Schizophrenia and medication adherence among the population in Morocco: a cross-sectional study at the University Psychiatric Center of Casablanca

Abstract

Introduction: schizophrenia is a chronic, disabling, and serious disease. It represents a challenge because of its prevalence and its consequences in terms of morbidity and mortality for patients, but also for their families and society. Patients often fail to adhere to their treatment, and this has a severe negative effect on the prognosis of the disease. Thus, the identification of the predictive factors influencing this compliance is very important for adequate management and a favorable evolution. The aim of the study is to assess the predictive factors of non-adherence in patients with schizophrenia.

Methods: a cross-sectional study of 320 patients diagnosed with schizophrenia according to the DSM-5 criteria, was conducted at the University Psychiatric Centre of Casablanca, Morocco. Epidemiological, clinical, and therapeutic data were collected using a hetero-questionnaire, while medication adherence was assessed using the Medication Adherence Rating Scale (MARS). The positive and negative symptoms scale (PANSS) was used to assess the severity of symptoms in patients with schizophrenia.

Results: in our study, the total sample comprised 320 (100%) patients, classified into two groups: 82 (25.62%) were categorized as adherent, while 238 (74.38%) were non-adherent, and 72% were male. The non-adherent group was young (p=0.003), and a significant proportion had no educational background (p=0.015), lived alone (p=0,001), in urban areas (p=0.031), non-regular follow-up (p=0.045) and had a toxic history (p=0.0001), early age of onset of the disease (p=0.002). Moreover, this group exhibited more severe schizophrenic symptoms (p=0.02), lacked insight into their condition (p=0.046), and predominantly used typical antipsychotics (p=0.019) with a high frequency of intake (p=0.0001). Sedation emerged as a predominant side effect (p=0.036) of treatment. Notably, a high frequency of hospitalizations (p=0.005) exhibited a strong association with medication non-adherence. The mean age of the sample was 32.9 years (standard deviation: 10.8), with a mean age of disease onset reported at 25.5 years (standard deviation=4.9).

Conclusion: this study highlights the prevalence of non-adherence among patients with schizophrenia, with significant associations observed with demographic factors, the severity of symptoms, treatment patterns, and hospitalization frequency, emphasizing the urgent need for tailored interventions to enhance medication adherence and improve patient outcomes in managing schizophrenia.

Keywords: Adherence; non-adherence; schizophrenia.