Transcript IMPACT OF SIDE EFFECTS OF ANTIPSYCHOTICS ON ATTITUDE

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
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Presenter/Author
Dr. Edward Katayi
(U56/64069/2013
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Supervisors
Dr. David Nyamu
Dr. TB Menge
Dr. Peter Karimi
BACKGROUND
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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 LEVELS
Odds Ratio (OR)
95% Confidence Interval
P- value
Sedation
0.23
0.103- 0.545
0.001
Extrapyramidal side
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
0.91
0.818- 1.022
0.117
GIT side effects
0.20
0.099-0.430
0.037
Cardiovascular side
0.81
0.702 -0.925
0.002
0.89
0.812-0.993
˂ 0.001
effect
effects
effects
Moderate side effects
DISCUSSION
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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
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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
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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
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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
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I would like to acknowledge my supervisors Dr. Nyamu, Dr.
Menge and Dr. Karimi for sharing their knowledge and
encouragement.
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I thank my colleagues for their support.
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Above all I thank the almighty God.
THANK YOU