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The paper "How Medication Compliance Affects Schizophrenia in Male Involuntary Patients" highlights that generally speaking, there is a high need to change the involuntary process of treating schizophrenic male patients to reduce the high lapse rates…
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How medication compliance affect Schizophrenia in male involuntary patients al affiliation: Table of Contents Compliance to medication has remained a stabling block on the way to involuntary treatment of schizophrenic patients. Specific highlight to male patients points out resistance and negative behaviors that limit compliance. In this light, the study seeks to determine how medication compliance affects Schizophrenia in involuntary treatment processes. Compliance is a deliberate process by patients to follow prescription from health professionals in the route to discovery. It has a great connection with the ability of patients to recover. The research relies on comprehensive analysis of secondary data including existing literature such as peer reviewed journals, books and information sites. Based on the findings, the study discusses and creates a connection between compliance, schizophrenia and the existing effects on male recovery process. Furthermore, the research seeks to establish routing causes of non-compliance in the attempt to create the connection.
Introduction
In the field of medicine, compliance also known as capacitance, adherence, or Concordance is the degree and willingness to which a patient suitably follows medical prescriptions from health professionals. Ordinarily, it refers to drug compliance, but the vast medical field can also attribute it to other situations such as medical equipment use, self-directed training, self care or psychological sessions (Fadem, 2014, p. 106). Notably, compliance is a tricky situation affected by both the patient and the health-care giver. Arguably, a positive physician-patient rapport is the most imperative factor in re-shaping compliance; nonetheless the soaring cost of prescription medication also contributes a major role (McEvoy, 2006, p. 16). In many circumstances, compliance gets confused with concordance; however, the latter remains the course by which a healthcare provider and patient make decisions together regarding a treatment process. Chief barriers to conformity include poor health literacy, ethnicity, age difference, the complexity of contemporary medication regimens, course completion, and lack of conception to treatment benefits. Concurrently, cases of non-discussed percussions, poor communication and high cost of prescription medicine greatly affect compliance. Undeniably, efforts to positively transform compliance aims at simplifying prescription packaging, initiating effective medication reminders, improving patient instruction, and reducing the number of simultaneous medications.
Globally, non-compliance is a foremost impediment to the successful delivery of health care. According to Estimates World Health Organization (2003) only 50% of patients suffering from chronic diseases mainly found in developed countries stick to treatment recommendations (Espejo, 2012, p. 65). Low rates of observance to therapies for hypertension, asthma, and diabetes are considered to contribute substantially to economic and human conditions (Amador, 2009, p. 62). Compliance figures may be overvalued in the medical writings, however, an extensive analysis of compliance proves the case. Patients suffering from psychiatric disorders refuse medications for a multiplicity of reasons constituting fear or experience with side effects. Additionally, the refusals are based on limited awareness of complication or delusional beliefs. Patients who follow this line must be medicated involuntarily. One disease that has attracted non compliance in the medical field is Schizophrenia. It is a brutal mental disorder that affects seven out of every one thousand adults in the world. The incidence of schizophrenia is low but due to the condition’s chronic nature, its prevalence is high (American Psychiatric Association, 2006, p. 67).
Noncompliance with prescription during asymptomatic phase is a universal problem in the treatment of male schizophrenia patients. For example, male patients are engrossed in a number of negative activities such as drinking that limit compliance (Torrey, 2006, p. 21). This is very dangerous despite happening under the direction of a psychiatrist. Evidently, studies believe that the long-term complications of involuntary medication on individuals with schizophrenia and other manic-depressive illnesses (bipolar disorder) are more positive and produce better results (Tandon, Keshavan & Nasrallah, 2008, p. 17). Based on research, majority of patients retrospectively agree to involuntary medication that it is in their best interest. Anecdotal depositions by opponents of involuntary medication attempt to sway public knowledge that it has devastating, widespread, and lasting effects remain unfounded (Buckley, Miller, Lehrer & Castle, 2009, p. 384).
