Medication Adherence with Clients with Schizophrenia - Essay Example

? A Review of Related Literature Medication Adherence in with Schizophrenia Individual with schizophrenia undergo different symptoms that lead to serious distress and inhibit role and social skills. The most usually adopted strategies for treating people with schizophrenia involve the administration of antipsychotic drugs. Antipsychotic medication has been reported to be effective in treating schizophrenia. Unfortunately, many individuals with the disorder do not adhere to their prescribed course of therapy, which leads to a considerable deterioration in the potential of antipsychotic medication. The prevalence of medication non-adherence has been reported to be almost half of the total population of patients with schizophrenia (Tabor & Lopez, 2004). The prevalence could even be higher considering that the figures do not count patient with schizophrenia who decline treatment or quit routine check-up. Hence, a frequent cause of treatment failure is medication non-adherence, and the most widespread kind of non-adherence is inadequate use of these drugs. The consequences of non-adherence involve disruption of work activities and home life, re-hospitalization, and recurrence of psychotic symptoms. Monitoring adherence to medications and evaluating side effects is an important medical task when caring for patients with schizophrenia (Higashi et al., 2013). This essay reviews the literature on medication adherence and non-adherence in patients with schizophrenia. Determinants of non-adherence to medication can be classified into four, namely, patient-based aspects (e.g. gender, age, income, education), health-based aspects (e.g. substance abuse, duration of ailment, symptomatology), aspects related to antipsychotic medication, and socio-environmental aspects (e.g. social support, relationship between healthcare provider and patient). The literature review of Higashi and colleagues (2013) explains that there are numerous studies that investigated the correlation between socio-demographic factors (e.g. gender, age, education) and medication non-adherence but discovered no consistent relationship. There are findings revealing that adolescents are less likely to adhere to medication than their older counterparts. Several studies have discovered no relationship between gender and non-adherence, but some researchers, like Tunnicliffe and associates (1992 as cited in Higashi et al., 2013), discovered that females have a greater tendency than males to adhere to anti-psychotic medication. It has also been reported that certain ethnic minority groups, such as African Americans, tend to be noncompliant. But there are other researchers, such as Owen and colleagues (1996 as cited in Higashi et al., 2013), who found no correlation between ethnicity and medication non-adherence. The researchers conclude that almost all studies report little or no correlation between socio-demographic factors and medication adherence. Lack of insight is a major attribute of individuals with schizophrenia. It is easy to understand why individuals with poor awareness have showed a greater risk for noncompliance to medication. There is no definite explanation of awareness in psychotherapy, but usually, it means understanding of one’s sickness and its outcomes or effects (Kozuki & Froelicher, 2003). Rusch and Corrigan (2002) enumerate four features of awareness: cognitive features, adherence based features, symptom based features, and temporal features. Lack of awareness has major therapeutic, clinical, and social significance. Nevertheless, its repercussions on medication adherence are most vital in the recovery period of schizophrenia. The patient’s extent of awareness of the disorder is directly associated with his/her attitudes toward or beliefs about the treatment. Rusch and Corrigan (2002) found out that psychological coping mechanism and neurocognitive problems may worsen lack of awareness. They also discovered that awareness predicted adherence to psychosocial therapies for schizophrenia. Lastly, they discovered that motivational interviewing can effectively enhance awareness and medication adherence in individuals with schizophrenia. Symptoms like delusion, aggression, confusion, and paranoia have all been related to medication non-adherence. The literature review of Linden and associates (2006) shows that medication non-adherence has been directly associated with the seriousness of the symptoms of schizophrenia. But there are some researchers, such as Bartko and colleagues (1988 as cited in Linden et al., 2006), who found no correlation between the seriousness of a client’s symptoms and medication noncompliance. They discovered that suspiciousness, aggression, hallucinations, and paranoid delusions will heighten the severity of non-adherence. The researcher discovered that patients with schizophrenia who adhered inadequately to medication had substantially more severe, negative symptoms of the disorder, particularly indifference and lack of motivation. Comorbid substance abuse is prevalent in schizophrenia. Continuous consumption of alcohol and use of illegal drugs can speed up a relapse that could necessitate greater amounts of antipsychotic medication to calm down the patient. Hayhurst and colleagues (2010) found out that patients with substance abuse and poor medication adherence have a greater tendency to be repeatedly hospitalized. They