The Organisational Development of Crises -

Chapter 2 – Theoretical Development

2.2 The Organisational Development of Crises

In this study, the reasons cited for treatment non-adherence among the different study population varied widely according to the perculiarities of each group.

6.7.1 The experience of side-effect as a cause of treatment non-adherence was mostly sited by subjects with Schizophrenia (15.9%), Bipolar disorder (4.1%) and least sited by sited subjects with diabetes mellitus (2.4%) as a cause of treatment non-adherence. This finding has been reported by several studies.

Joan et al (2008) in a study in Uganda of reasons for treatment non-adherence among subjects with diabetes, experience of side effect was not significantly associated with non-adherence. Several studies in subjects with schizophrenia and bipolar disorder have mentioned side effect experience in 28% of subjects with Schizophrenia, Rizwan et al,(2005).

6.7.2 Financial obstacle was mentioned as a reason for treatment non-adherence mostly by subjects with Diabetes mellitus (57.3%) compared to schizophrenia (9.7%) and Bipolar disorder (11.6%). This may be due to the fact that majority (75.6%) are either unemployed or retired and therefore may be depending on financial assistance from others to manage the illness.

6.7.3 Medication currently not necessary was not cited as a reason for non-adherence by any subject with Diabetes mellitus wheras Schizophrenia (7.1%) and Bipolar disorder (12.4%) cited this as a reason. This may imply that all

the subjects with diabetes mellitus have a full awareness about being sick and the need for treatment wheras this may not be so in subjects with mental disorders.

6.7.4 Forgetfulness as a cause of treatment non-adherence was mostly cited by subjects with mental disorders, Schizophrenia (15.0%), Bipolar disorder (11.6%) than by subjects with Diabetes mellitus (2.4%). A possible reason for this may be that since the subjects with diabetes mellitus are more elderly, (mean age 59.68), compared to those with mental illness, schizophrenia (36.02), Bipolar disorder (34.50) , more are married (85.4%), more are living with someone (100%), these factors may mean more social support network, more supervision at medication intake (65.9%).

6.7.5 Fasting as cause of treatment of treatment non adherence were more more cited by subjects with mental illness. Schizophrenia (7.1%), Bipolar disorder (5.8%) compared to Diabetes mellitus (1.2%). A plausible explanation for this may be that since Nigerians (28.4%) believe in spiritual causation of mental illness, Uwakwe, (2007) and 65.7% would recommend prayer houses for treatment of mental illness, it is logical that more subjects would be involved in fasting.

6.7.6 Use of native medicine as a cause of treatment non-adherence is another reason that is cited more often by mental disorder patients, Schizophrenia 2.7%, Bipolar disorder (7.4%) compared to Diabetes mellitus (1.2%). In his study on pathway to care, Odinka (2011) noted that 76% of the population used non-orthodox treatment as their first treatment option. He opined that this could be attributed to their belief in the supernatural and magical causation of their problem.

6.7.7 Advise from significant others : Here again, the patients with mental illness, Schizophrenia (7.1%), Bipolar disorder(1.7%) were more influenced negatively as regards treatment adherence than the patients with Diabetes mellitus (1.2%). The reason for this could still be attributed to people’s idea about a possible spiritual causation of mental illness (Odinka, 2011).

6.7.8 Disturbs me at work: As a reason for treatment non-adherence was cited by 6.2% of subjects with Schizophrenia, 18.2% of subjects with Bipolar disorder and 1.2% of subjects with Diabetes mellitus. One possible explanation for this non-adherent behaviour especially among subjects that are employed, are that disturbing side-effects that will make their treatment obvious to others at work may occur (Adewuya, 2007).

6.7.9 Drugs not available was cited by 7.1% of subjects Schizophrenia, 5.1%

of subjects with Bipolar disorder and 4.9% of subjects with Diabetes mellitus.

Several Nigerian studies, Adewuya (2007), Adisa (2009), Enwere et al (2006), have reported cost as a cause of treatment non-adherence. This is particularly important against the background of widespread poverty in this country, (Adisa, 2009).

70 Limitations

The findings from this study may not be generalisable to the general population because assessment for treatment adherence was point prevalence estimation rather than a serial estimation which may be more reflective of the true adherence rate. Also the study depended on a seven day recall of adherence with no corroboration of the answers given with a better or a second method of assessing adherence like pill counts or plasma drug estimation or medication event monitoring. Moreover, it is to be noted that there may be reluctance on the part of patients to give honest information on their adherence status.

