ABSTRACT
Objectives@#The adherence to antipsychotics is essential for relapse prevention in schizophrenia. Although 40–60% of schizophrenia patients suffer from non-adherence problems, some patients had consistently good adherence. They are clinically desirable examples of non-adherent patients. This qualitative study aimed to explore the actors influencing medication adherence in people with schizophrenia with good adherence to the patients’ perspectives. @*Methods@#In-depth semi-structured interviews were conducted with 23 subjects with schizophrenia. Narratives were elicited on the attitudes toward illness and treatment, familiar support for treatment, and perceived stigma about psychosis over time. @*Results@#In the process of changing from non-adherence to adherence, symptomatic relapse, involuntary treatment, and familial support played leading roles. The patients’ experiences on their own made them accept the illness and necessity of medications. Once the patients accepted the need for treatments, side effects and social stigma did not influence their adherence. Reducing psychotic symptoms was the priority of the treatment effects on the patients’ perspectives. @*Conclusion@#Adherence in schizophrenia requires multiple factors that affect the attitude toward illness and medication over time. Therefore, it is necessary to understand the specific process of adherence and develop the relevant interventions to facilitate those processes over time.
ABSTRACT
OBJECTIVES: Clozapine is the drug of choice in treatment-resistant schizophrenia. However, its use is often delayed and a significant proportion of clozapine treated patients fails to respond and experience potentially dangerous side-effects. The aim of this retrospective study was to describe the clinical characteristics of patients started on clozapine and the rate and reason of discontinuation of clozapine. METHODS: Medical records of 83 patients started on clozapine during the period of 2012–2016 were reviewed. RESULTS: Clozapine started on patients in chronic phase; the mean age of start was 38.1 years old and the mean number of psychiatric admission was 6.5. A majority (80.7%) of the patients had been subjected to antipsychotic polypharmacy prior to clozapine and most (61.5%) of them were being treated with polypharmacy including clozapine. Overall, 39 (47.0%) subjects had continued clozapine whereas 15 (18.1%) discontinued it; 29 (34.9%) were lost to follow-up. The most common reason for discontinuation was side-effects (n=13) including six life-threatening cases, most of which occurred within 6 months of its start. CONCLUSION: This study demonstrated that there is some evidence of delays to clozapine use, high rates of polypharmacy and significant rate of discontinuation during the early phase of clozapine treatment.