In the event that people suffering from schizophrenia do not approve the treatment, mental health professionals, families, friends, and the legal system may have to wait for actions that threaten, challenge, or comprehensive acts that might, or do harm. In case, this happens they are involuntarily admitted to hospital after which compulsory community (outpatient) behavior orders are initiated. When schizophrenia is left untreated for long periods, it unfavorably affects a person’s psychological state, leading poor outcomes (Van & Kapur, 2009, p. 636). It affects work and normal life hence risking the life of the surrounding population. Whilst many countries maintain the use of Obligatory Dangerousness Criterion to establish whether involuntary treatment is necessary, some countries have also initiated other methods. In the United Kingdom (UK), some parts of Canada and Europe, for example, involuntary treatment is allowed even if patients have not been proven to be dangerous.
Based on the 2003 announcement on medication adherence, the World Health Organization (WHO) quoted the proclamation by Haynes et al., which said that mounting the effectiveness of adherence solutions may have an extensive shock on the health of the populace than any other enhancement made in medical treatments (Boden, 2011, p. 83). The research was act as an eye opener to the many people who regard involuntary treatment as a sure way of recanting hope for patients. Poor adherence to medication fronts increased morbidity and ultimately death, which is estimated to costs approximately $100 billion annually (Schultz, North & Shields, 2007, p. 1828). Despite commitment to improve patient-doctor relationship for over 2000 years, more problems still arise. In the contemporary world, more complex medical regimens build it even less likely that health practitioners will to oblige compliance and partnership with patients in doing what is right for successful recovery.
Objective
To determine how medication compliance affects Schizophrenia in male involuntary patients.
Arguably male Schizophrenia patients subjected to involuntary medications show limited compliance. It, therefore, is the objective of the paper to assess the relationship between medical compliance and aspirations involuntary male Schizophrenic patients.
Methodology
The research was mainly a survey research aimed at reviewing secondary data sources and literature. The purposive study furthermore seeks to conduct an institutional assessment with regards to professional health judgments to find resultant effects of involuntary Schizophrenic patient treatments. While assessing, this compliance of the same patients is important as this form the gist to the main study. While reviewing, the existing literature, the study will seek to find out why involuntary hospitalization of Schizophrenic male patients is necessary. This is substantiated by the rights of patient under involuntary treatment, reactions of patients towards involuntary treatment, and most importantly compliance of the patients towards treatment. The clinical question of how medication compliance affects Schizophrenic situations will also find answers after finding out the amount of patients who appreciate and recover from the process. This will help in unearthing the vast information in the widening gap of medical compliance within psychological patients.
Findings
Male schizophrenia patients’ manifest unethical misconducts in the medication process that affect compliance. They have a heavier smoking pattern contrary to the general schizophrenic population. Although assumptions propose that smoking can ease symptomatology of schizophrenia and lessen side effects of antipsychotics no evidence exist to prove the assertion. Both male and female involuntarily hospitalized patients uphold a number of rights, some of which are purposely connected to the commitment. Such rights include information of commitment, representation by an attorney, opposition to confinement, incidence at the commitment hearing, independent psychiatric examination, trial by jury, and transformation to voluntary status. Extra civil rights of the mentally ill regardless of status include humane care and treatment in the slightest restrictive setting, which has open communication to the outside world. They also have privileged meetings with their attorney, physician, visitors or the clergy. Most importantly, they have a confidentiality of records, ownership of their own money and clothing, compensation for any work undertaken in the hospital (Boden, 2011, p. 84). Conceivably, many of the rights may be provisionally restricted by the staff if deemed necessary; however, treatment cannot be forced. These are some of the rights that have caused commitment and compliance difficult for schizophrenic patients hence limiting treatment. Most patients feel protected by the rights rested upon them by the law hence making involuntary treatments difficult.
