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 Table of Contents    
ORIGINAL ARTICLE  
Year : 2017  |  Volume : 59  |  Issue : 1  |  Page : 69-76
Treatment compliance and noncompliance in psychoses


Department of Psychiatry, JJM Medical College, Davangere, Karnataka, India

Click here for correspondence address and email

Date of Web Publication12-Apr-2017
 

   Abstract 

Background: Compliance or noncompliance with treatment significantly influences course and outcome of psychiatric disorders. While noncompliance has been extensively researched, compliance has received less attention. The current study was conducted to elicit reasons for compliance and noncompliance in patients having psychoses attending psychiatric clinics.
Materials and Methods: A total of 196 compliant and 150 noncompliant patients were interviewed using self-designed tools to elicit sociodemographic data, details of illness, and treatment. Factors contributing to compliance and noncompliance were grouped under illness-related, clinician-related, medication-related, family-related, and economic-related domains and compared.
Results: Compliance was significantly more in females and middle- and high-socioeconomic status patients. They had less substance use, high physical comorbidity, high attendance in the outpatient department, and better remission. Clinician-related, family-related, and medication-related domains were contributing more to compliance whereas illness-related and economic-related domains seemed to have more bearing on noncompliance.
Conclusions: Compliance and noncompliance are determined multidimensionally. Domains related to clinician, family, and medications have to be reinforced to enhance compliance. Illness-related and economic domains have to be resolved to reduce noncompliance.

Keywords: Compliance, noncompliance, psychoses

How to cite this article:
Rao K N, George J, Sudarshan C Y, Begum S. Treatment compliance and noncompliance in psychoses. Indian J Psychiatry 2017;59:69-76

How to cite this URL:
Rao K N, George J, Sudarshan C Y, Begum S. Treatment compliance and noncompliance in psychoses. Indian J Psychiatry [serial online] 2017 [cited 2019 Oct 23];59:69-76. Available from: http://www.indianjpsychiatry.org/text.asp?2017/59/1/69/204437



   Introduction Top


There have been dramatic improvements in pharmacotherapy of psychotic disorders in the past 60 years contributing to reduction of symptoms, prevention of relapse, and improvement in social functioning.[1] Despite these gains, treatment of psychotic disorders remains a major challenge. The actual effectiveness of antipsychotic medications is well below the efficacy obtained from clinical trials when relapse rates are considered.[2] One of the reasons for this state could be noncompliance to treatment. Compliance is defined as the extent to which a person's behavior coincides with medical or health advice.[3] Noncompliance can be defined as opposite of compliance. There has been an attempt to divide noncompliance into primary (not buying or receiving the medicines) and secondary (not complying with the instructions regarding dosage, frequency, and duration of medication intake).[4] In recent times, the terms compliance and noncompliance have been considered as clinician oriented. To shift the emphasis onto patients, the terms adherence and nonadherence have been suggested. However, in clinical practice, these terms are used interchangeably.

Noncompliance rates in schizophrenia vary widely, ranging from 20% to 89%.[5] Various reasons have been cited in literature for noncompliance. These include poor insight, side effects of medicines, poor remission of symptoms, and poor therapeutic alliance.[6],[7],[8],[9] It also includes stigma associated with the illness,[9],[10] poor family support,[11] ignorance about need to continue treatment,[12] and economic reasons.[9],[13] In addition, when patients improve, they may not feel the need to continue medications anymore.[12] In Indian studies, noncompliance has been found to be related to lack of knowledge, financial difficulties, side effects, and no improvement.[14],[15] Distance to hospital, lack of caregivers, poor insight, and lack of time have also been cited as reasons for noncompliance.[15] It is also reported that there is high prevalence of substance abuse in schizophrenia in noncompliant patients.[16] Other contributing factors are low priority accorded to health by patients and their caregivers, higher importance to economic activities, tendency to deal with problems only when they become acute and high emphasis on doctors' exclusive role in alleviating symptoms of the patient.[17] Noncompliance is strongly related to clinical outcomes such as relapse, rehospitalization, and suicide attempts in schizophrenia [18] and bipolar disorder.[19] It also results in poor quality of life and financial burden with about 40% of total costs of illness being attributed to rehospitalizations.[20]