Poor matching for age is another limitation for age is another limitation that will make inferences less precise.

Inspite of the above limitations, the strength of this study lies in the fact that it compares adherence in three medical conditions as against one study population in many adherence studies.

71 Implication of this study to practice.

The result of this study have highlighted some significant risk factors for treatment non-adherence in this environment which can be used to design adherence counseling protocol to be admistered to every patient in both physical and mental health arena. The single most important contributor to treatment outcome in all fields of medical endeavour remains treatment adherence. Simple adherence counseling protocol developed around findings from research work, can be a cost effective way to significantly improve treatment adherence.

The clinical relevance of the findings of this study on the impact of supervision and number of tablets taken in a day on treatment adherence is that clinicians can improve adherence behaviour by prescribing simple drug regimen of few tablets per day and secondly, regular adherence counselling to patients and their family members on the need for continual supervision of patients’ drug intake.

72 Recommendations

1. There is the need for more studies to be carried out in this environment to address among other things the shortcomings of this work and also increase efforts to identify more risk factors for treatment non-adherence that could be perculiar to this environment to provide data to plan effective intervention strategies to improve treatment adherence.

2. There is a need to develop a policy framework to allow for strengthening of health education programmes in all levels of health care settings to enlighten all stake holders in patients management to effectively join in the crusade to regularly address the poor treatment adherence problem in the populace.

3. Clinicians should adopt a policy of regular and routine adherence counseling to the patient and family members as a cost effective way to improve treatment adherence

4. A policy of routine institutional based intervention progammes to highlight the problems and implications of non-adherence to treatmemt is a step in the right direction.

Future research

Future studies should address the deficiencies of this work as well as addressing other factors affecting treatment adherence.

Conclusion

This study has shown treatment adherence rate to be significantly lower in mental disorders compared to physical disorder. It has highlighted some modifiable risk factors which can be a focus of

attention in the effort to improve treatment adherence for all groups of patients. The finding that non supervision of treatment and the number of tablets taken in a day are significant risk factors for treatment non-adherence can be converted to significant gains in the crusade to improve treatment adherence.

REFERENCES

Ademola, B.A., Brett, D.T., Moruf, L.A., Laurence, K. (2009). Family participation in treatment, post discharge appointment and medication adherence at a Nigerian psychiatric hospital. Bjp.rcpsych.org/194/1/86

Adewuya, A.O., Ola,B.A., Mosaku, S.K., Fatoye, F.O, Eegunranti, A.B.

(2006). Attitude towards antipsychotics among out-patients with schizophrenia in Nigeria. Acta Psychiatric Scand; 113:207-211.

Adewuya, A.O., Owoeye, O.A., Erinfolarin, A.R., Coker, A.O., Ogun, O.C., Okewale, A.O., Dada, M.U., Eze, C.N., Bello-Mojeed, M.A., Akindipe, T.O., Olagunju, A.T., Etim, E. (2009). Prevalence and correlates of poor medication adherence amongst psychiatric outpatients in southwest Nigeria.

Gen Hosp Psychiatry. Mar-Apr.

Agarwal, M.R., Sharma, V.K., Kishoe Kumar, K.V.Lowe,D. (1998).Non-Compliance with Treatment in Patient Suffering from Schizophrenia: A Study to Evaluate Possible Contributing Factors. Int J Soc Psychiatry. 44(2): 92-106.

Awad, A.G. (1999). Anti Psychotic Medication in Schizophrenia: How Satisfied are our Patients? Clear Perspectives; Management Issues in Schizophrenia 2:1-6.

Awad, A.G. (2004). Antipsychotic Medication Compliance and Attitudes towards Treatment. Current Opinion in Psychiatry 17:75-80.

Baldessarini, R., Perry, R., Pike, J.(2008). Factors associated with treatment nonadherence among US bipolar disorder patients. Hum Psychopharmacol. 23(2):95-105.

Bebbington, P.E. (1995). The content and context of compliance. I nt Clin Psychopharmacol, 9(Suppl 5), 41-50.

Birchwood, M., Smith, J., Drury, V., Healy J., Macmillan F., Slade M.

(1994). A Self-Report Insight Scale for Psychosis, Reliability, Validity and Sensitivity to Change. Acta Psychiatrica Scandinavica 89:62-67.

