Impact of Side Effects of Antipsychotics on Attitude and Adherence to Treatment among Adult Psychiatric Outpatients at

Mathari Hospital in Kenya

Defense Presentation

AUTHORS AND SUPERVISORS

Presenter/Author Dr. Edward Katayi

(U56/64069/2013

Supervisors Dr. David Nyamu Dr. TB Menge Dr. Peter Karimi

BACKGROUND

In sub-Saharan Africa, mental disorders account for nearly 10% of the total burden of disease.

Psychotic disorders are disabling illnesses associated with disruption in cognition, emotion, psychosocial and occupational functioning.

Antipsychotic medications are the main stay treatment of psychotic disorders and adherence is required for optimal benefit.

BACKGROUND

The use of antipsychotics entails a trade-off between the benefits of alleviating psychotic symptoms and the risk of troubling side effects.

These side effects may impact on the patient’s attitude towards their use and lead to non-adherence.

The results of nonadherence includes; relapse, rehospitalization, longer time to remission, increased risk of suicide among others.

OBJECTIVES

To determine the prevalence of side effects of antipsychotics in psychiatric adult outpatients at Mathari Psychiatric Hospital

To determine the impact of side effects on patients’ attitude towards antipsychotic medication.

To determine the association between the side effects of antipsychotics and the level of adherence to treatment.

RESEARCH QUESTIONS

What was the prevalence of side effects of antipsychotics among adult psychiatric adult outpatients?

What was the relationship between the side effects of antipsychotics and patient attitude towards their use?

What was the relationship between the side effects of antipsychotics and the level of drug adherence among psychiatric adult outpatients?

SIGNIFICANCE OF THE STUDY

Nonadherence to medication remains a challenging problem in the management of psychotic disorders.

In Kenya like many other African countries, there are no documented studies assessing the relationship between patient reported antipsychotic side effects and adherence.

The findings will help to determine the extent of adherence and attitude towards antipsychotic treatment .

METHODOLOGY

A cross sectional study design and convenient sampling method was used and the study was at Mathari Psychiatric Hospital.

Ethical approval was granted by the KNH /UoN ERC and permission from the study site was given.

The target population consisted of adult psychiatric outpatients on antipsychotics and a sample of 164 participants was recruited.

METHODOLOGY

Data collection was done between July and August2014

The research instruments used included: Socio-demographic data questionnaire, Glasgow Antipsychotic Side effect Scale, Drug Attitude Inventory and Medication Adherence Rating Scale

Data analysis was done using STATA version 10 software.

Descriptive and regression analysis were used. Statistical significance was set at p value less than 0.05.

RESULTS- SAMPLE BASELINE CHARATERISTICS

The study consisted of 164 psychotic outpatients and the ratio of male to female was 1: 0.8

Majority had at least primary (39.63%) or secondary education (35.98%).

More than half of the participants (56.10%) were single and 31.71% were married.

A large number (46.34%) were unemployed , 32.93% were self employed and 4.27% were students.

RESULTS- SAMPLE BASELINE CHARATERISTICS

Majority of the patients were taking typical antipsychotics (87.20%) and a few were on atypical antipsychotics (21.34%)

Haloperidol (57.93%) and chlorpromazine (46.95%) were the most widely prescribed typical antipsychotics

Majority of the patients were on more than one antipsychotic medication (64%)

RESULTS- SAMPLE BASELINE CHARATERISTICS

RESULTS- PREVALENCE OF SIDE EFFECTS

RESULT- EXTENT OF SIDE EFFECTS

RESULT- ATTITUDE TOWARDS TREATMENT

In general 53.65% of the patients had a positive subjective attitude toward antipsychotics treatment.

Side effects which had a statistical significant association with negative attitude towards treatment were:

Positive DAI-10 Score (n= 88)

Negative DAI-10 Score (n=76)

n % n % P value χ2

Moderate SE 23 26.14 50 65.79 ˂ 0.001 20.02

Sedation 67 76.13 67 88.15 0.001 12.66

EPS 61 69.31 67 88.15 0.002 10.39

Sexual dysfunction 28 31.82 38 50.00 0.024 5.32

Cardiovascular SE 31 35.22 41 53.94 0.003 9.16

RESULT-ADHERENCE TO TREATMENT

Only 39.63% reported complete adherence to medication.

Variables like gender, education level, marital status, employment status and psychiatric diagnosis did not significantly impact on patient’s adherence to medication (p > 0.05)

Nonadherence was positively and statistically significantly influenced by negative attitude towards antipsychotic medications treatment.

RESULTS-ASSOCIATION BETWEEN SIDE EFFECTS AND ADHERENCE

LEVELSOdds Ratio (OR) 95% Confidence

Interval

P- value

Sedation 0.23 0.103- 0.545 0.001

Extrapyramidal

side effect

0.43 0.286- 0.633 ˂ 0.001

Sexual dysfunction 0.82 0.651- 1.022 0.014

Weight gain 0.98 0.832 -1.148 0.786

Anticholinergic side

effects

0.91 0.818- 1.022 0.117

GIT side effects 0.20 0.099-0.430 0.037

Cardiovascular side

effects

0.81 0.702 -0.925 0.002

Moderate side

effects

0.89 0.812-0.993 ˂ 0.001

DISCUSSION

The high prevalence of side effects is in agreement with other previous studies, possibly because most of our participants were on typical antipsychotics (87. 20%).

In general majority of our participants had a positive attitude towards treatment. Other studies have also shown similar results.

In our study, severity of side effects was associated with negative subjective attitudes towards medication.

Adherence to medication was influenced by side effects, just like other previous studies.

DISCUSSION

Sexual dysfunction, extrapyramidal symptoms, sedation, GIT side effect and cardiovascular side effects where associated with reduced likelihood of adherence.

However patients who had a positive attitude towards their medication had an increased likelihood of adherence to treatment.

Majority of participants who were counseled about their medication had a positive subjective attitude towards treatment.

CONCLUSION

We found a high prevalence of antipsychotic side effects (94.14%)

Remarkably most patients did not completely adhere to their medications because of side effects.

However patients who had a positive attitude towards medication had a high likelihood of adherence.

Therefore improving patient’s attitude towards treatment by managing the side effects adequately and promptly may increase adherence.

RECOMMENDATIONS

Adequate and timely management of antipsychotics side effects should be encouraged to improve adherence.

Patient counseling on medication and their side effects can improve attitude towards treatment.

Use of antipsychotics with lesser side effects should be encouraged to improve adherence.

ACKNOWLEDGEMENT

I would like to acknowledge my supervisors Dr. Nyamu, Dr. Menge and Dr. Karimi for sharing their knowledge and encouragement.

I thank my colleagues for their support.

Above all I thank the almighty God.

THANK YOU