The reasons cited for compliance are wish to lead a normal life, fear of illness, advice of family and friends, and clinical improvement with treatment.[12] Attitude of family and friends has been found to be related to both compliance and noncompliance.[9],[12]

Whereas noncompliance has been fairly well researched, compliance has received less attention. There have been very few studies which have looked at the reasons for compliance and noncompliance simultaneously.[12] The current study assesses and compares reasons for compliance and noncompliance simultaneously in patients having psychoses.


   Materials and Methods Top


Patients of both genders with a minimum age of 18 years having a primary diagnosis of psychoses attending psychiatric outpatient department (OPD) formed the sample of the study. The patients were divided into two groups – compliant and noncompliant based on their visits to treatment centers in the preceding 1 year. Compliant patients were defined as those who took medications for at least 80% of the days in the past 1 year.[21] The rest were considered as noncompliant. This was determined from the follow-up records. Patients aged below 18 years, those with diagnoses other than psychotic disorders and whose medical records were inaccessible or incomplete were excluded from the study.

After obtaining informed consent, a minimum of 100 consecutive patients, at least 50 each of compliant and noncompliant were included in the study from three psychiatric centers. The three centers were government general hospital attached to a medical college, private medical college hospital, and private psychiatric hospital. The patients were drawn from three different setups, so that reasons for compliance and noncompliance could be generalized across different setups to some extent. The sample size was 112 patients from government general hospital (62 compliant and 50 noncompliant), 100 from private medical college hospital (50 compliant and 50 noncompliant), and 134 patients from private psychiatric hospital (84 compliant and 50 noncompliant). Thus, a total of 196 compliant and 150 noncompliant patients were enrolled into the study. The study was conducted from October 2015 to March 2016.

Sociodemographic data, details of illness, and treatment history were noted for each participant in a semistructured pro forma specifically designed for the study. A 26-item questionnaire to elicit reasons for compliance & noncompliance was devised based on reviewed literature and authors' clinical experience. An allowance was made for additional reasons given by the patients. The items were grouped into illness-related, clinician-related, medication-related, family-related, and economic-related domains and numbered as 1, 2, 3, 4, and 5, respectively. The questionnaire was administered to patients individually. The statements had to be answered as either “Yes” or “No.” “Yes” responses were scored as “1” and “No” responses were scored as “0.”

Sociodemographic variables, illness variables, treatment variables, and factors contributing to compliance and noncompliance were analyzed and compared between compliant and noncompliant groups.

Statistical analysis was done using SPSS version 22 (IBM). Mean and standard deviation were calculated for continuous variables and proportions for categorical variables. Comparisons of mean values between two groups were analyzed using student's t-test unpaired. Comparison of mean value within the group was analyzed using student's t-test paired. Mann–Whitney test was used where the data failed normality test. To compare the association between groups, Chi-square test was used. P< 0.05 was considered statistically significant.


   Results Top


The sample consisted of 346 patients; 196 compliant and 150 noncompliant. [Table 1] summarizes sociodemographic variables. Compliance was observed to be significantly more in females (58.67%) and those from middle- and high-socioeconomic strata (37.24%).
Table 1: Sociodemographic variables in compliant and noncompliant groups

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[Table 2] shows the psychiatric diagnoses, comorbidities, substance use, family history of psychoses, and current clinical status. The most common diagnosis in both the groups was bipolar affective disorder (mania and depression), followed by schizophrenia spectrum disorders (schizophrenia, delusional disorder, schizoaffective disorder) and depressive disorders (recurrent depressive disorder, major depressive disorder with psychotic symptoms). Other diagnoses included organic psychosis, postictal psychosis, and alcohol-induced psychotic disorder. Substance use was found to be significantly more in noncompliant group (54%), whereas physical comorbidities were found to be significantly more in compliant group (21.96%). The two groups differed significantly regarding their current clinical status. Most of compliant patients were in complete remission (29.59%) or at least partial remission (66.84%), but majority of noncompliant patients were symptomatic (36.67%) or only partially remitted (60%).
Table 2: Illness characteristics in compliant and noncompliant groups