Black, H.R. (1999). Will better tolerated antihypertensive agents improve blood pressure control? JNC VI revisited. AM J Hypertensive, 12:225s 30s Blaum, C.S., Velez, L., Hiss, R. G. (1997). Characteristics related to poor glycemic control in NIDDM patients in community practice. Diabetes care 20:7-11.

Blenkiron, P. (1996). The elderly and their medication: understanding and compliance in a family practice. Postgrad Med J. 72(853):711-6.

Botelho, R., Dudrak, R. (1992). Home assessment of Adherence to long term medication in the elderly. The Journal of Family practice. 35: 61-64.

Breen, R., and Thornhill, J.T. (1998). Non Compliance with Medication for Psychiatric Disorders: Reasons and Remedies. CNS Drugs 9: 457-471.

Burdick K.E., Endick, C.J, Goldberg J.F. (2001). Assessing cognitive deficits in mood disorders: are self report valid? Poster presented at: 154^th Annual Meeting of the American Psychiatric Association; New Orleans, LA.

Byerly, M.J., Fisher, R, A, Whatley, K.,Varghese, F., Carmody, T., et al, (2005). A comparison of electronic monitoring versus clinician rating of antipsychotic adherence in outpatients with Schizophrenia. Psychiatry Res, 133 (2-3), 129-33.

Cabeza, I.G., Diaz SEI., Amador, M.S., Rodriguez, G.M., Gonzalez, D.E., Chavez, M. (1990). Factors related to treatment adherence in schizophrenic patients. Acta Esp Psychiatr. 27:211-216( in Spanish).

Carlos, A.P., Yolanda, V.M., Yolanda, S., Rosendo, R., Raul, A. (2009).

Performance of two questionnaires to measure treatment adherence in patients with Type-2 Diabetes. BMC Public Health. 9:38 doi:10.1186/1471-2458-9-38.

Casey, D.E. (2001). Barriers to progress-the impact of tolerability problems.

Int Clin Psychopharmacol 2001; 16 suppl 1:S15-19

Cathryn, R,. (1999). Factors Influencing Patient Adherence in Diabetes.

University of Calgary.

Chesney M.A (2002). Factors affecting adherence to antiretroviral therapy.

Clin. Infect. Dis., 30(S2), S171-S176.

Claxton, A., Cramer, J., Pierce, C. (2001). A Systematic Review of the Associations between Dose Regimens and Medication Compliance. Clin Ther 23:1296-1310.

Copeland, L.A., Zeber, J.E., Salloum, I.M., Pincus, H.A., Fine, M.J., Kilbourne, A.M. (2OO8). Treatment adherence and illness insight in veterans with bipolar disorder. J Nerv Ment Dis. 196(1):16-21.

Cramer, J., A. (2004). A systematic review of adherence with medication for diabetes. Diabetes Care 27:1218-1224.

Cramer, J.A., Schayer, R.D., Mattson, R.H., (1990). Compliance Declines between Clinic Visits. Arch Intern Med. 150: 1509-10.

Cramer, J. A., Spilker, B. (1991). (eds); Patients compliance in medical practice and clinical trials. New York, Raven Press, . pp 175-86

Cramer, J.A., Rosenheck, R. (1998). Compliance with Medication Regimens for Mental and Physical Disorders. Psychiatric Services. 49:196-201.

Day, J., Wood, G., Dewey, M., Bentall, R.P. (1995). A Self-rating Scale for Measuring Neuroleptic Side effects: Validation in a Group of Schizophrenic Patients. British Journal of Psychiatry. 166:650-653.

Degmecic, D., Pozgain, I., Filakovic, P. (2007). Psychoeducation and compliance in the treatment of patients with Schizophrenia. Coll Antropol 31:1111-5.

Demyttenaere, K., Haddad, P. (2002). Compliance with antidepressant therapy and antidepressant discontinuation symptoms. Acta Psychiatrica Scandinavica, Supplementum 403:50-6.

Diaz, E., Neuse, E., Sullivan, M.C., Pearsall, H.R., Woods, S.W. (2004).

Adherence to conventional and atypical antipsychotics after hospital discharge. J Clin Psychiatry 65(3): 354-360.

Dixon, L., Weiden, P., Torres, M., Lehman, A.M. (1997). Assertive community treatment and medication compliance in the homeless mentally ill. Am J Psychiatry 1997;154:1302-1304.

Dolder, C.R., Lacro, J.P., Dunn, L.B., Jeste, D.V. (2002). Antipsychotic medication adherence: is there a difference between typical and atypical agents? Am J Psychiatry. 195(1): 103-108.