found out that patients with substance abuse were several times more likely to refuse to adhere to medication than others who did not have substance abuse. Other researchers, like Olfson and associates (2000), studied the factors related to medication non-adherence and found out that substance abuse came out as the major determinant of non-adherence to medication. These researchers also report that patients with a history of substance abuse may be more distressed or anxious which may itself result in a persistent habit of non-adherence and deteriorating mental condition. The correlation between medication non-adherence and negative side-effects is another unresolved issue in the medical field. Some researchers have constantly observed a connection with side-effects, whereas others have not. It has also been reported that patients who suffered from negative side effects had greater adherence than patients who did not. Higashi and colleagues (2013) discovered in their study of patients’ rejection of antipsychotic medication that the most widespread cause of non-adherence is aversion to adverse side-effects, alongside uselessness of medication and stigma of mental disorder. Generally, social network and family support are related to favorable outcomes in clinical interventions verifying the fact that the greater support a patient receives from his/her family or friends, the more favorable the outcome. Empirical findings prove that patients with schizophrenia getting adequate support from their families are more likely to adhere to medication than those receiving little or no family support (Sellwood et al., 2003). Olfson and colleagues (2000) discovered in patients assessed after discharge from hospital that those whose families declined to take part in patient medication were more likely to refuse to adhere to antipsychotic treatment. They also emphasized that involving family members in discharge preparation can boost adherence and outcome. Moreover, taking anti-psychotic medication can be construed as a sign of being weak or socially apathetic, and some may become troubled with the idea that prolonged, intensive medication may result in addiction (Olfson et al., 2000). A cynical and frequently adverse belief about chemical medication of mental disorder may be widespread in society, and individuals can have previous assumptions or mistaken beliefs about medication which could serve as a path to the willingness to acknowledge suggestion. In the study of Sellwood and associates (2003) the communicated feelings of the caregivers were discovered to be a major feature of adherence to medication in schizophrenia. They discovered that if individuals with the disorder live with caregivers who are highly communicative of their emotions, they are more likely to adhere to medication than if they live independently. Even though several psychosocial treatments for schizophrenia have been developed recently, knowledge is incomplete about their efficacy in discouraging non-adherence to medication. The efficacy of several approaches and programs like case management, family education, social skills training, and psychotherapy in reinforcing adherence has been reviewed (Thornton et al., 2006). Zygmunt and associates (2002) presented a thorough assessment of psychosocial approaches for encouraging medication adherence and made a conclusion that psychosocial approaches without complementary supportive services and behavioral elements are less likely to enhance adherence to medication in schizophrenia. Yet, they discovered that community care approaches like assertive community interventions derived from rules of motivational interviewing are show more potential than other psychosocial treatments. They suggested several techniques to enhance adherence: giving sympathetic, encouraging feedback for adherence; adapting to everyday routines; administering medication regimes step by step; supporting the involvement of patients in their own care; encouraging the patient to take part in the process of decision making; giving clear, written information and directions; and keeping treatment uncomplicated (Zygmunt et al., 2002). Knowledge about the understanding that individuals with schizophrenia have about their health condition and medication is relevant to medication adherence. Rusch and Corrigan (2002) interviewed several individuals with schizophrenia who were confined in the hospital for acute medication. They discovered that majority of the respondents were aware of their treatment regimen and only a few were informed of the right dosage. They discovered that providing information or education to the patients and their families about side effects, medication outcomes, and symptoms has the capability to reinforce adherence in patients with schizophrenia. Moreover, skills training courses which include acquiring details about treatment, as well as side effects and advantages, and cooperation with healthcare providers were found to be quite useful in enhancing adherence. It was also discovered that helping and permitting patients with schizophrenia to take their medication on their own, which is an essential skills training, improved adherence to medication. The effectiveness of motivational interviewing in encouraging adherence to medication has also been reported. In this approach, patients are persuaded to express favorable outcomes of complying with medication (Rusch & Corrigan, 