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Adherence to follow-up appointments was significantly more in compliant group than noncompliant group (P < 0.000). Follow-up visits by patients' attendants to procure medicines on behalf of the patients (treatment by proxy) were significantly higher in compliant group (P < 0.000) [Table 3].
Table 3: Comparison of compliant and noncompliant groups

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[Table 4] shows the domain-wise analysis of items associated with compliance and noncompliance. Mean scores of each domain were compared within and between groups. Total score and scores on domains 1, 3, 4, 5 were significantly higher in compliant group as compared to noncompliant group. Scores on domain-2 did not differ between groups.
Table 4: Comparison between compliant and noncompliant groups

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As different domains had different number of items, the mean scores of each domain were converted into percentages, so that they become comparable. Ranks were assigned to these percentages. In the compliant group, higher ranks indicated higher compliance. The domains 2 and 4 were related to high compliance (rank 1 and 2), domain 3 was related to moderate compliance (rank 3), and domains 1 and 5 were related to low compliance (ranks 5 and 4).

In the noncompliant group, higher ranks suggested higher noncompliance. The domains 1 and 5 were related to high noncompliance (rank 1 and 2), domain 3 was related to moderate noncompliance (rank 3), and domains 4 and 2 were related to low noncompliance (ranks 4 and 5). The domains which contributed more to compliance contributed less to noncompliance.

Item-wise comparisons in domains were done within and between groups [Table 5]. All the individual items in domain-1 were significantly positive in compliant group than in noncompliant group. Items of good doctor-patient relationship in domain-2, side effects in domain-3, family support in domain-4, and affordability of medications and time to attend OPD in domain-5 were significantly positive in compliant group than noncompliant group. However, the item that “no delay in receiving treatment at hospital” in domain-2 elicited significantly more positive responses in noncompliant group as compared to compliant group. Regarding the items which were not statistically different between the groups, the extent of their contribution to compliance or noncompliance was determined on the basis of the percentages of responses. Those items which were positively responded by more than 50% of the patients were considered to play equal role in compliance and noncompliance. Those items which were positively responded by <50% of the patients were considered to play lesser role in compliance and noncompliance.
Table 5: Item wise comparison between compliant and noncompliant groups

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The item clinical improvement was found to contribute to both compliance and noncompliance for different reasons. 61.22% of compliant patients reported that they continued treatment as they felt that the treatment was effective while 52% of noncompliant patients reported that the clinical improvement made them think that medications are no longer required. If there was no improvement with initial treatment, it was reasoned by some that there was no need to continue ineffective treatment. This led to noncompliance without a chance to change the treatment regimen by the clinician.


   Discussion Top


Noncompliance is not limited to psychiatric patients. It occurs in all branches of medicine. The figures of noncompliance in nonpsychiatric patients in some Indian studies are HIV-30%,[22] tuberculosis-6 to 50%[23],[24],[25] multidrug-resistant tuberculosis-19%,[26] hypertension-28.9%,[27] diabetes mellitus-42.3%,[28] head and neck cancer-23.5%,[29] cervical cancer-61.1%,[30] curative cancer treatment-33.33%,[31] lung cancer-36%.[32] Even in studies conducted abroad noncompliance has been reported in various medical conditions; tuberculosis global noncompliance rate-61.7%,[33] HIV optimal treatment-68%,[34] hypertension-30.5%,[35] diabetes mellitus (new detection)-20.6%.[36] It has been reported that adequate adherence is found only in the 1st year of treatment in breast cancer patients.[37] Thus, noncompliance is common in many chronic medical illnesses too.

Psychiatric disorders may have different perspective from that of chronic medical illnesses. Yet, psychoses are a group of chronic psychiatric disorders needing long-term medication. Hence, factors of noncompliance in them may have relevance to noncompliance in other chronic medical conditions.

