Factors Increasing Noncompliance of Psychiatric Patients Undergoing for Psychotropic Therapy

Introduction: The positive result of the treatment regimen mainly depends on the adherence of the patients towards the instruction given by the physician and termed as the noncompliance or incomplete adherence to treatment. Methods: The present study aimed to descriptively analyze and identify the reasons that increasing the incomplete adherence for psychotropic therapy based on information retrieved from the patient and their relatives in Institute of Mental Hospital (IMH), Chennai.90 participants were interrogated using a structured questioner by purposive-sampling procedure after receiving their informed consent. Results: The present study showed the involvement of different factors such as pre – mature stopping the drug regimen (28.8%), buying lesser quantity of the drugs than prescribed by physicians (24.4%), and irregular drug consuming (23.3%). The present study importance of creating the awareness regarding the optimal followups and emphasized the advices regarding the changing the mental health service regimes. The patients and relatives should be given the psychological based awareness for reducing the noncompliance on the psychotropic regimes.


INTRODUCTION
The noncompliance is the behavior of the patients that usually not following the instructions given by the physicians properly and it is a major factor for the failure of the treatment regime. It is found with all of the patient population from the children to adults, especially in women patients. In chronic diseases, the majority of the patients turned to be non-compliance due to positive drug effects and it is to be a major problem in health services of both developed and developing nations. Most of patients, up to 80% of patients, complete treatment regime (with a median value, 50%) [1][2]. Compliance towards the therapeutic regime directly determines the success of the medication whereas, noncompliance is the major cause for serious sideeffects and prognosis of the illness. Those drugs nowadays occupy first line of treatment almost every patients encountered with psychological illness. In India, psychosis is the most common mental disorder found among the people and it is major cause for mental related hospitalization. The psychosis is related to gross impairment or distort in identifying the reality or the reality testing. It is a common problem in adult population, but, the ales are the major victims than the females. The prognosis and diagnosis on psychotic patient is a challengeable one and the ratio of recurrence is very common since, most of them do not complete or compliance with the medications [3][4][5].
The psychotic patient are advised to adhere and compliance with the instruction given to them and complete the treatment tenure [6]. But, nearly half of their population do not complete the tenure and proportionally they decrease with the time due to many reasons. The non-adherence towards the treatment is found to be a major factor for reoccurrence and re-hospitalization. Many of the patients do not follow the prescribed treatment because of various reasons [7]. The noncompliance is a personalized behavior that deviate the patients in fulfilling the medical advices from the respective physicians and single most reason that prevent 100% success in psychosis treatments. Poor medication is another most reason for unsuccessful scenario followed by the side effects of the prescribed drugs [8]. One third of the patients never complete the tenure and most of them are re-hospitalized. This make extra burden on their medical expenses and caring systems. In India, a clear and optimal statistics is absent to analyze the exact scenario related to the noncompliance in psychotic patients [9][10][11]. In addition, it is also correlated with the increased morbidity, suicidal thoughts and mortality among the patients [12]. But, it is not only the responsibility of the patients but, it is the responsibility of the health care professionals such as nurses, physicians and principle investigators. The proper awareness about the advantages of completing the treatment regimens should be given to the patients, their relatives and the associated health care providers also [13].

MATERIALS AND METHODS
The present study is a descriptive and Purposive sampling technique study (n=90, a year long study) conducted on out-patient department in psychiatric Out Patient Department, IMH, and Chennai. The sample size is 90 and the patients were included in the study based on their individual curiosity from either of the gender. The exclusion criteria included the patients suffering from physical problems associated with the psychological intention. The patient data were collected and categorized as age, type of family, duration of marital life, number of children, monthly income, occupation, educational status , religion, area of living, history of domestic violence, duration of mental illness. The written informed consent was obtained from the participants before their participation.
Pre conclusion in the treatment is frequently found in psychotic patients. The present study showed that 28.8% (26) of them stopped to take drugs on feeling better before the treatment tenure. 24.4% (22) of them informed that usually they run out of pills and stopped the regime further. Nearly, equal patient population (24.4%) took the pills irregularly. In addition to, 23.3% (21) of the subjects were dependent on others for pills provision and 15.5% (14) patients forgot the pills or too busy for adhering the regimes. 11.1% (10) of them felt difficulties in transportation and 7.7% (7) fearing of the side-effects of the drugs. 7.7% informed that they unable to buy the adequate pills due to the non-cooperation from their family members. 5(5.5%) of them felt

DISCUSSION
The results obtained in the present study concordance with the previous reports conducted in the same medical service Centre (2015). The results showed that most of the patients' study explored that majority of the subjects perceived disease characteristics related factors as main reason for non-compliance.

CONCLUSION
The study showed that most of factors associated with the noncompliance of treatment are mainly depend upon the patient's mentality in psychotic treatments. Hence, the present showed the importance of patient care for achieving the 100% successful treatment for psychotic diseases.

CONSENT
As per international standard or university standard, patients' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
The study was approved by the Institutional Ethics Committee