Response to Issues concerning the Article 'Treatment Compliance and Noncompliance in Psychoses'

By Rao, K. | Indian Journal of Psychiatry, January-March 2018 | Go to article overview

Response to Issues concerning the Article 'Treatment Compliance and Noncompliance in Psychoses'


Rao, K., Indian Journal of Psychiatry


Byline: K. Rao

Sir,

We thank the authors immensely for their interest shown in our article ≴Treatment compliance and non-compliance in psychoses≵[1] and more so for their incisive evaluation. We prefer to respond to all issues raised in the letters to the editor.[2],[3],[4]

We are aware of the concept of adherence and have alluded to it in the introduction. Although the word noncompliance denotes the conformity of patient behavior to treatment recommendations, it does not degrade noncompliant patients as uncooperative and untrustworthy. It is true that in the article persistence with medication use was considered central for compliance/adherence with treatment. The first component of adherence, namely, initiation of first dose of medication was not focused as the cases had already approached for treatment and were in treatment for sometime. Compliance is akin to the second component of adherence-implementation of treatment regimen. The third component, discontinuation can denote noncompliance. Hence, in clinical practice adherence and compliance are used interchangeably though academic scrutiny may not agree with it. It reminds the adage ≴call the rose by any name it smells the same≵ but it is true roses themselves vary in their fragrances.

Focus of the present study was to simultaneously study reasons for compliance and/or noncompliance so that a comprehensive list of factors could be arrived at.

We have brought out the point that relapse of a symptom as a factor for compliance. It is interesting to note that ≴consequences≵ of noncompliance (not noncompliance per se ) as a factor for compliance and ≴consequences≵ of compliance (not compliance per se ) as a factor for compliance. This was one of the advantages of this study which focused on compliance and noncompliance simultaneously.

Although outpatient records are not considered accurate for research purposes, in the present study, the dependent variable compliance/noncompliance could be detected easily based on the visit to treatment center. However, after case selection, each patient was assessed individually using structured questionnaires to elicit influence of independent variables on the dependent variable. Patients with improper, inaccessible, and incomplete records were excluded from the study.

We agree that use of validated scales for obtaining data would have increased the strength of the study. This point has been reflected in the article. However, the present study has helped to prepare a comprehensive list of factors influencing compliance and noncompliance and categorize them into various domains which has not been done in earlier studies.

The study did not use diagnostic criteria for selection of sample. Cases having psychotic features were selected and then those patients who qualified for the study were assigned diagnoses based on ICD 10. The aim of the study was not to know which disorders had more compliance or noncompliance. …

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