Compliance and noncompliance mainly have three research questions: (1) extent of noncompliance, (2) determinants of noncompliance, (3) strategies to improve compliance and decrease noncompliance. This article deals with the second question.

Female patients in the present study were more compliant than males which is not in keeping with the findings of previous studies.[14] This might be so because females in this sample were mostly homemakers or agriculturists who had time to follow-up at hospital regularly and probably; they were also expected to resume their household responsibilities at the earliest. In the present study, compliance was found to be significantly more in patients from middle- and high-socioeconomic status. Financial status and awareness about health might have contributed to this finding. In line with this previous studies have observed higher noncompliance rates in lower socioeconomic strata.[38],[39] In this study, there was no difference between the compliant and noncompliant group with respect to age, education, occupation, religion, family type, place of residence, and marital status. In contrast, other studies have observed that young age,[38] unmarried status,[40] lower educational qualification,[38],[41] and joint family status [14] are associated with noncompliance.

The common psychiatric diagnosis in the present study was bipolar disorder followed by schizophrenia spectrum disorders. Similar finding has been noted in another Indian study.[14] Compliance did not differ significantly with respect to the diagnostic subgroups or a positive family history. The compliant group had significantly higher comorbidity of chronic physical illness. Probably, in them, hospital visits may serve a dual purpose of consultation for medical and psychiatric illnesses. Therefore, the treating clinician should give equal importance to treatment of patients' physical as well as psychiatric conditions. As reported in earlier studies, in this study too, substance use was significantly associated with noncompliance.[16],[42]

Neither total duration of illness nor duration of treatment was different between the two groups. As expected, compliant patients attended OPD as and when called whereas noncompliant patients did not. “Treatment by proxy” was significantly higher in compliant group. This is a flexible, low cost, and patient-friendly policy which could improve compliance.

Significantly more of the compliant patients had achieved complete or at least partial remission. This may mean that remission associated with compliance may boost confidence in treatment. A previous study has found that compliance is associated with lesser relapses and lesser rehospitalizations.[42] However, remission can also make some patients complacent and stop treatment. Some noncompliant patients remained symptomatic or only partially remitted. Association of lack of remission with noncompliance has been reported by Moritz et al.[9],[12] Lack of remission can frustrate some patients and their attendants resulting in loss of faith in treatment and render them noncompliant. On the other hand, nonremission can goad them to continue treatment to achieve remission. Thus, clinical improvement determining compliance and noncompliance may be influenced by the perception of the patients and attendants. This stresses the role of clinicians in educating patients and their attendants about the need for continued treatment to prevent relapse and reasonable time required for remission of symptoms.

Inaccessibility to hospital services has been cited as a reason for noncompliance in previous studies.[15],[43] In this study, there was no difference between the two groups with respect to distance to the hospital or transportation charges. Thus, these factors may not distinguish between compliance and noncompliance.

In domain-wise analysis, illness-related, medication-related, family-related, and economic-related domains were significantly associated with compliance than noncompliance. Clinician-related domain did not differ between groups. Identical scores in clinician-related domain between groups can imply that it is equally important in both the groups. Systematic reviews of research in this area have grouped the factors into different areas but have not statistically compared between groups.[44],[45]

In the present study, clinician-related and family-related domains were contributing more to compliance (ranks 1 and 2) and less to noncompliance (ranks 4 and 5). Medication-related domain was related to moderate compliance and noncompliance (rank 3). Illness-related and economic domains seemed to have less bearing on compliance (ranks 4 and 5) than noncompliance (ranks 1 and 2).

In addition to domain-wise comparison, individual items were also compared between two groups.

In line with earlier research, there was positive influence of good doctor-patient relationship on compliance.[46],[47] Communication skills of doctors, promptness of service, and personal attention of doctor may also have a significant role in compliance and noncompliance. These points have not been alluded in earlier studies.

