patient in determining
whether, when and how their
medicine is taken
from Resistance to Concordance
Compliance
1
Adherence
2
Concordance
3
Compliance
“the extent to which the
patient follows the health
professionals’ advice and
takes the treatment”
Adherence
the extent to which a person’s
behaviour corresponds with
agreed recommendations
from a healthcare provider

18. Dr mohammad hussein
www.nafsy.net
mh@nafsy.net
/nafsy.net
@nafsyclinic