Donnelly, J.E., Donnelly, W.J., Thong, Y.H. (1987). Parental perception and attitude towards Asthma and it’s treatment: a controlled study. Social Science and Medicine. 24:431-437.

Duncan, J.C., Rogers, R. (1998). Medication compliance in patients with chronic Schizophrenia: implications for the community management of mentally disordered offenders. J Forensic Sci. 43:1133-7. {pubmed).

Dusing, R., Lottermoser, K., Mengden, T. (2001). Compliance with drug therapy –New Answers to an old question. Nephrol Dial Transplant 2001:16:1317-1321.

Eisen, S.A., Miller, D.K., Woodward, R.S., Spitznagel, E., Przybeck, T.R.

(1990). The effect of prescribed daily dose frequency on patient medication compliance. Arch Int Med. 150:1881-84.

Enwere, O.O., Salako, B.L., Falade, C.O. (2006). Prescription and cost consideration at a diabetic clinic in Ibadan, Nigeria. Annals of Ibadan postgraduate medicine. 4:35-39.

Ernani, T.H., Maria, I.B., Jose, E. (2008). Development and validation of a multidimensional questionnaire assessing non-adherence to medicines. Rev Saude publica 42(4).

Fenton, W.S., Blyer, C.R., Heinssen, R.K. (1997). Determinants of Medication Compliance in Schizophrenia. Empirical and Clinical Findings.

Schizophrenia Bulletin 23: 637-651.

Feinstein, A.R. (1990). On white-coat effects and the Electronic Monitoring of Compliance. Arch Intern Med. 150:1377-8.

Fleck, D.E., Keck, P.E., Corey, B., Strakowski, S.M. (2005). Factors associated with medication adherence in African Americans and white patients with bipolar disorder. J Clin Psychiatry. 66(5):646-652.

Fleischhacker, W.W., Meise, U., Gunther, V., Kurz, M. (1994). Compliance with Anti-psychotic Drug Treatment: Influence of Side Effects. Acta Psychaitric Scandinvica. Suppl 382:11-15.

Frank, A.F., Gunderson, J.G. (1990). The Role of the Therapeutic Alliance in the Treatment of Schizophrenia. Journal of General Psychiatry 47:228-236, Freudenreich, O., Cather, C., Evins, A.E., Henderson, D.C., Goff, D.C.

(2004). Attitudes of schizophrenia outpatient towards psychiatric

medication: relationship to clinical variables and insight. J Clin psychiatry.

65:1372-1376.

Gasquet, 1., Tcharny – Lessenot, S., Lepine, J., Falissard, B. (2006) Patient Satisfaction with Psychotropic Drug: Sensitivity to Change and Relationship to Clinical Status, Quality of Life, Compliance and Effectiveness of Treatment: Results from a Nationwide 6 Month Prospective Study.

European Psychiatry 21:531-538.

Gelder M, Harrison P, Cowen P. (2006). Shorter Textbook of Oxford, 5^th edition. Oxford University press.

Gilmore, J.E., Temple, D.J., Taggart, H.M. (1989). A study of drug compliance, including the effects of a treatment card, in elderly patients following discharge home from hospital. Aging (Milano) 1(2):153-8.

Golin, C.E., Liu, H., Hays, R.D., Miller, L.G., Bec, C.K., Ickovics, J. (2002).

A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med, 17:756-65.

Harris, M., Lustman, P. (1988). The Psychologist in Diabetes care. Clinical Diabetes 16: 1-7.

Haynes, R.B., Mc Donald, H.P., Garg, A.X. (2002). Helping patient follow prescribed treatment, Clinical applications. JAMA. 288:2880-83.

Hellewell, J.S., Kalali, A.H., Langham, S.J., McKellar, J., Awad, A.G.

(1999). Patient Satisfaction and Acceptability of Long Term Treatment with Quatiepine. International Journal of Psychiatry in Clinical Practice 3:105-113.

Hofer, A., Kemmler, G., Eder, U., Honeder, M., Fleischhacker, W.W.

(2002). Attitude towards antipsychotics among outpatient clinic attendees with schizophrenia. J Clin Psychiatry 63:49-53.

Hogan, T.P., Awad, A.G., Eastwood, R. (1983). A Self Report Scale Predictive of Drug Compliance in Schizophrenic: Rehabilitative and Discriminative Validity. Psychological Medicine 13: 177-183.

.Holzinger, A., Loffler, W., Muller, P., Priebe, S., Angermeyer, M. C.