The findings of present study concurred with earlier studies that good family support and positive attitude of family members were significantly associated with high compliance [12] and unfavorable attitude with noncompliance.[46] The influence of family on compliance is a modifiable factor which can be achieved through psychoeducation.[11],[48],[49] Implementation of this measure is beset with operational difficulties in countries with limited workforce. Stigma of mental illness affecting compliance and noncompliance has been reported in previous studies.[9],[48],[50] However, stigma of relapse was found to play a lesser role in compliance and noncompliance in our study.

In medication-related domain, previous studies have reported that side effects of medicines as barrier to compliance [12],[14],[15] and once daily drug dosage and long-acting injectables in place of oral medicines as facilitators of compliance.[9],[48],[50] Present study, while concurring with these factors found that factors of ease of availability of medicines, lesser number of medicines, ease of swallowing medications, and easy regimen of medications also played a role in compliance.

In illness-related domain, awareness about illness, need for long-term treatment, wish to lead a normal life, and fear of symptom deterioration were associated with compliance as has been reported in earlier studies.[12],[15],[46],[51],[52] Thus, imparting insight about the nature of illness, emphasis about the need for prolonged treatment is crucial to reduce rates of noncompliance. Disparity between explanatory models of illness held by doctors and patients is also to be minimized to improve compliance.[4]

In economic domain, impact of the item “availability of medicines for free” in compliance and noncompliance cannot be commented because only one of the three treatment centers had provision to provide free medicines. Association of affordability of medicines with issues of compliance and noncompliance in patients' of lower socioeconomic status has significant implication in developing countries. However, cost of medications has been found to contribute to noncompliance even in developed countries [9],[43] though in a lesser frequency.[13],[14] In developed countries, extensive health insurance coverage and financial incentives for long-term treatment may result in relatively better compliance.[53] Lack of time to attend the hospital has been cited as a reason for noncompliance in an earlier Indian study [15] as was the case in the present study. In addition, less frequent follow-up and treatment by proxy were considered to play a significant role in compliance. Earlier Indian studies have observed distance to hospital as one of the reasons for noncompliance.[14],[15] However in this study, this factor appeared to play a lesser role in distinguishing between compliance and noncompliance.


   Conclusions Top


Compliance or noncompliance is determined multidimensionally. Domains related to clinician, family, and medications played a major role in compliance and these have to be reinforced to enhance compliance. Illness-related domain and economic domain played a major role in noncompliance. Specific reasons such as insight into illness and treatment, exacerbation of symptoms on discontinuation of treatment, wish to improve further, good doctor-patient relationship, less side effects, good family support, affordability of medicines, and having time to attend OPD were significantly related to compliance. These have to be addressed to reduce noncompliance. The finding that compliant patients had higher physical comorbidity emphasizes need for detection and adequate management of associated physical morbidity to enhance compliance. Since compliance and thus noncompliance is a dynamic concept, the above-mentioned reasons are to be looked for and addressed continuously during treatment. As total compliance is difficult to achieve, adequate compliance for effective treatment may have to be accepted.

Limitations and implications for future research

This was a cross-sectional assessment. A longitudinal assessment would be more appropriate. The questionnaire used to elicit reasons for compliance and noncompliance was self-designed and not standardized. This study has more relevance in developing countries where economic burden of taking treatment has to be borne by patients and their families and many are ignorant about need for appropriate treatment. Future studies need to be carried out on larger samples and in neurotic spectrum disorders. The setup of service may have some bearing on the compliance and noncompliance, this issue is being addressed in another study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Gilbert PL, Harris MJ, McAdams LA, Jeste DV. Neuroleptic withdrawal in schizophrenic patients. A review of the literature. Arch Gen Psychiatry 1995;52:173-88.  Back to cited text no. 1
    
2.
Leucht S, Heres S. Epidemiology, clinical consequences, and psychosocial treatment of nonadherence in schizophrenia. J Clin Psychiatry 2006;67 Suppl 5:3-8.  Back to cited text no. 2
    
3.
Haynes R, Taylor D, Sackett D. Compliance in Health Care. Baltimore: Johns Hopkins University Press; 1979.  Back to cited text no. 3
    