The disappointment of male schizophrenic individuals to take prescribed medications mainly mood stabilizers or antipsychotics such as lithium remains one of the vast problems in psychiatric care. It often fronts reversion of symptoms, homelessness, re-hospitalization, and incarceration in prison because of episodes arising from violence or victimization (McEvoy, 2006, p. 16). Non-compliance is not only a problem in schizophrenic cases but also for other medical conditions, which rely on prescriptions for long periods, including epilepsy, diabetes, hypertension, asthma, and tuberculosis. Medication compliance may be total but is partially defined as a failure to take 30 percent or more of the set medication. The single most considerable reason patients with schizophrenia fail to take their medication is due to their lack of consciousness of their illness (Van & Kapur, 2009, p. 638). Other important reasons include concurrent drug abuse, costs, and a worsening relationship between psychiatrist and patient. A mounting body of facts points to lack of insight as a medically based condition that is responsible for non commitment to prescription. Evidently, half of the people with schizophrenia may not be obtaining the treatment the needed treatment because of a brain deficit, which renders them unable to recognize that they are ill (Amador, 2009, p. 62).
According to according to Amador, a director of psychology at the New York State Psychiatric Institute and professor of psychology in the department of psychiatry at Columbia University College of Physicians and Surgeons, Compliance of male schizophrenic patients is very important in involuntary treatments; however, people with this condition do not accept as true that they are ill notwithstanding evidence to the contrary (Fincham, 2005, p. 72). People have illogical and bizarre elucidations for symptoms and life situations stemming from their illness. This further complicates compliance to schizophrenia treatment. Though the number of involuntary hospitalizations in comparison to total psychiatric admissions has considerably decreased from 90% in 1949 to 55% in 1980 in the United States, civil assurance of the mentally ill is a clear route for inpatient treatment (Stillwell, Fineout-Overholt, Melnyk & Williamson, 2010, p. 59).
Male patients without compliance have inability ability to show no recognition of their mental condition. In this effect, the non commitment attracts suicidal complications for unwilling patients to seek treatment. Individuals who reject that they have any illness, which needs treatment may portray behaviors that subject themselves or others in danger. On the other hand, patients may identify their symptoms as a fraction of an illness but disagree with recommended treatment (American Psychiatric Association, 2006, p. 67). Untreated depression or psychosis can have overwhelming effects on both the sick individual and surrounding people. Arguably, such effects include assaults, suicide, inadvertent misfortunes stemming from delusional thinking, social and financial ruin as well as the inability to take care for personal needs. Due to lack of insight, civil assurance may be initiated to help compliance.
Treatment of schizophrenia is often convoluted by patients lack of insight into the disease, sporadically warranting involuntary treatment. Approximately 40% of people with schizophrenia cannot recognize that they have the disorder (Leucht, & Heres, 2006, p. 06). This is for the reason that part of the brain damaged by schizophrenia is also accountable for self-analysis. With schizophrenia, one asks the sick brain to analyze itself, which is impossible. Compliance with medication is a chief problem for people with many chronic diseases such as hypertension, diabetes, and rheumatoid arthritis (Kane & Correll, 2010, p. 81). For schizophrenia, it is problematic due to the relapse high rate. Failure to comply with involuntary medication may lead to various problems (Courtney & McCutcheon, 2010, p. 112).
On the other hand, compliance significantly faces threat from Anosognosia which makes the person unaware of illness hence no valuing the sickness. In general drug abuse affects rationality of patients limiting their capacity to make choices based on their health (Smith, Weston & Lieberman, 2010, p. 340). In many cases, patients under the poor influence of drugs forget or divert resources from the right direction of discovery. Arguably, health systems have various assistants in terms of doctors, nurses as well as other personnel. Poor relationships arising from the mental health providers can greatly discourage patients from directly gaining treatment. The poor relationships range from unclear instructions to harsh or non-personalized care (McEvoy, 2006, p. 16). A poor bond between psychiatric staff and patients is a factor in patients’ non-adherence to medications. It is a poor therapeutic alliance that subjects patients to danger rather than discovery.