(2002). Subjective illness theory and antipsychotic medication compliance by patient with schizophrenia. J Nerv. Ment.Dis 190(9):597-603.

Horizons/Population council (2004). Adherence to Antiretroviral Therapy in Adults. A Guide For Trainers. 1-130.

Jenny, J. (1986). Differences in Adaptation to Diabetes between Insulin-Dependent and Non-Insulin Insulin-Dependent Patient: Implications for Patient Education. Patient Education and Counseling 8: 39-50.

Jeste, S.D., Patterson, T.L., Palmer, B.W., Dolder, C.R., Gowman, S., Jeste, D.V. (2003). Cognitive Predictors of Medication adherence among middle aged and older outpatients with schizophrenia. Schizophr Res: 63:49-58.

Joan, N,K., Erisa, O., Agatha, P, N. (2008). Non-adherence to diabetes treatment at Mulago Hospital in Uganda: prevalence and associated factors.

African health services. 8(2):67-73.

Kampman, O., Laippala, P.,Vaananen J (2002). Indicators of medication compliance in first-episode psychosis. Psychiatry Res. 110:39-48.

Kaplan, H., Sadock, B.J. and Sadock.(1998). Synopsis of psychiatry 8^th ed.

Baltimore: lippincott Williams and Wilkins;

Karve, S., Cleves, M.N., Helm, M., Hudson, T.N., West, D.S., Martin, B.C.

(2009). Good and poor adherence: optimal cut point for adherence measures using administrative claims data. Curr Med Opin, 25 (9) 2303-10.

Keith, S.J., Kane, J.M. (2003). Partial Compliance and Patient Consequences in Schizophrenia: our Patients Can do better. J Clin Psychiatry. 64: 1308-1315.

Kemp, R., Kirov, G., Everitt, B., Hayward, P., David, A. (1998).

Randomised Controlled trail of Compliance Therapy: 18-month Follow Up.

British Journal of Psychiatry. 1772:413-419.

Kendel, R.E., Zeally, A.K. (1993). Companion to psychiatric studies 5^th edition , chapter 8; schizophrenia pp 397-426, Edinburg, Churchil Livingstone.

Kessler, R.C., Angermeyer, M., Anthony, J., De Graaf, R., Demyttnaere, K., Gasket, I., Gureje, O et al. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organisation’s World Mental Survey Initiative. World Psychiatry. 6;3 168-178.

Kozma, C., Grogg, A. (2003). Medication compliance and hospitalization in schizophrenia. Presented at: College of Psychiatric and Neurologic Pharmacists 6^th Annual meeting; May 1-4, 2003; Charleston, SC

Kraemer, H.C., Kazdin, A.E., Offord, D.R., Kessler, R.C., Jenson, P.S., Kupfer, D.J. (1997). Coming to Terms with the Terms of Risk. Arch Gen Psychiatry: 54:337-343.

Krueger, K.P., Berger, B.A., Felkey, B. (2005). Medication adherence and persistence: a comprehensive review. Adv in Ther. 22:313-356.

Lacro, J.P., Dunn, L.B., Dolder, C.R., Leckband, S.G., Jeske, D.V. (2002).

Prevalence of and Risk Factors for Medication non adherence in Patient with Schizophrenia: a Comprehensive Review of Recent Literature. J Clin.

Psychiatry.63(10):892-909.

Last Jm.ed. A Dictionary of Epidermology 4^th Ed. (2001) New York NY:

Oxford University Press.

Lehman, A.F., Steinwachs, D.M. (1998). Translating research into practice:

the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull; 24:1-10. {pubmed).

Lieberman, J.A., Koreem, A.R., Chakos, M. (1996). Factors influencing treatment response and outcome of first-episode Schizophrenia: implications for understanding the pathopsysiology of Schizophrenia.

J Clin Psychiatry. 57(Suppl 9):5-9. (pubmed).

Lieberman, J.A., Stroup, T.S., Mc Evoy, J.P., Swart M.P., Rosenheck, R.A.,Perkins, D.O.,Keefe, R.S., David, S.M., David, S.M., Lebowith, B.D., Severe, J., Hsiao, J.K. (2005). for the Clinical Antipsychotic Trials of Intervention Effectiveness Investigators. Effectiveness of Anti-Psychotic Drugs in Patient with Chronic Schizophrenia. N. Engl J M 353: 1209-1222.

