입원중인 정신분열중환자의 약물거부 一투약거부자와 순웅자의 비교

Drug Refusal in Hospitalized Patients with Schizophrenic Disorder ： A Comparison between Refusers and Compilers

Hospitalized patients with schizophrenic disorder may directly refuse their offered antipsychotic medication. This study was designed to compare the refusers with the compliers in relation to some of the potential risk factors contributing to the refusal. The factors included in the present study were 1) sociodemographic characteristics, 2) the level of psychopathology by the BPRS, 3) the level of satisfaction with therapeutic team and ward environment, 4) the schedule of drug administration，5) the side effects requiring readjustment of the drug, and 6) the subjective response to current medication. 23 hospitalized psychiatric patients who overtly refused antipsychotic medication, and who according to DSM-111 were diagnosed as suffering from schizophrenic disorder，were recognized as the refusers. A sample of 23 compliers, who willingly accepted antipsychotic medication, was matched for age(± 5 years), sex, diagnosis, treatment ward and length of current hospitalization (±7days). The data was mainly collected by the investigator’ s semistructured interview with the patients and by review of medical records. The resurlts were as follow. 1) There was no significant difference in education, marital status, illness duration, frequency of previous psychiatric hospitalization, and type of admission between the two groups. 2) Raings on the BPRS showed the refusers were significantly (p<0.01) more symptomatic than the compliers. The refusers had significantly higher scores on the BPRS for anxiety (p〈0. 05), emotional withdrawal (p<0.005), depressive m ood(p<b.05), hostility (p< 0.05), uncooperativeness( P<0.00l), motor retardation (p<0.05), and blunted affect (p < 0 .0 l). 3) Although there was no significant difference in the level oi satisfaction with therapeutic team and ward environment between the two groups, both groups in general demonstrated satisfaction with the therapeutic team and dissatisfaction with ward environment. 4) Comparison of the prescribed neuroleptic dose per day in Chlorpromazine equivalents for the refusers and compliers showed no significant difference, while the total number of tablets and the frequency of administration each day were significantly (p<0.05, respectively) greater and more frequent in the refusers than in the compliers. 5) Severe side effects requiring readjustment of the current drugs were significantly (p<0.05) more frequently identified in the refusers than in the compliers. 6) Subjective response to their current antipsychotic medication was dysphoric in both groups, but significantly (p<0.05) more dysphoric in the refusers than in the compliers. In summary, our study reveals that drug refusal may result not only from the irrational symptoms of the patients, but also from their reasonable objections. So these findings need to be considered in order to enhance the understanding of durg refusal. In so doing, we might not only improve the clinical aspect of prevention and management of drug refuser, but also safeguard the patientf s rights both to receive and to refuse medication.