Notably, male schizophrenic patients are the most tricky to deal with since they know they are right while they have no capacity to judge. Such relationships include psychologists, psychiatrists, social workers, nurses, and psychiatric assistants in both outpatient and inpatient units. It requires activities such as allocating enough time to listen to patients, explaining things, treating them with esteem, and accommodating them in feasible treatment decisions. This marks a primary step towards compliance and ultimately full recovery (Tandon, Belmaker, Gattaz, et al..2008, p. 29). In limited cases, medication side effects affect compliance of patients towards gaining medication. As a matter of fact, side effects need professional assistance; however, when consistent it discourages commitment to compliance. Based on studies of individuals in the first-episode schizophrenia, 82 percent relapse within five years due to non-compliance with medication. A national investigation of Americans identified individuals with severe mental illness who were not getting treatment because of the actions. As expected, most patients wanted to provide solutions to their own problems while other believed they had no problem.
Discussion
Medication compliance remains a major problem to recovery of male involuntary schizophrenic patients. It affects the general process from different perspectives. To start with is the many rights accorded to patients which although is necessary prevents smooth administration of involuntary health procedures (Torrey, 2006, p. 17). By allowing patients the rights to information of commitment, representation by an attorney, opposition to confinement, incidence at the commitment hearing, independent psychiatric examination, trial by jury, and transformation to voluntary status. Involuntary medication naturally becomes a voluntary process, which relies on willingness of the patients. In this light compliance is based on the patient’s goodwill but restraints from existing laws.
Arguably, medication compliance is a process of ensuring patient follows medical prescriptions from health professionals (Hor &Taylor, 2010, p. 88). It involves providing the serene environment and people required to smoothly facilitate the whole process. Despite commitment to ensure patients recover well, commitment is fairly difficult as patients have the ability to question and rightfully claim wrong decisions. For instance, schizophrenic patients lack the rationality to make decisions yet they believe they right. This makes the whole involuntary process ineffective as they rely on their already damaged brain to make choices on what to do at home and hospital (Boden, 2011, p. 84).
Non compliance by male schizophrenic patients results to homelessness, re-hospitalization, and incarceration in prison due to episodes of violence or victimization. On the other hand, compliance leads to full recovery and proper care (American Psychiatric Association, 2006, p. 67). Despite the latter, presenting a vast hope, patients chose noncompliance from patients who cannot recognize their own disorder. Contrary to expectations, they engulf in massive drug abuse despite involuntary steps to save their lives. Arguably, alcohol and other drugs magnanimously complicate health status of sick people. For example, alcohol lead to cancer and impaired judgments that further makes schizophrenic diseases complex. From this perspective, compliance is a key to patient’s recovery, but at the same time spoils the whole involuntary process.
Research has proven beyond reasonable doubt that adherence to prescription restores rationally. Schizophrenia leads to memory lapse and loss, which makes one unable to make decisions. In any case a schizophrenic person makes a decisions, he cannot account for it they are not able to rationally appraise. As a result, they are not needed in crucial decisions that require future considerations (DeLisi, 2011, p. 23). Arguably, Schizophrenia causes hallucinations and delusions leading to weird behaviors. These actions can harm people around or the patient himself. Based on research, one third of the schizophrenic patients commit suicide as a way of deliberation from the pain (Fadem, 2014, p. 112). The trend is worrying because involuntary processes create high chances for saving the patients. Conceivably, it is very difficult for patients suffering from schizophrenia to share their suicidal intentions with family or others. Making right decisions of saving them event within involuntary confinements, therefore, is difficult. This makes commitment to compliance a major factor that greatly shapes the patient’s recovery process (Kane & Correll, 2010, p. 81).
Compliance is not a one way strategy of recovery but two sides of the same coin. The process requires dedication from the doctors and medical practitioners and not only patients. Doctors have a leading role in modifying their environment to accommodate patients in various ways. For example, patients have to be subjected to accommodative decisions making despite professional decision making from doctors. In addition, it is the role of health practitioners to fabricate information in a manner that suites patient’s interest. However, this should be done while taking note of ethical considerations. The modifications should include cost considerations, which is a key factor that prevents patient’s commitment. Affordable services accosted with efficient health delivery systems guarantees success of schizophrenic cases.