Liu-Seifert, H., Adams, D.H., Kinon, B.J. (2005). Discontinuation of Treatment of Schizophrenia patients is driven by poor Symptom Response: a

Pooled Post-hoc Analysis of four atypical Antipsychotic drugs. BMC Medicine.

3:21-30.

Markowitz, M. (2000).Resistance, fitness, adherence, and potency: mapping the paths to virologic failure. JAMA. 283: 250-1.

Matsui, D.M. (1997). Drug compliance in Peadiatrics clinical and research issues. Peadiatrics clin north AM, 44: 1-14.

Miasso, A.I., Cassiani, S.B., Pedrao, L.J (2008). Bipolar affective disorder and medication therapy. Identifying barriers. Rev Latino-am Emfermagem.

16(4):739-45.

Micheal, F., Grunebaum, M.,D, Peter, J., Weiden, M., D, Mark, M.P (2001);

J Clin psychiatry, 62; 394-399.

Misdrahi, D., Llorca, P.M., Lancon, C., Bayle, F.J. (2002). Compliance in schizophrenia: predictive factors, therapeutic considerations and research implications. Encephale 2002;28:266-272 (in French).

Mishali, M., Vaknin, Y.S., Omer, H., Heymann, A.D., (2007).

Conceptualization and measurement of resistance to treatment: the resistance to treatment questionnaire for people with diabetes. Family Practice. 24:610-615.

Moningstar, B.A., Sketris, G.C., Sclar, D.A. (2002). Variation in Pharmacy Prescription Refill Adherence Measured by Type of Anti-hyperglycaemic drug Therapy in Seniors in Nova Scotia Canada J Clinical Pharmacy &

Therapeutics. 27(3): 213-220.

Morisky, D.E., Green, L.W., Levine, D.M. (1986). Concurrent and Predictive Validity of a Self-Reported Measure of Medication Adherence Med. Care 24(1):

67-74.

Mueser, K.T, Mc Gurk, S.R. (2004) Schizophrenia. Lancet.363: 2063-2072.

Naber, D. and Kaspar, S. (2000). the Importance of Treatment Acceptability to Patients. International journal of Psychiatry in Clinical Practice. 4 (Suppl.1): 252-534.

Nose, M., Bar bui, C. and Tansella, M. (2003). How often do Patients with Psychosis Fail to Adhere to Treatment Programmes? A Systematic Review.

Psychol. Med. 33 (7): 1149-1160.

Olfson, M., Marcus, S.C., Wilk, J., West, J.C. (2006). Awareness of Illness and Non-adherence to antipsychotic Regime in Persons with Schizophrenia.

Psychiatr Serv.: 57:205-211.

Olfson, M., Mechanic, D., Hansell, S., Boyer, C.A., Walkup, J., Weiden, P.J. (2000). Predicting medication non-compliance after hospital discharge among patients with schizophrenia. Psychiatr Serv. 51:216-22.

Osterburg, L. and Blashke, T. (2005). “Adherence to Medication”. New England Journal of Medicine 353 (5); 487-497.

Paes, A.H., Bakker, A., Sol-Agnie, C.J. (1997). Impact of Dosage Frequency on Patient Compliance. Diabetis Care:20:1512-7

Pellegrim, K.L., Stuat, G.W., Maree, B., Fruch, B.C. and Ballenger, J.C.

(2001). A Brief Scale for Assessing Patients Satisfaction with care in out patient Psychiatric Services. Psychiatric Services 52:816-819.

Perkins, D.O. (1999). Adherence to antipsychotic Medications. J Clin.

Psychiatry. 60 (Suppl 21): 25-30.

Perkins, D.O. (2002). Predictors of noncompliance in patients with Schizophrenia. J Clin Psychiatry, 63(12), 1121-8.

Piette, J.D., Heisler, M., Krein, S. (2005) The role of patient-physician trust in moderating medication non-adherence due to cost pressures. Arch Intern Med. 165:1749-1755.

Prado-Aguilar, C., Martinez, Y., Sergovia-Bernal, Y., Arias-Ulloa, R.

(2009). Performance of two questionnaires to measure treatment adherence in patients with type-2 Diabetes. BMC Public Health. Doi:10.1186/1471-2458-9-38.

Razali, M.S. & Yahya, H. (1995). “Compliance with treatment in schizophrenia: a drug Intervention program in a developing country”. Acta Psychiatrica Scand. 91(5); 331-335.