4.
Swaminath G. You can lead a horse to the water. Indian J Psychiatry 2007;49:228-30.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Young JL, Zonana HV, Shepler L. Medication noncompliance in schizophrenia: Codification and update. Bull Am Acad Psychiatry Law 1986;14:105-22.  Back to cited text no. 5
    
6.
Byerly MJ, Nakonezny PA, Lescouflair E. Antipsychotic medication adherence in schizophrenia. Psychiatr Clin North Am 2007;30:437-52.  Back to cited text no. 6
    
7.
Karow A, Czekalla J, Dittmann RW, Schacht A, Wagner T, Lambert M, et al. Association of subjective well-being, symptoms, and side effects with compliance after 12 months of treatment in schizophrenia. J Clin Psychiatry 2007;68:75-80.  Back to cited text no. 7
    
8.
Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. New York: Guilford Press; 2002.  Back to cited text no. 8
    
9.
Moritz S, Favrod J, Andreou C, Morrison AP, Bohn F, Veckenstedt R, et al. Beyond the usual suspects: Positive attitudes towards positive symptoms is associated with medication noncompliance in psychosis. Schizophr Bull 2013;39:917-22.  Back to cited text no. 9
    
10.
Tranulis C, Goff D, Henderson DC, Freudenreich O. Becoming adherent to antipsychotics: A qualitative study of treatment-experienced schizophrenia patients. Psychiatr Serv 2011;62:888-92.  Back to cited text no. 10
    
11.
Razali MS, Yahya H. Compliance with treatment in schizophrenia: A drug intervention program in a developing country. Acta Psychiatr Scand 1995;91:331-5.  Back to cited text no. 11
    
12.
Moritz S, Hünsche A, Lincoln TM. Nonadherence to antipsychotics: The role of positive attitudes towards positive symptoms. Eur Neuropsychopharmacol 2014;24:1745-52.  Back to cited text no. 12
    
13.
Sullivan G, Wells KB, Morgenstern H, Leake B. Identifying modifiable risk factors for rehospitalization: A case-control study of seriously mentally ill persons in Mississippi. Am J Psychiatry 1995;152:1749-56.  Back to cited text no. 13
    
14.
Sultan S, Chary S, Vemula S. A study of non-compliance with pharmacotherapy in psychiatric patients. APJ Psychol Med 2014;15:81-5.  Back to cited text no. 14
    
15.
Roy R, Jahan M, Kumari S, Chakraborty P. Reasons for drug non-compliance of psychiatric patients: A centre based study. J Indian Acad Appl Psychol 2005;31:24-8.  Back to cited text no. 15
    
16.
Sparr LF, Moffitt MC, Ward MF. Missed psychiatric appointments: Who returns and who stays away. Am J Psychiatry 1993;150:801-5.  Back to cited text no. 16
    
17.
Shamasundar C. Non-compliance of prescriptions by the patients. Indian J Psychiatry 2008;50:73-4.  Back to cited text no. 17
[PUBMED]  [Full text]  
18.
Novick D, Haro JM, Suarez D, Perez V, Dittmann RW, Haddad PM. Predictors and clinical consequences of non-adherence with antipsychotic medication in the outpatient treatment of schizophrenia. Psychiatry Res 2010;176:109-13.  Back to cited text no. 18
    
19.
Velligan DI, Weiden PJ, Sajatovic M, Scott J, Carpenter D, Ross R, et al. The expert consensus guideline series: Adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry 2009;70 Suppl 4:1-46.  Back to cited text no. 19
    
20.
Weiden PJ, Olfson M. Cost of relapse in schizophrenia. Schizophr Bull 1995;21:419-29.  Back to cited text no. 20
    
21.
Cramer JA, Roy A, Burrel A. Medication compliance and persistence: Terminology and definitions. Int Soc Pharmacoecon Outcomes Res 2008;11:44-7.  Back to cited text no. 21
    
