Reasons associated with treatment non-adherence in schizophrenia in a Pakistan cohort

Ahmad, Ismail Sheikh; Khalily, Muhammad Tahir; Hallahan, Brian

doi:10.1016/j.ajp.2017.07.024

Cited by 21 publications

(22 citation statements)

References 38 publications

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“…Treatment nonadherence is a well-known identified factor associated with a relapse of many mental disorders including major depressive disorder (Gopinath, Katon, Russo, & Ludman, 2007) and schizophrenia (Ahmad, Khalily, & Hallahan, 2017). Although toxicology reports were unavailable, a clinical theme established from multisource psychological autopsy interviews was treatment nonadherence and indeed it is probable that nonadherence rates were higher than those elicited on interviews.…”

Section: Discussionmentioning

confidence: 99%

Psychological autopsy review on mental health crises and suicide among youth in Pakistan

Abdullah

Khalily

Ahmad

et al. 2018

Asia-Pacific Psychiatry

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Introduction Ascertaining putative sociodemographic and clinical causes for death by probable suicide can potentially help implement region‐specific strategies to reduce suicide rates. In this study, we wanted to investigate methods utilized and the psychosocial and mental health characteristics of youths (aged 12‐26 y) who died by probable suicide. Method We examined data from mental health clinical files and forensic reports and performed qualitative psychological autopsy interview from more than multiple sources for each youth who died by probable suicide between 1 May and 31 December 2015 in the Khyber Pakhtunkhwa Province of Pakistan. Results The two most common methods of probable suicide were by firearm use and self‐poisoning utilizing pesticides that were significantly associated with male and female gender, respectively. The most common mental health difficulties were major depressive disorder and harmful use of psychoactive substances. Other clinical features particularly evident included thoughts of self‐harm, irritability and aggression, low self‐esteem, treatment nonadherence, family dispute, and financial distress. Conclusion Efforts to reduce the ease of access to firearms and pesticides may potentially have a beneficial effect in reducing the suicide rate in this region of Pakistan.

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Section: Discussionmentioning

confidence: 99%

Psychological autopsy review on mental health crises and suicide among youth in Pakistan

Abdullah

Khalily

Ahmad

et al. 2018

Asia-Pacific Psychiatry

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“…A lack of training of health-care professionals in a number of LMICs, the stigma associated with mental disorders exacerbated by preconceptions and cultural issues as well as a lack of clear referral systems and support to treat mental disorders, all negatively impact on care provision alongside concerns with access to care and appropriate treatment [3,4,12,16,23,[37][38][39][40][41][42][43][44][45][46][47][48][49]. There is also considerable use of traditional medicines and faith healers in a number of LMICs which may also have a negative impact on patient outcomes; however, this may not always be the case [50][51][52].…”

Section: Generalmentioning

confidence: 99%

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

Godman

Grobler

Van-De-Lisle

et al. 2019

Expert Opinion on Pharmacotherapy

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Introduction: Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middleincome countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed. Areas covered: Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments. Expert opinion: Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients' rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up.

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“…However, currently only a minority of people affected by mental health receive basic treatment (6,(9)(10)(11). Whereas there is evidence from higher income countries that not all people with mental disorders receive adequate treatment, this is worse in low and middle income countries (LMICs) where mental health services are traditionally lacking, and large segments of the population do not have ready access to health care or receive inadequate care (9,10,12,13). Where services exist in LMICs, these tend to be based in hospitals and oriented predominantly towards urban conditions, although community care is now increasing (6).…”

Section: Introductionmentioning

confidence: 99%

“…To date, there have been relatively few studies reporting on mental health conditions in Pakistan. Those that have been published include studies on common psychiatric disorders in outpatient care, general and major depressive disorders, factors associated with psychotic relapses and nonadherence of anti-psychotic medicines, gender differences in response to antipsychotics, cognitive disorders, and prescribing preferences of mental health professionals (7,13,64,(66)(67)(68)(69)(70)(71). However, we are not aware of any study that has comprehensively assessed utilization and expenditure patterns of antipsychotic medicines across Pakistan as a first step to improving treatment options if concerns.…”

Section: Introductionmentioning

confidence: 99%

Trends in the prescribing of antipsychotic medicines in Pakistan: implications for the future

Mahmood

Hussain

Rehman

et al. 2018

Current Medical Research and Opinion

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There has been an appreciable increase in antipsychotic utilization in recent years in Pakistan, especially atypical antipsychotics, with little polypharmacy. Ongoing utilization of typical antipsychotics may be due to comorbidities such as diabetes and cardiovascular disease. Issues of international non-proprietary name prescribing need investigating along with the high number of medicines per encounter and gender inequality.

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Reasons associated with treatment non-adherence in schizophrenia in a Pakistan cohort

Cited by 21 publications

References 38 publications

Psychological autopsy review on mental health crises and suicide among youth in Pakistan

Psychological autopsy review on mental health crises and suicide among youth in Pakistan

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

Trends in the prescribing of antipsychotic medicines in Pakistan: implications for the future

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