Reid, D., Abramson, M., Raven, J., Walters, H.E. (2000). Management and treatment perceptions among young adults asthma in Melbourne: The Australian experience from the European Community Respiratory health survey. Respirology. 5:281-7.

Robinson, D., Woemer, M.G., Alvir, J.M. (1999). Predictors of relapse following response from a first episode of Schizophrenia or Schizoaffective disorder. Arch Gen Psychiatry. 56:241-7. {pubmed}.

Robson, J. (2002). Broad Spectrum: How Concordance Challenges us to Rethink our Attitudes. The Pharmaceutical Journal. 268:836.

Rofail, D., Gray, R. and Gournay, K. (2005). The Development and Internal Consistency of the Satisfaction with Anti Psychotic Medication Scale.

Psychological Medicine. 35:1-10.

Ryan, j.j., Weilage, M.E., Spaulding, W.D. (1999). Acuracy of the seven subtest WAIS-R short form in chronic schizophrenia. Schizophr Res 39(1):79-83. {pubmed}.

Sackett, D.L. and Haynes, B,R. (1976). Compliance with Therapeutic Regimens. Baltimore, MD: John Hopkins University Press.

Sajatovic, M., Blow, F.C., Kales, H.C., Valenstein, M., Ganoczy, D., Ignacio, R.V. (2007). Age comparison of treatment adherence with antipsychotic medications among individuals with bipolar disorder. Int J Geriatr Psychiatry. 22(10):992-998.

Scott, J. and Pope, M. (2002). Non adherence with Mood Stabilizers:

Prevalence and Predictors J Chin Psychiatry 63(5); 384-390.

Sharma, T., Harvey, P.D (2000). Enhancement as a treatment strategy in schizophrenia.in: Cognition in Schizophrenia: impairment, importance and treatment strategies. Oxford Press, 2000 pp 286-302.

Shelly, A., Colleen, J,M., David, B.H., Scott, B.P., Jeffrey, A.J., Lori, R.

(2005). Assessing Medication Adherence Among Older Persons in community settings. Can J Clin Pharmacol. Vol 12(1) winter ; e152-e164.

Gelder, M., Harrison, P., Cowen, P. (2006). Shorter Oxford Textbook of Psychiatry, Fifth Edition. Oxford University press.

Greenhouse, W.J., Meyer, B., Johnson, S.L (2000). Coping and medication adherence in Bipolar disorder in Bipolar disorder. J Affect Disord; 59(3):237-41.

Spagnoli, A., Ostino, G., Borga, A.D., D Ambrosio, R., Maggiorotti, P., Todisco, E. (1989). Drug compliance and unreported drugs in the elderly. J.

AM Geriatrics Soc, 37:619-24.

Stein, M.D., Rich, J.D., Maksad, J., Chen, M.H., Hu, P., Sobota, M.

(2000). Adherence to antiretroviral therapy among HIV- infected methadone

patients: Effects of ongoing illicit drug use. American Journal of Drug and Alcohol Abuse. 26: 195-205.

Tait, L., Birchwood, M. and Trower, P. (2003). Predictive engagement with Services for Psychosis: Insight Symptoms and Recovery Style. British Journal of Psychiatry 182:123-128.

Tay, R., Khan, S., Khanum, S.A. (2002). Non compliance to treatment in schizophrenic patients, J Parkistan Inst Med. Sci. 13;691-3.

Thompson, C.J., Cummings, J.F., Chalmers, J., Gould, C., Newton, R.W.

(1996). How have patients reacted to the implications of the DCCT? Diabetes Care. 16:1116-23.

Urguhart, J. (1997). The Electronic Medication event Monitor: Lesson for Pharmaco Therapy Clin Pharmacokinet:32; 345-56.

Urguhart, J. (2002). The Odds of the Nons when an Aptly Prescribed Medicine Isn’t Working: Non Compliance, Non-absorption, Non-response. Br J clin Pharmacol:54: 212-20.

Uwakwe R. (2007). The views of selected Nigerians about mental disorders.

Nigerian Postgraduate Medical journal 14:319-324.

Valentine, M., Ganoczy, D., Mc Carthy, J.F., Lee, T.A., Blow, F.C. (2006).

Antipsychotic Adherence Overtime Among Patients Receiving Treatment for Schizophrenia A retrospective Review. J Clin Psychiatry. 67(10): 1542-50.

Velligan, D.I., Wang, Y.W., Glahn, D.C., Barrett, J.A., Maples, N.J., Ereshefsky, L, et al, (2006). Defining and assessing adherence to oral antipsychotics: a review of the literature. Schizophr Bull, 32 (4), 724-42.

