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Older psychiatric in-patients' knowledge about psychotropic and non-psychotropic medications

  • Sri Perecherla (a1) and Alastair J. D. Macdonald (a2)
Abstract
Aims and method

We hypothesised that, because of stigma associated with mental illness, patients' knowledge of psychotropic medication would be less than that of non-psychotropic medication. We set out to establish the extent of knowledge about these medications using a cross-sectional survey of in-patients over 65 years of age in south London.

Results

Of the study population (n = 86), 42% demonstrated an understanding of the purpose of taking both psychotropic and non-psychotropic medication, 15% understood only their psychotropic medication, 16% understood only their non-psychotropic medication and 27% understood neither medication. A surprising finding was that more than 20% of these patients with cognitive impairment were not able to recount their legal status; this factor was independently related to whether or not they knew the purpose of their psychotropic medication, and also whether or not they knew the purpose of neither type of medication.

Clinical implications

Poor knowledge of medication has been associated with non-adherence and relapse. Older adults are likely to receive multiple medications because of their increased susceptibility to physical and psychiatric disorders with increasing age, so even more emphasis has to be placed on increasing knowledge of medication.

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Copyright
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.
Corresponding author
Sri Perecherla (s.perecherla@nhs.net)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Mitchell, AJ, Selmes, T. Why don't patients take their medicine? Reasons and solutions in psychiatry. Adv Psychiatr Treat 2007; 13: 336–46.
2 Cooper, C, Bebbington, P, King, M, Brugha, T, Meltzer, H, Bhugra, D, et al. Why people do not take their psychotropic drugs as prescribed: results of the 2000 National Psychiatric Morbidity Survey. Acta Psychiatr Scand 2007; 116: 4753.
3 Pratt, SI, Mueser, KT, Driscoll, M, Wolfe, R, Bartels, SJ. Medication nonadherence in older people with serious mental illness: prevalence and correlates. Psychiatr Rehabil J 2006; 29: 299310.
4 Knapp, M, King, D, Pugner, K, Lapuerta, P. Non-adherence to antipsychotic medication regimens: associations with resource use and costs. Br J Psychiatry 2004; 184: 509–16.
5 Nosé, M, Barbui, C, Gray, R, Tansella, M. Clinical interventions for treatment non-adherence in psychosis: meta-analysis. Br J Psychiatry 2003; 183: 197206.
6 Department of Health. National Service Framework for Older People. Department of Health, 2001.
7 Department of Health. Prescriptions Dispensed in the Community: Statistics for 1989–99 – England. Statistical Bulletin, 2000.
8 National Prescribing Centre. Prescribing for the older person. MeReC Bulletin 2000; 11: 3740.
9 Marinker, M. From Compliance to Concordance: Achieving Shared Goals in Medicine Taking. Royal Pharmaceutical Society of Great Britain, 1997.
10 Wetherell, JL, Unutzer, J. Adherence to treatment for geriatric depression and anxiety. CNS Spectr 2003; 8 (12 suppl 3): 4859.
11 Lowe, CJ, Raynor, DK, Courtney, EA, Purvis, J, Teale, C. Effects of self medication programme on knowledge of drugs and compliance with treatment in elderly patients. BMJ 1995; 310: 1229–31.
12 Brown, KW, Billcliff, N, McCabe, E. Informed consent to medication in long-term psychiatric in-patients. Psychiatr Bull 2001; 25: 132–4.
13 Folstein, M, Folstein, S, McHugh, P. ‘Mini-Mental State’, a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.
14 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
15 Chow, S, Ruskey, F. Drawing area-proportional Venn and Euler diagrams. In Graph Drawing (ed Liotta, G): 466–77. Springer,, 2004.
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BJPsych Bulletin
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  • EISSN: 1758-3217
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Older psychiatric in-patients' knowledge about psychotropic and non-psychotropic medications

  • Sri Perecherla (a1) and Alastair J. D. Macdonald (a2)
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eLetters

Discrimination between psychotropic and non-psychotropic treatment by patients

Gurinder P Singh, CT2 Psychiatry
09 March 2012

Perecherla et al [1] state they found no evidence that patients discriminated between psychotropic and non-psychotropic treatment. A lack of concordance with psychotropic medication has been reported to be as high as 75% over the course of a year [2]. While this may be on par with adherence to non psychotropic medications, there were significant factors which were not taken into consideration in this study.

Only patients who could communicate in English were included. This may have excluded patients from minority ethnic groups and other non-White British backgrounds thereby ignoring their cultural and religious beliefs regarding medication. This surely must reduce the relevance of the results topopulations with significant ethnic groups. Further, the authors were unable to ascertain the duration of treatment in participants. This is an important factor as adherence improves with development of insight [3]. The opposite is true of acute relapse. In addition, it is not clear if the sample was drawn from acute or long stay wards. It is unclear if the sample consisted of patients who were stable on psychotropic medication and had insight or were acutely unwell. It is quite possible that most ofsample consisted of patients who were stabilised on a drug regime, had insight and knew the purpose of their psychotropic medication. However this may not be the case in acute episodes of care where the patient often lacks insight and questions the need to continue psychotropic medications. The authors state that in case of participants on more than two psychotropics, the "longest term treatment option" was selected. We fail to understand how this was established if duration of treatment was unknown? In the example given of bipolar disorder patient, the mood stabiliser was selected rather than the antipsychotic as the primary treatment; this was based on the assumption that mood stabilisers had been used first. However it is well known that many patients get treated with antipsychotics as first line. It is quite possible that antipsychotic medication was the initial intervention used and the patient took it as matter of routine. In summary, medication adherence is a complex issue with various factorsaffecting it such as lack of insight, religious & cultural beliefs, level of education & socio economic status, co morbid alcohol misuse to name a few [4]. While we welcome this paper, we also recognise the needto improve our understanding of the issues surrounding adherence and believe further studies are needed in this area.

References1.Perecherla et al. Older psychiatric in-patients' knowledge about psychotropic and non-psychotropic medications; The Psychiatrist (June 2011); 35; 220-224.2.Mitchell AJ, Selmes T.Why don't patients take their medicine? Reasons and solutions in psychiatry. Advances in Psychiatric Treatment 2007; 13:336-46.3.Droulout T, Liraud F, Verdoux H. Relationships between insight and medication adherence in subjects with psychosis; Encephale; 2003 Sep-Oct; 29(5):430-7.4.Patel M, David, A. Medication adherence: predictive factors & enhancement strategies psychiatry, Elsevier, 2007; 3, 10:41-44.

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Conflict of interest: None declared

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