2002). Based on this, Zygmunt and colleagues (2002) formulated an ‘adherence treatment’ that provided patients the chance to evaluate the favorable and unfavorable aspects of antipsychotic medication. They found out that this strategy increased rates of adherence. Hayhurst and colleagues (2010) studied the outcomes of psycho-educational approaches and behavioral modification in medication adherence. The behavioral modification approach required finding an appropriate location for administering treatment, complementing medication with certain behavior and furnishing a self-assessment form. As expected, behavioral modification participants displayed a considerably greater adherence than the control group. Educating individuals with schizophrenia and their families about the relapse prevention and biological attributes of the disorder, using memory-enhancing and cognitive techniques and encouraging the involvement of the community will also increase the possibility of medication adherence (Hayhurst et al., 2010; Thornton et al., 2006). Several psycho-education-based approaches like home based outpatient services, cognitive reconstruction of attitudes within the family, and providing details about the use and side effects of the treatment have been discovered to be related to increased adherence to medication (Thornton et al., 2006). Sellwood and colleagues (2003) examined the efficacy of behavioral family therapy in individuals with schizophrenia. Those who were involved in the intervention showed greater rate of adherence than the control group. They used pharmacotherapy to further increase adherence and reported greater rate of adherence in the intervention group. The difficulty of the medication regimen has also been discovered to discourage medication adherence. The side effects of medication are significantly correlated with non-adherence to medication. The antipsychotic medication is associated with several side effects like weight gain, sexual problems, and neuroleptic dysphoria. However, with better side effects and greater effectiveness of the newer antipsychotic medications than the old ones medication adherence has considerably increased (Sellwood et al., 2003). Despite of the attempts made in the field of psychosocial therapy and the advancements in medication-based reports, medication non-adherence in individuals with schizophrenia remains a major problem. Conclusions Medication non-adherence is a serious problem confronting healthcare professionals. In an illness like schizophrenia, where non-adherence unavoidably will result in relapse and often to repeated confinement, the cost of non-adherence is substantial. The intricacy of aspects influencing adherence is emphasized in this literature review. As an outcome of this intricacy it is apparent that no particular technique can be adopted to boost the rate of medication adherence of individuals with schizophrenia. Even though there is no definite agreement as what factors influence or do not influence adherence, there is adequate proof that aspects like level of awareness of the disorder, substance abuse, demographic factors and those related to antipsychotic medication, significantly affect the possibility of patients with schizophrenia complying with their medication. Moreover, the identification of these aspects highlights the major responsibility of the nurse in improving adherence to medication and thus alleviating the affliction and helping with the improvement of the patients’ condition. Nursing practice has a very important contribution to the mitigation of negative side-effects; providing information and psycho-education to raise awareness; and the development of a more secure, stable, and sympathetic social environment. References Hayhurst, K., Drake, R., & Lewis, S. (2010). Patient factors associated with receipt of combination antipsychotic drug therapy in the treatment of schizophrenia. Journal of Psychopharmacology, 24(1), 83-89. Higashi, K. et al. (2013). Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Therapeutic Advances in Psychopharmacology, 3(4), 200-218. Kozuki, Y. & Froelicher, E. (2003). Lack of Awareness and Non-adherence in Schizophrenia. Western Journal of Nursing Research, 25(1), 57-74. Linden, M., Scheel, T., & Eich, F. (2006). Improvement of patient compliance after switching from conventional neuroleptics to the atypical neuroleptic amisulpride. Journal of Psychopharmacology, 20(6), 815-823. Olfson, M. et al. (2000). Predicting medication noncompliance after hospital discharge among patients with schizophrenia. Psychiatric Services, 51, 216-222. Rusch, N. & Corrigan, P.W. (2002). Motivational interviewing to improve insight and treatment adherence in schizophrenia. Psychiatric Rehabilitation Journal, 26(1), 23-32. Sellwood, W. et al. (2003). The family and compliance in schizophrenia: the influence of clinical variables, relatives knowledge and expressed emotion. Psychological Medicine, 33(1), 91-96. Tabor, P. & Lopez, D. (2004). Comply with Us: Improving Medication Adherence. Journal of Pharmacy Practice, 17(3), 167-181. Thornton, A. et al. (2006). The impact of atypical antipsychotic medications on long-term memory dysfunction in schizophrenia spectrum disorder: a quantitative review. Journal of Psychopharmacology, 20(3), 335-346. Zygmunt, A. et al. (2002). Interventions to improve medication adherence in schizophrenia. American Journal of Psychiatry, 159, 1653-1664. Read More