22.
Mhaskar R, Alandikar V, Emmanuel P, Djulbegovic B, Patel S, Patel A, et al. Adherence to antiretroviral therapy in India: A systematic review and meta-analysis. Indian J Community Med 2013;38:74-82.  Back to cited text no. 22
[PUBMED]  [Full text]  
23.
Singh V, Jaiswal A, Porter JD, Ogden JA, Sarin R, Sharma PP, et al. TB control, poverty, and vulnerability in Delhi, India. Trop Med Int Health 2002;7:693-700.  Back to cited text no. 23
    
24.
Gopi PG, Vasantha M, Muniyandi M, Chandrasekaran V, Balasubramanian R, Narayanan PR. Risk factors for non-adherence to directly observed treatment (DOT) in a rural tuberculosis unit, South India. Indian J Tuberc 2007;54:66-70.  Back to cited text no. 24
    
25.
Kulkarni P, Akarte S, Mankeshwar R, Bhawalkar J, Banerjee A, Kulkarni A. Non-adherence of new pulmonary tuberculosis patients to anti-tuberculosis treatment. Ann Med Health Sci Res 2013;3:67-74.  Back to cited text no. 25
[PUBMED]  [Full text]  
26.
Central TB Division. TB India 2015. Revised National Tuberculosis Control Programme Annual Status Report. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India; 2015.  Back to cited text no. 26
    
27.
Praveen KN, Halesh LH. Antihypertensive treatment: A study on correlates of non adherence in a tertiary care facility. Int J Biol Med Res 2010;1:248-52.  Back to cited text no. 27
    
28.
Mukherjee S, Sharmasarkar B, Das KK, Bhattacharyya A, Deb A. Compliance to anti-diabetic drugs: Observations from the diabetic clinic of a medical college in Kolkata, India. J Clin Diagn Res 2013;7:661-5.  Back to cited text no. 28
    
29.
Pandey KC, Revannasiddaiah S, Pant NK. Evaluation of factors in relation with the non-compliance to curative intent radiotherapy among patients of head and neck carcinoma: A study from the Kumaon region of India. Indian J Palliat Care 2015;21:21-6.  Back to cited text no. 29
[PUBMED]  [Full text]  
30.
Dutta S, Biswas N, Muhkherjee G. Evaluation of socio-demographic factors for non-compliance to treatment in locally advanced cases of cancer cervix in a rural medical college hospital in India. Indian J Palliat Care 2013;19:158-65.  Back to cited text no. 30
[PUBMED]  [Full text]  
31.
Venkateswaran C, Kumar SK. A Pilot Study of Factors Affecting Patient Compliance to Curative Treatment of Cancer. Available from: http://www.cds.ac.in/krpcds/report/Chitra.pdf. [Last accessed in 2016 Apr].  Back to cited text no. 31
    
32.
Julka PK, Sharma DN, Madan R, Mallick S, Haresh KP, Gupta S, et al. Treatment compliance in lung cancer patients. Clin Oncol (R Coll Radiol) 2015;27:754-5.  Back to cited text no. 32
    
33.
Sotiropoulou P, Gourgoulianis K, Konstantinou K, Petinaki E, Roupa Z. Retrospective study of measuring tuberculosis therapy compliance: Greece as a host country for vulnerable populations before and during the financial crisis. Mater Sociomed 2015;27:328-32.  Back to cited text no. 33
    
34.
Abara WE, Adekeye OA, Xu J, Heiman HJ, Rust G. Correlates of combination antiretroviral adherence among recently diagnosed older HIV-infected adults between 50 and 64 years. AIDS Behav 2016;20:2674-81.  Back to cited text no. 34
    
35.
Tong X, Chu EK, Fang J, Wall HK, Ayala C. Nonadherence to antihypertensive medication among hypertensive adults in the United States-HealthStyles, 2010. J Clin Hypertens (Greenwich) 2016;18:892-900.  Back to cited text no. 35
    
36.
Chen CC, Cheng SH. Continuity of care and changes in medication adherence among patients with newly diagnosed diabetes. Am J Manag Care 2016;22:136-42.  Back to cited text no. 36
    
37.
Smith SG, Sestak I, Forster A, Partridge A, Side L, Wolf MS, et al. Factors affecting uptake and adherence to breast cancer chemoprevention: A systematic review and meta-analysis. Ann Oncol 2016;27:575-90.  Back to cited text no. 37
    
