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Medication refusal among patients treated in a community mental health rehabilitation service

Published online by Cambridge University Press:  02 January 2018

Rob Macpherson*
Affiliation:
Wotton Lawn, Horton Road, Gloucester GL1 3PX
Minh Alexander
Affiliation:
Royal United Hospital
W. Jerrom
Affiliation:
United Bristol Healthcare Trust, Barrow Hospital, Bristol
*
Correspondence
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Abstract

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Aims and method

This study aimed to examine medication refusal and its associated variables in a representative sample of patients on the Gloucester rehabilitation service case register. One hundred and seventy-four of 199 patients on the Gloucester rehabilitation register were surveyed. Insight cognitive function, knowledge of treatment, psychopathology and patient satisfaction were independently rated.

Results

Thirty-five per cent of patients had refused treatment in the past month. Negative attitudes to treatment and historical indices of non-compliance were associated, identifying a consistent core of patients at continuing risk of refusal. However of refusers, 84% were persuaded within one month to take treatment, mostly by their community keyworker. Treatment refusal was associated with diagnosis of affective disorder, higher Brief Psychiatric Rating Scale score and failure to use a dosett dispenser, but not with insight cognitive function, satisfaction with treatment, knowledge of treatment, a range of illness and demographic factors or any particular treatment type.

Clinical implications

Drug refusal was evidently mostly managed by community keyworkers, and without recourse to the Mental Health Act. Simple techniques such as the use of dosett dispenser may be valuable. Problems of communicating with the severely mentally ill about their long-term treatment were discussed.

Type
Original Papers
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © 1998 The Royal College of Psychiatrists

References

Babiker, I. E. (1986) Non-compliance in schizophrenia. Psychiatric Developments, 4, 329337.Google Scholar
Barnes, T. R. E. & Pantelis, C. (1992) Treatment resistant schizophrenia. Schizophrenia Monitor, 2, 14.Google Scholar
Birchwood, M., Smith, J., Drury, V., et al (1993) A self report insight scale for psychosis: Reliability, validity and sensitivity to change. Acta Psychiatrica Scandinavica, 86, 16.Google Scholar
Blackwell, B. (1972) The drug defaulter. Clinical Pharmacology and Therapeutics, 13, 841848.Google Scholar
Blessed, G. & Thompson, P. (1987) Correlation between the 37-item mental test score and abbreviated 10-item mental test score by psychiatric day patients. British Journal of Psychiatry, 152, 206209.Google Scholar
Corrigan, P. W., Liberman, R. P. & Engel, J. D. (1990) From non-compliance to collaboration in the treatment of schizophrenia. American Journal of Psychiatry, 107, 786789.Google Scholar
Kemp, R., Hayward, P., Applewhite, G., et al (1996) Compliance therapy in psychotic patients: randomised controlled trial. British Medical Journal, 312, 345349.Google Scholar
Kissling, W. (1994) Compliance, quality assurance and standards for relapse prevention in schizophrenia. Acta Psychiatrica Scandinavica, 89 (suppl. 382), 1624.Google Scholar
Macpherson, R., Jerrom, W. & Hughes, A. (1996) A controlled study of education about drug treatment in schizophrenia. British Journal of Psychiatry, 168, 709717.Google Scholar
Macpherson, R., Jerrom, W. & Hughes, A. (1997) Drug refusal among schizophrenic patients in the community. Journal of Mental Health, 6, 141147.Google Scholar
Macpherson, R., Alexander, M., Jerrom, W., et al (1998) A survey of patients and keyworker satisfaction with a mental health rehabilitation service. Journal of Mental Health, in press.Google Scholar
Marder, S. R., Swann, E., Winslade, W. J., et al (1984) A study of medication refusal by involuntary psychiatric patients. Hospital and Community Psychiatry, 35, 724726.Google Scholar
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale. Psychiatric Reports, 10, 799.Google Scholar
Royal College of Psychiatrists (1987) Community Treatment Orders: A Discussion Document. London: Royal College of Psychiatrists.Google Scholar
Van Putten, T. V. (1974) Why do schizophrenic patients refuse to take their drugs? Archives of General Psychiatry, 31, 6772.Google Scholar
Zito, J. M., Routt, W. W., Mitchell, J. E., et al (1985) Clinical characteristics of hospitalised psychiatric patients who refuse antipsychotic drug therapy. American Journal of Psychiatry, 142, 822826.Google ScholarPubMed
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