Alcohol use in Tanzanians with chronic psychotic disorders and poor medication adherence

Emily Simon,Carol Blixen,Michelle Aebi,Jessie Mbwambo,Kristin Cassidy,Jennifer B Levin,Isaac Lema,Godwin Njiro,Sylvia Kaaya,Martha Sajatovic

doi:10.4102/sajpsychiatry.v27i0.1570

Abstract

BackgroundThe burden of chronic psychotic disorders (CPDs) in sub-Saharan Africa (SSA) is significant. Poorly medically adherent patients are more likely to have worse outcomes and require more resources. However, factors impacting effective treatment of CPD in this population are unclear.AimExamine the relationship between alcohol use and disease management and compare alcohol risk stratification between the Alcohol Use Disorders Identification Test (AUDIT) and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in poorly medication adherent Tanzanians with CPD.SettingMuhimbili National Hospital and ambulatory clinics in Dar es Salaam, Tanzania.Methods100 Tanzanians with CPDs and suboptimal medication adherence were dichotomized into low and moderate-to-high risk alcohol use based on AUDIT scores and compared regarding medication attitudes, adherence and psychiatric symptoms. Patients completed the ASSIST for comparison to AUDIT risk stratification.ResultsModerate-to-high risk alcohol users had worse medication attitudes (p < 0.01), medication adherence (previous week, p = 0.01; previous month, p < 0.001), and psychiatric symptoms (p = 0.03). They were younger, predominately male and more likely to have a family history of alcohol abuse. A logistic regression analysis found age, gender and family history of abuse as significant predictors of hazardous alcohol use (p = 0.02, 0.02, < 0.01, respectively). Risk stratification between AUDIT and ASSIST aligned in 85% of participants.ConclusionAlcohol use is an important consideration in treating poorly adherent Tanzanians with CPD. The ASSIST was comparable to the AUDIT in stratifying risky alcohol use with the additional benefit of screening for other substances.

Highlights

Chronic psychotic disorders (CPDs) such as schizophrenia and schizoaffective disorder can pose significant burden to affected individuals[1,2] and the communities where they reside.[3,4] Reduced quality of life, disorder relapse, impaired personal and professional achievement and premature mortality because of suicide or other causes characterise some of the challenges that can arise when treatment is insufficient.[2,5] Concurrent psychosocial services and antipsychotic medications along with appropriate monitoring of health status are the mainstay of disease management.[6]
The data for this cross-sectional study were collected as part of a larger 3-phase/3-aim 24-month project focused on medication adherence enhancement in Tanzanians with CPDs and a history of poor medication adherence
The first phase of the study consisted of an observational mixedmethods approach aimed at assessing reasons for poor treatment adherence amongst Tanzanians with CPD

Summary

Introduction

Chronic psychotic disorders (CPDs) such as schizophrenia and schizoaffective disorder can pose significant burden to affected individuals[1,2] and the communities where they reside.[3,4] Reduced quality of life, disorder relapse, impaired personal and professional achievement and premature mortality because of suicide or other causes characterise some of the challenges that can arise when treatment is insufficient.[2,5] Concurrent psychosocial services and antipsychotic medications along with appropriate monitoring of health status are the mainstay of disease management.[6] access and proper utilisation of mental healthcare services are a challenge globally, with estimations as dismal as 76% – 85% of patients in low- and middle-income countries going without treatment.[2] predictions indicate that mental health resources will be in continued deficit in coming years, amplified by growing disease burden.[7] For example, in sub-Saharan Africa (SSA), the most disabling conditions amongst those aged 10–14 years are brain disorders.[8,9] This includes regions such as Tanzania, where neuropsychiatric disorders are estimated to make up approximately 5.3% of the global burden of disease.[10]. The burden of chronic psychotic disorders (CPDs) in sub-Saharan Africa (SSA) is significant. Factors impacting effective treatment of CPD in this population are unclear

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