Ventura, M.A., Green, M.F., Shaner, A. and Liberman, R.P. (1993).

Training and Quality Assurance with the Brief Psychiatric Rating Scale. “The

Drift Buster”. International Journal of Methods in Psychiatric Research. 3:

221-244.

Weiden, P.J., Kozma, C., Grogg, A., Locklear, J. (2004). Partial Compliance and Risk of Rehospitalisation Among Patients with Schizophrenia. Psych Serv.55: 886-891.

Weiden, P., Rapkin, B., Mott, T. (1994). Rating of medication influences (ROMI) scale in Schizophrenia. Schizophr Bull. 17:325-51. {pubmed).

Weiden, P.J., Olfson, M. (1999). Cost of relapse in Schizophrenia.

Schizophrenia Bulletin. 21:419-429.

Weiser M., Shneider-Beeri M., Nakash N et al (2000). Improvement in cognition associated with Novel antipsychotic drugs: a direct drug effect or reduction of EPS? Schizophr Res

Weiss, K.A., Smith, T.E., Hall, J.W., Piper, A.C., Huppert, J.D. (2002).

Predictors of risk of nonadherence in outpatients with schizophrenia and other psychotic disorders. Schizophr Bull, 28(2),341-9.

Weiss, R.D., Greenfield, S.F., Najavitis, L.M. (1998). Medication compliance among patients with bipolar disorder and substance abuse. J Clin Psychiatry.

59(4):172-174.

World Health Organisation. (2003) Adherence to Long-term Therapies:

Evidence for action Geneva, Switzerland (PP 3-4).

World Health Organisation (1992): The ICD-10 classification of mental and behavioral Disorders. Diagnostic criteria for Research. Geneva.

www.statpages.org

Wyatt, R.J., Henton, I. (1995). An economic evaluation of manic- depressive illness. Social Psychiatry and Psychiatric epidermiology. 31:213-219.

Young, J.L., Zonana, H.V., Shepler, L. (1976). Medication Non Complaince in Schizophrenia. Codification and Update. Bull AM Acard Psychiatry Law.

Young, J.L., Spitz, R.T., Hillbrand, M., Daneri, G. (1999). Medication adherence failure in Schizophrenia: a forensic review of rates, reasons, treatments, and prospects. J Am Acad Psychiatry law, 27(3), 426-44.

91 APPENDIX I

SOCIO-DEMOGRAPHIC INTERVIEW SCHEDULE

1. Subject’s identification number………

2. Subject’s diagnosis………..

3. Address……….

4. Interviewer’s name………..

5. Interview date………

6. Subject’s Sex 1.Male 2.Female 7. Subject’s Age (as at last birthday)………….

8. Marital status

1. Married

2. Never married 3. divorced 4. widowed

9. Highest completed level of education 1. No formal education

2. Primary school; completed…. 5. Not completed…

3. Secondary school: completed… 6. Not completed...

4. Tertiary education: completed… 7. Not completed...

10. Occupation………

11. place of residence 1. city 2. village

12. Parents of patient 1.One alive 2. Both alive 3. Both dead

13. Religion:

1. Christian 3. Traditional 2. Muslim 4. Others

14. Employment status

1. Student 3.Unemployed 2. Employed 4. Retired

15. What is the duration of your illness (in Months) ---

16. How many different types of tablets do you usually take per day?

1. One 2. Two 3. Three 4. Four

17. How many tablets do you take in a day?

1. one 2. Two 3. Three 4. Four 5. Five 6. Six

18. What is your estimated Income per annum (in Naira) 1. Below 10,000 3. 50,000-100,000 2. 10,000-50,000 4. Above 100,000

19. What is your living arrangement?

1. Alone 2 .with spouse

3. With parents 4. Other relatives 20. How do you take your drugs?

1. Takes drugs by self

2. Not supervised

3. Supervised

21. If supervised, by whom?

1. Friend 2.Parents 3.Spouse. 4. Children

22. How much do you spend in a month to buy your drugs (In Naira) 1. Below 1000 3. 2000- 3,000

2. 1000-2000 4. Above 3,000

93 23. Who pays for the drugs?

1. Self 2. Friends

3. Other relatives 4. Parents

5. Spouse 6. Children

25. Do you sometimes stop taking your drugs because significant others (Religious leaders, trado-medical practitioners, relatives) adviced you to stop?