Conclusion and recommendations
Conclusion
Involuntary schizophrenic medication has no use in male patients without compliance. Male patients like binge drinking, making harsh decisions and resisting different medications for varied reasons. Arguably, compliance is the ability of patients to succinctly follow doctor’s directives. The disease affects their brain limiting the ability to make rational decisions. Subsequently, they have no ability to differentiate between good or bad things making them a liability in terms of decisions. Despite this, they have rights and privileges that protect them from any form of harsh decisions. For this reason, many have not succeeded in making helpful decisions making compliance a block in the involuntary process of treatment. Failure to commit to health recovery procedures mainly arise from lack of awareness, high cost of medication, unfriendly environments, and Anosognosia
Recommendations
There is high need to change the involuntary process of treating schizophrenic male patients to reduce the high lapse rates. In this light, there is necessity to incorporate technology in research and treatment process. This helps in curtailing long procedures while at the same time promoting efficiency. It is also evident that awareness creation is inevitable. The process helps in building the capacity of patients to handle sensitive information while allowing others to make rational choices on their behalf. There is also need to revolutionize the hospital environment as well as treatment costs to accommodate all patients. This promotes compliance to the already widening treatment process.
References
Amador, X. (2009). Poor Insight in Schizophrenia: Overview and Impact on Medication Compliance. New York: McMahon Publishing Group
American Psychiatric Association. (2006). Evidence-Based Treatments for Schizophrenia: Information for families and Other Supporters. Arlington, VA: American Psychiatric Association.
Boden, R. (2011). Early non-adherence to medication and other risk factors for rehospitalization in schizophrenia and schizoaffective disorder. Schizophr Res, 133, 36–41.
Buckley, P. F., Miller, B. J., Lehrer, D. S. & Castle, D. J. (2009). Psychiatric co morbidities and schizophrenia. Schizophr Bull, 35 (2), 383–402.
Courtney, M. D., & McCutcheon, H. (2010). Using evidence to guide nursing practice 2nd ed. Sydney: Churchill Livingstone/Elsevier.
DeLisi, L. E. (2011). 100 questions & answers about schizophrenia: painful minds (2nd ed.). Sudbury, Mass.: Jones and Bartlett Publishers.
Espejo, R. (2012). Mental illness. Detroit: Greenhaven Press.
Fadem, B. (2014). Behavioral science (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Fincham, J. E. (2005). Taking your medicine: a guide to medication regimens and compliance for patients and caregivers. Binghampton, N.Y.: Pharmaceutical Products Press.
Hor, K. & Taylor, M. (2010). Suicide and schizophrenia: A systematic review of rates and risk factors. Journal of psychopharmacology, 24 (4 l), 81–90.
Kane, J. M. & Correll, C.U. (2010). Pharmacologic treatment of schizophrenia, Dialogues Clin Neurosci, 12 (3), 345–57.
Leucht, S., Heres, S. (2006). Epidemiology, clinical consequences, and psychosocial treatment of non-adherence in schizophrenia. J Clin Psychiatry, 67 (5), 3–8.
McEvoy, J. P. (2006). Risks versus benefits of different types of long-acting injectable antipsychotics. J Clin Psychiatry, 67 (5), 15–18.
Schultz, S. H., North, S. W. & Shields, C. G. (2007). Schizophrenia: A review. Am Fam Physician, 75 (12), 1821–9.
Smith, T., Weston, C. & Lieberman, J. (2010). Schizophrenia (maintenance treatment). Am Fam Physician, 82 (4), 338–339.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M. & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. The American Journal of Nursing, 110 (3), 58-61.
Tandon, R. Belmaker, R. H., Gattaz, W. F., et al. (2008). World Psychiatric Association Pharmacopsychiatry Section statement on comparative effectiveness of antipsychotics in the treatment of schizophrenia. Schizophr. Res., 100 (1–3), 20–38.
Tandon, R., Keshavan, M. S. & Nasrallah, H. A. (2008). Schizophrenia, “Just the Facts”: what we know in 2008 part 1: overview” (PDF).Schizophrenia Research, 100 (1–3), 4–19
Torrey, E. F. (2006). Surviving schizophrenia: a manual for families, patients, and providers (5th ed.). New York: Collins
Van, O. J. & Kapur, S. (2009).Schizophrenia. Lancet, 374 (9690), 635–45
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