Reasons for Schizophrenia Patients Remaining out of Treatment: Results from a Prospective Study in a Rural South Indian Community.
BACKGROUND
A few studies have examined the factors associated with schizophrenia patients remaining untreated in India.


METHODS
We identified 184 schizophrenia patients in a rural community, offered the treatment with antipsychotics and followed them up in their Primary Health Centers for 1-year. Twenty-nine (15.8%) patients remained untreated at both the baseline and 1-year follow-up despite our best attempts to keep them under the treatment umbrella. They were interviewed in detail regarding the reasons for remaining untreated. This group was compared with another group of patients (n = 69) who had stopped the treatment at baseline but were successfully brought under the treatment umbrella throughout the 1-year follow-up period.


RESULTS
The reasons for remaining untreated were (n; %): (a) Unsatisfactory improvement with previous treatment attempts (19; 65.5%), (b) poor bond between the patients and the families (6; 20.7%), (c) active symptoms not allowing any treatment efforts from the family members (6; 20.7%), (d) magico-religious beliefs about the illness and its treatment (4; 13.8%), (e) poor social support (3; 10.3%), (f) adverse effects of the medications (2; 6.9%), and (g) perception of recovery and cure (1; 3.4%). For many patients, a constellation of these reasons was responsible for them remaining untreated. In contrast, the common reasons for those who restarted medications to have stopped the treatment at some time were the lack of awareness, the need to continue medications (47; 68.1%), and the financial constraints (28; 40.6%).


CONCLUSIONS
The predominant reason for schizophrenia patients not remaining on the treatment in this rural community was the families' lack of faith in antipsychotic treatment. Provision of comprehensive treatment package including medical, psychosocial and rehabilitative services, and sensitizing the community about benefits of the treatment may help in ensuring that all patients with psychosis receive the best care.
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India.
Channaveerachari Naveen
CN
Kumar
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India.
Jagadisha
J
Thirthalli
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India.
Kudumallige Krishnappa
KK
Suresha
Department of Psychiatry and Sleep Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
Basappa K
BK
Venkatesh
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India.
Kengeri V
KV
Kishorekumar
Manasa Nursing Home, Thirthahalli, Shivamogga, Karnataka, India.
Udupi
U
Arunachala
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India.
Bangalore N
BN
Gangadhar
Remaining untreated; rural community; schizophrenia