Virtual Medical Centre

Living with Schizophrenia

• Introduction to schizophrenia
• Living with schizophrenia
• The importance of medication compliance

Introduction to schizophrenia 

The term schizophrenia was first coined by Swiss psychiatrist Eugen Bleuler to describe the presence of schisms between thought, emotion and behaviour. Clinically, schizophrenia is a disturbance lasting for at least 6 months and including at least one month of at least two of the following:

• Delusions
• Hallucinations
• Disorganised speech
• Grossly disorganised or catatonic behaviour
• Negative symptoms

Living with schizophrenia

Schizophrenia remains one of the top causes of disability in the world, despite more than five decades of pharmacological and psychosocial interventions. The impairments faced by people with schizophrenia are widespread, affecting social, occupational and independent living activities. People with schizophrenia commonly have disabilities in partner relationships, work roles, social withdrawal, household participation, general interests, self care and social friction. These disabilities are especially common among young and middle aged adults, and occur even in people responding to treatment for psychosis.

A long term study looked at the change in social disability of people who had a first episode psychosis. It found that the level of social disability for a particular individual fluctuated with time, and many individuals experienced different levels of disability. About one third of the people involved in the study improved considerably over 15 years, and 40% had little or no disability at the end. However, one out of seven did not improve.

The importance of medication compliance

Several scientific studies have shown that most patients with schizophrenia are noncompliant with their medications. This means that they either do not take the correct dose of their medications, or do not take their medication regularly. Several studies have shown that 90% or more of schizophrenic patients do not take their medication as directed. There are various reasons why patients do not take their medication, including forgetting to pick up a refill, cost, or an intentional decision to not take medication.

Patients who do not take their medication as directed often experience poorer outcomes, including increased hospitalisation rates. A large study used information from pharmacists to identify patients who did not take their medication as directed. They found that patients with good compliance had the lowest rates of hospital admission. As compliance decreased, the rates of hospital admissions increased. Once admitted to hospital, those who were less compliant stayed longer in hospital. 

Medication Adherence Rating Scale
(MARS)

Using the MARS tool, you and your patient can determine willingness and ability to take oral medication every day.

		Yes	No
1.	Do you ever forget to take your medication?
2.	Are you careless at times about taking your medicine?
3.	When you feel better, do you sometimes stop taking your medicine?
4.	Sometimes if you feel worse when you take the medicine, do you stop taking it?
5.	I take my medication only when I am sick.
6.	It is unnatural for my mind and body to be controlled by medication.
7.	My thoughts are clearer on medication.
8.	By staying on medication, I can prevent getting sick.
9.	I feel weird, like a ´zombie´, on medication.
10.	Medication makes me feel tired and sluggish.

Results

This individual has scored  out of 10 on the adherence rating scale.

It is likely they are adhering to their schizophrenia medication.

This individual has scored  out of 10 on the adherence rating scale.
They are not adhering to the prescribed medication schedule.

References:

1. Thompson K et al. Schizophrenia Research 2000;42:241-7.
2. Fialko L, et al. Schizophrenia Research 2008;100:53-9.