Non–adherence and predictors in patients with schizophrenia on second generation antipsychotics at Amanuel Mental Specialized Hospital, Ethiopia

Background: Schizophrenia is a chronic and profound mental disorder. Non–adherence to prescribed medication regimens is a major concern in the treatment of schizophrenia. This study aimed to investigate the prevalence, factors, and reasons contributing to non–adherence among Ethiopian patients with schizophrenia who are receiving second-generation antipsychotics (SGAs). Methods: A hospital–based cross–sectional study was done at Amanuel Mental Specialized Hospital (AMSH) from 03/10/2022 to 31/8/2023. Data were collected using the drug attitude inventory-10 (DAI-10) tool. Analysis was conducted using Statistical Package for Social Sciences (SPSS) version 25. Univariate and multivariate binary logistic regression analyses were conducted. Results: Most participants were male, (90.0%), and aged 26-40 years, (53.5%). Mean doses for risperidone and olanzapine prescribed were 4.9mg (±2.4) and 13.5mg (±5.0), respectively. Close to 40% of patients were khat (Catha edulis) users. The mean Positive and Negative Syndrome Scale (PANSS) total score was 71.1 ± 35.9 and the Clinical Global Impression-Severity (CGI-S) score was 3.42 ± 1.21. Around 31.4% of participants were non-adherent. Forgetfulness (31.73%) and stigma (27.31%) were the primary reasons cited for non–adherence. The multivariate binary logistic regression analysis revealed a significant association between non–adherence and several key factors. Patients with a PANS score equal to or greater than 71 (95% CI: 1.04, 3.80; p = 0.02), Patients categorized as having a moderate to markedly severe illness (95% CI: 1.1, 3.1; p = 0.024), duration of follow-up (DUP) (6-10) years (95% CI: 1.4, 129; p = 0.02), and age (26-40) years (95% CI: 0.3, 0.9; p = 0.04) were found to be statistically significant predictors of non–adherence. Conclusion: The investigators recommended that counseling of the patients to highlight the importance of adherence, instituting regular and comprehensive symptom monitoring, tailoring interventions to address reasons for non-adherence, promoting early intervention and treatment initiation to reduce the DUP, and customizing interventions based on age-specific needs.