Nurse and Pharmaceutical Care (NuPhaC)

MSM-PSY

Medication self-management in hospitalised patients with Schizophrenia spectrum and bipolar disorders

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Background 

Schizophrenia spectrum and bipolar disorders are severe psychiatric disorders, with schizophrenia spectrum disorders (SSD) affecting around 1% and bipolar disorders (BD) affecting about 3% worldwide. The majority of the psychiatric pathologies at the admission is in Schizophrenia and other psychotic disorders category in Belgium (Namely, 41% in Flanders, 88% in Brussels and 49% in Wallonia). Together with psychoeducation, pharmacotherapy is often the first line of treatment of these severe psychiatric disorders. Psychoeducation may be defined as the education, with the focus on knowledge, of a person with psychiatric disorder in subject areas that serve the goals of treatment and rehabilitation. The aim of psychoeducation is to increase patients' knowledge and understanding of their disease and treatment to cope more effectively with their disease to enable the patient to engage in behaviour change to prevent hospitalization. SSD and BD are often complicated by recurring psychotic relapses. Non-adherence, substance abuse, and stressful life events are risk factors for this relapse, in which non-adherence is the most common cause.

Medication non-adherence represents a paramount challenge encountered by healthcare providers in the management of psychotic disorders. Patients with treatment failure have a high risk of relapse resulting in acute psychosis, leading to psychiatric (re)hospitalizations and considerable economic costs. Non-adherence is highly prevalent, ranging between 63–74% in patients with SSD and about 50% in patients with BD. About 25% of patients discontinue their medication within the first week after discharge from inpatient treatment. Medication non-adherence is one of the most consistent predictors of relapse. Non-adherence puts patients at risk for exacerbations of psychosis and relapse resulting in hospital visits and admission. Relapse rates appear to be high at 78–82% for SSD and 60% for BD. Non-adherent patients have an average relapse risk that is 3.7 times greater than adherent patients. Reasons for non-adherence include, amongst others, lack of knowledge of the disease and/or the disease severity, the (anxiety of) side-effects, difficulty recognizing

symptoms, not acknowledging the need for antipsychotic therapy, distrust in the effectiveness (The effect of non-adherence to antipsychotic treatment on rehospitalization in patients with psychotic disorders), negative attitudes towards medication, past history of non-adherence, substance abuse, cognitive impairments (predictors) and deficient communication between inpatient units and primary healthcare providers. Additionally, problems with adherence are recurrent, and therefore repeated sessions are needed to maintain adherence. Extensive follow-up periods are important, as researchers need to measure the immediate effects of their intervention(s) on adherence, but also intermediate and long-term effects.

Patients who are not able to self-manage their medication, but are expected to do MSM after discharge, should be given the opportunity to learn to self-manage their medication whilst in hospital. Providing the innovative possibility to self-manage medication in a controlled environment enables healthcare providers to immediately intervene when medication related problems occur.

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Objectives

The research accomplished in this project provides fundamental pillars for the development of a medication self-management (MSM) intervention to prevent non-adherence and relapse rates in patients with SSD or BD.

 

Specific research aims for this dissertation derived from the general aim:

- Explore the impact of interventions on medication adherence in patients with SSD or BD.

- To describe the prevalence of MSM in Flemish psychiatric hospitals.

- Explore the perspectives of all stakeholders involved in the MSM procedure in patients with severe mental illness.

- To describe psychiatric healthcare providers’ willingness to MSM and their attitude, conditions, benefits, and ability towards it during hospitalisation.

- To describe the attitudes of patients with SSD or BD regarding MSM during hospitalisation. A secondary aim is to identify various factors associated with patient willingness to participate in MSM and to describe their assumptions concerning needs and necessary conditions, as well as their attitudes towards their medication.

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Research output

1. Interventions to Improve Medication Adherence in Patients with Schizophrenia or Bipolar Disorders: A Systematic Review and Meta-Analysis.

Loots, E.; Goossens, E.; Vanwesemael, T.; Morrens, M.; Van Rompaey, B.; Dilles, T.

Int. J. Environ. Res. Public Health 2021, 18, 10213. https://doi.org/10.3390/ ijerph181910213
2. Medication Self-Management in Hospitalised Patients with Schizophrenia or Bipolar Disorder: The Perceptions of Patients’ and Healthcare Providers’.

Loots, E.; Leys, J.; Proost, S.; Morrens, M.; Glazemakers, I.; Dilles, T.; Van Rompaey, B.

Int. J. Environ. Res. Public Health 2022, 19, 4835. https://doi.org/10.3390/ijerph19084835

3. The attitude of healthcare providers towards medication self-management in hospitalised patients diagnosed with schizophrenia or bipolar disorders.

Loots, E.; Hadouchi, S.; Dilles, T.; Van Rompaey, B.; Morrens, M.

Journal of Psychiatric and Mental Health Nursing 2023, DOI: 10.1111/jpm.12903

4. Medication self-management in Flemish psychiatric hospitals: A prevalence study in hospitalised patients with schizophrenia spectrum or bipolar disorder.

Loots, E.; Van Rompaey, B.; Dilles, T.; Morrens, M.

June 2023. Nursing 38(2):14-21. DOI: 10.24078/vpg.1970.1.23426

5. Attitudes of patients with schizophrenia spectrum or bipolar disorders towards medication self-management during hospitalisation.

Loots, E.; Van Rompaey, B.; Dilles, T.; Morrens, M.

J Clin Nurs. 2023 Dec 1. doi: 10.1111/jocn.16936.

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Time

2019-2024