Antipsychotic Medication Adherence and Satisfaction Among Palestinian People with Schizophrenia

Waleed      M. Sweileh; Manal      S. Ihbesheh; Ikhlas      S. Jarar; Ansam      F. Sawalha; Adham      S. Abu Taha; Sa'ed      H. Zyoud; Donald      E. Morisky

Abstract

Background: In Arab and Muslim-dominated countries, spirituality and religiosity shape the belief and practices toward chronic illnesses. No previous studies were published to assess adherence to and satisfaction with antipsychotic medications in persons with schizophrenia in the Arab world. Objective: To assess medication adherence and treatment satisfaction with antipsychotics in a sample of Palestinian people with schizophrenia. Methodology: Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). Treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Psychiatric symptoms were assessed using the expanded Brief Psychiatric Rating Scale (BPRS-E). Data were entered and statistically analyzed using SPSS 16 for windows. Results: A convenience sample of 131 persons with schizophrenia was studied. Based on MMAS-8, 44 persons (33.6%) had a low rate, 58 (44.3%) had a medium rate and 29 (22.1%) had a high rate of adherence. Age was significantly correlated (P=0.028) with adherence score. However, variables like use of monotherapy or atypical or depot antipsychotics were not significantly associated with higher adherence. The means of satisfaction with regard to effectiveness, side effects, convenience and global satisfaction were 72.6 ± 20.5, 67.9 ± 31.47, 63.2 ± 14.3 and 63.1 ± 18.8 respectively. There was a significant difference in the means of effectiveness (P < 0.01), convenience (P < 0.01), global satisfaction (P < 0.01), but not side effects domains (P=0.1) among persons with different levels of adherence. Furthermore, there was a significant difference in the means of positive symptom score (P < 0.01), manic (P < 0.01) and depression (P < 0.01) but not negative symptom score (P=0.4) among persons with different levels of adherence. Conclusions: Medication nonadherence was common and was associated with low treatment satisfaction scores and poor psychiatric scores. Medication related factors had insignificant effects on adherence scores.

Keywords: Schizophrenia, medication adherence, treatment satisfaction, Palestine, Psychiatric symptoms, depression/ anxiety, manic excitement/ disorganization, distractibility, motor hyperactivity, self neglect, hallucinations