38.
Nosé M, Barbui C, Gray R, Tansella M. Clinical interventions for treatment non-adherence in psychosis: Meta-analysis. Br J Psychiatry 2003;183:197-206.  Back to cited text no. 38
    
39.
Carpenter PJ, Morrow GR, Del Gaudio AC, Ritzler BA. Who keeps the first outpatient appointment? Am J Psychiatry 1981;138:102-5.  Back to cited text no. 39
    
40.
Rabinovitch M, Béchard-Evans L, Schmitz N, Joober R, Malla A. Early predictors of nonadherence to antipsychotic therapy in first-episode psychosis. Can J Psychiatry 2009;54:28-35.  Back to cited text no. 40
    
41.
Huang WF, Cheng JS, Lai IC, Hsieh CF. Medication compliance in outpatients with schizophrenia in one veterans hospital in Taiwan. J Food Drug Anal 2009;17:401-7.  Back to cited text no. 41
    
42.
Hunt GE, Bergen J, Bashir M. Medication compliance and comorbid substance abuse in schizophrenia: Impact on community survival 4 years after a relapse. Schizophr Res 2002;54:253-64.  Back to cited text no. 42
    
43.
Shuler KM. Approaches to improve adherence to pharmacotherapy in patients with schizophrenia. Patient Prefer Adherence 2014;8:701-14.  Back to cited text no. 43
    
44.
Fenton WS, Blyler CR, Heinssen RK. Determinants of medication compliance in schizophrenia: Empirical and clinical findings. Schizophr Bull 1997;23:637-51.  Back to cited text no. 44
    
45.
Sendt KV, Tracy DK, Bhattacharyya S. A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders. Psychiatry Res 2015;225:14-30.  Back to cited text no. 45
    
46.
Baloush-Kleinman V, Levine SZ, Roe D, Shnitt D, Weizman A, Poyurovsky M. Adherence to antipsychotic drug treatment in early-episode schizophrenia: A six-month naturalistic follow-up study. Schizophr Res 2011;130:176-81.  Back to cited text no. 46
    
47.
Frank AF, Gunderson JG. The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome. Arch Gen Psychiatry 1990;47:228-36.  Back to cited text no. 47
    
48.
Lang K, Meyers JL, Korn JR, Lee S, Sikirica M, Crivera C, et al. Medication adherence and hospitalization among patients with schizophrenia treated with antipsychotics. Psychiatr Serv 2010;61:1239-47.  Back to cited text no. 48
    
49.
Leff J, Berkowitz R, Shavit N, Strachan A, Glass I, Vaughn C. A trial of family therapy versus a relatives' group for schizophrenia. Two-year follow-up. Br J Psychiatry 1990;157:571-7.  Back to cited text no. 49
    
50.
Diaz E, Neuse E, Sullivan MC, Pearsall HR, Woods SW. Adherence to conventional and atypical antipsychotics after hospital discharge. J Clin Psychiatry 2004;65:354-60.  Back to cited text no. 50
    
51.
Olivares JM, Thirunavukarasu M, Kulkarni J, Zhang HY, Zhang M, Zhang F. Psychiatrists' awareness of partial and nonadherence to antipsychotic medication in schizophrenia: Results from an Asia-Pacific survey. Neuropsychiatr Dis Treat 2013;9:1163-70.  Back to cited text no. 51
    
52.
Streicker SK, Amdur M, Dincin J. Educating patients about psychiatric medications: Failure to enhance compliance. Psychosoc Rehabil J 1986;4:15-28.  Back to cited text no. 52
    
53.
Pavlickova H, Bremner SA, Priebe S. The effect of financial incentives on adherence to antipsychotic depot medication: Does it change over time? J Clin Psychiatry 2015;76:e1029-34.  Back to cited text no. 53
    

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Correspondence Address:
K Nagaraja Rao
Department of Psychiatry, JJM Medical College, Davangere - 577 004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_24_17

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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