1. Impact of Side Effects of Antipsychotics on Attitude and Adherence to Treatment among Adult Psychiatric Outpatients at Mathari Hospital in Kenya Defense Presentation

2. AUTHORS AND SUPERVISORS  Presenter/Author  Dr. Edward Katayi (U56/64069/2013  Supervisors  Dr. David Nyamu  Dr. TB Menge  Dr. Peter Karimi

3. BACKGROUND  In sub-Saharan Africa, mental disorders account for nearly 10% of the total burden of disease.  Psychotic disorders are disabling illnesses associated with disruption in cognition, emotion, psychosocial and occupational functioning.  Antipsychotic medications are the main stay treatment of psychotic disorders and adherence is required for optimal benefit.

4. BACKGROUND  The use of antipsychotics entails a trade-off between the benefits of alleviating psychotic symptoms and the risk of troubling side effects.  These side effects may impact on the patient’s attitude towards their use and lead to non-adherence.  The results of nonadherence includes; relapse, rehospitalization, longer time to remission, increased risk of suicide among others.

5. OBJECTIVES  To determine the prevalence of side effects of antipsychotics in psychiatric adult outpatients at Mathari Psychiatric Hospital  To determine the impact of side effects on patients’ attitude towards antipsychotic medication.  To determine the association between the side effects of antipsychotics and the level of adherence to treatment.

6. RESEARCH QUESTIONS  What was the prevalence of side effects of antipsychotics among adult psychiatric adult outpatients?  What was the relationship between the side effects of antipsychotics and patient attitude towards their use?  What was the relationship between the side effects of antipsychotics and the level of drug adherence among psychiatric adult outpatients?

7. SIGNIFICANCE OF THE STUDY  Nonadherence to medication remains a challenging problem in the management of psychotic disorders.  In Kenya like many other African countries, there are no documented studies assessing the relationship between patient reported antipsychotic side effects and adherence.  The findings will help to determine the extent of adherence and attitude towards antipsychotic treatment.

8. METHODOLOGY  A cross sectional study design and convenient sampling method was used and the study was at Mathari Psychiatric Hospital.  Ethical approval was granted by the KNH /UoN ERC and permission from the study site was given.  The target population consisted of adult psychiatric outpatients on antipsychotics and a sample of 164 participants was recruited.

9. METHODOLOGY  Data collection was done between July and August2014  The research instruments used included: Socio-demographic data questionnaire, Glasgow Antipsychotic Side effect Scale, Drug Attitude Inventory and Medication Adherence Rating Scale  Data analysis was done using STATA version 10 software.  Descriptive and regression analysis were used. Statistical significance was set at p value less than 0.05.

10. RESULTS- SAMPLE BASELINE CHARATERISTICS  The study consisted of 164 psychotic outpatients and the ratio of male to female was 1: 0.8  Majority had at least primary (39.63%) or secondary education (35.98%).  More than half of the participants (56.10%) were single and 31.71% were married.  A large number (46.34%) were unemployed, 32.93% were self employed and 4.27% were students.

11. RESULTS- SAMPLE BASELINE CHARATERISTICS  Majority of the patients were taking typical antipsychotics (87.20%) and a few were on atypical antipsychotics (21.34%)  Haloperidol (57.93%) and chlorpromazine (46.95%) were the most widely prescribed typical antipsychotics  Majority of the patients were on more than one antipsychotic medication (64%)

12. RESULTS- SAMPLE BASELINE CHARATERISTICS

13. RESULTS- PREVALENCE OF SIDE EFFECTS

14. RESULT- EXTENT OF SIDE EFFECTS

15. RESULT- ATTITUDE TOWARDS TREATMENT  In general 53.65% of the patients had a positive subjective attitude toward antipsychotics treatment.  Side effects which had a statistical significant association with negative attitude towards treatment were: Positive DAI-10 Score (n= 88) Negative DAI-10 Score (n=76) n%n%P value χ2χ2 Moderate SE2326.145065.79 ˂ 0.001 20.02 Sedation6776.136788.150.00112.66 EPS6169.316788.150.00210.39 Sexual dysfunction2831.823850.000.0245.32 Cardiovascular SE3135.224153.940.0039.16

16. RESULT-ADHERENCE TO TREATMENT  Only 39.63% reported complete adherence to medication.  Variables like gender, education level, marital status, employment status and psychiatric diagnosis did not significantly impact on patient’s adherence to medication (p > 0.05)  Nonadherence was positively and statistically significantly influenced by negative attitude towards antipsychotic medications treatment.

17. RESULTS-ASSOCIATION BETWEEN SIDE EFFECTS AND ADHERENCE LEVELS Odds Ratio (OR)95% Confidence IntervalP- value Sedation0.230.103- 0.5450.001 Extrapyramidal side effect 0.430.286- 0.633 ˂ 0.001 Sexual dysfunction0.820.651- 1.0220.014 Weight gain0.980.832 -1.1480.786 Anticholinergic side effects 0.910.818- 1.0220.117 GIT side effects0.200.099-0.4300.037 Cardiovascular side effects 0.810.702 -0.9250.002 Moderate side effects0.890.812-0.993 ˂ 0.001

18. DISCUSSION  The high prevalence of side effects is in agreement with other previous studies, possibly because most of our participants were on typical antipsychotics (87. 20%).  In general majority of our participants had a positive attitude towards treatment. Other studies have also shown similar results.  In our study, severity of side effects was associated with negative subjective attitudes towards medication.  Adherence to medication was influenced by side effects, just like other previous studies.

19. DISCUSSION  Sexual dysfunction, extrapyramidal symptoms, sedation, GIT side effect and cardiovascular side effects where associated with reduced likelihood of adherence.  However patients who had a positive attitude towards their medication had an increased likelihood of adherence to treatment.  Majority of participants who were counseled about their medication had a positive subjective attitude towards treatment.

20. CONCLUSION  We found a high prevalence of antipsychotic side effects (94.14%)  Remarkably most patients did not completely adhere to their medications because of side effects.  However patients who had a positive attitude towards medication had a high likelihood of adherence.  Therefore improving patient’s attitude towards treatment by managing the side effects adequately and promptly may increase adherence.

21. RECOMMENDATIONS  Adequate and timely management of antipsychotics side effects should be encouraged to improve adherence.  Patient counseling on medication and their side effects can improve attitude towards treatment.  Use of antipsychotics with lesser side effects should be encouraged to improve adherence.

22. ACKNOWLEDGEMENT  I would like to acknowledge my supervisors Dr. Nyamu, Dr. Menge and Dr. Karimi for sharing their knowledge and encouragement.  I thank my colleagues for their support.  Above all I thank the almighty God.

23. THANK YOU