Treatment discontinuation in schizophrenia: A qualitative exploration from a rural South Indian community

BACKGROUND: Medication discontinuation remains a big hurdle for retaining persons with schizophrenia under the treatment AMBIT. It is imperative to understand reasons for the same to effectively tackle it. METHODS: The study was carried out in Turuvekere, a rural South Indian taluk (an administrative block). Qualitative interviews were conducted with consenting consecutive nineteen patients (along with their family members) who had discontinued medications. All interviews were transcribed. Enlisted reasons were then color coded to synthesize different factors. From the 16th patient onward, no new reason emerged. Three more interviews were done to ensure that there was no additional reason. RESULTS: The following factors (average 4.26 factors per patient) led to medication discontinuation: (1) lack of support/supervision from family/well-wishers (n = 14/19 [73.68%]); (2) lack of insight and cooperation from the patient (n = 11; [57.89%]); (3) lack of awareness about the illness (8 [42.10%]); (4) adverse effects of medications (n = 8; [42.10%]); (5) financial factors (n = 8; [42.10%]); (6) distance/transport (n = 8; [42.10%]); (7) lack of knowledge about treatment process (n = 7; [36.84%]); (8) perceived lack of beneficial effects of treatment (n = 5; [26.32%]); (9) treatment center-related issues (n = 4; [21.05%]); and others. CONCLUSIONS: Medication discontinuation is driven by a diverse set of interrelated factors among community-living persons with schizophrenia. Professionals need to be aware of this complexity to effectively manage the problem.