Medication compliance in schizophrenic out patients with psychoactive substance use co-morbidity: a cross-sectional study


  • Saurabh Ahlawat Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India
  • Vikrant Aggarwal Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India
  • Rakesh Kumar Department of Psychology, Gurukula Kangri (deemed to be university), Haridwar, Uttarakhand, India



Medication adherence, PANSS, Schizophrenia, Substance use, MARS, MMAQ-8


Background: Medication adherence is an important issue in the treatment and management of persons with psychiatric disorders including schizophrenia. Apart from side effects and inefficient outcomes of psychiatric medications, substance abuse also complicates the adherence pattern to the prescribed medications. Present study was designed to estimate the magnitude of medication non-adherence and its correlates in patients with schizophrenia having co-morbid psychoactive substance use.

Method: The 60 schizophrenic patients with active substance use were taken from OPD of institute of mental health and hospital, Agra. Positive and negative syndrome scale (PANSS), alcohol, smoking and substance involvement screening test (ASSIST), medication adherence rating scale (MARS) and Morisky 8-item medication adherence questionnaire (MMAQ-8) were used to gather relevant clinical data along with a proforma for recording socio-demographic characteristics.

Results: The results revealed an alarming level of medication adherence. The 91.7% sample (55 patients) met the criteria for medication non-adherence. Majority of the patients were using alcohol (58.3%) and cannabis (51.7%). Conclusions: Given the high rate of medication non-compliance it is suggested that specific intervention aimed at compliance to prescribed medication is needed in this population.


Picchioni MM, Murray RM. Schizophrenia. BMJ. 2007;335(7610):91-5.

WHO. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: WHO. 1992.

Muscatello MR, Bruno A, De Fazio P, Segura-Garcia C, Pandolfo G, Zoccali R. Augmentation strategies in partial responder and/or treatment-resistant schizophrenia patients treated with clozapine. Expert Opin Pharmacother. 2014;15(16):2329-45.

Khokhar JY, Dwiel LL, Henricks AM, Doucette WT, Green AI. The link between schizophrenia and substance use disorder: A unifying hypothesis. Schizophr Res. 2018;194:78-85.

WHO. Neuroscience of psychoactive substance use and dependence. Geneva: WHO; 2004.

Hartney E. Indigenous mental health and substance use leadership research planning initiative. Centre for Health Leadership and Research, Royal Roads University. 2019.

Volkow ND. Substance use disorders in schizophrenia--clinical implications of comorbidity. Schizophr Bull. 2009;35(3):469-72.

Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990;264(19):2511-8.

Ringen PA, Lagerberg TV, Birkenaes AB, Engn J, Faerden A, Jónsdottir H et al. Differences in prevalence and patterns of substance use in schizophrenia and bipolar disorder. Psychol Med. 2008;38(9):1241-9.

van Dijk D, Koeter MW, Hijman R, Kahn RS, van den Brink W. Effect of cannabis use on the course of schizophrenia in male patients: a prospective cohort study. Schizophr Res. 2012;137(1-3):50-7.

Sara GE, Burgess PM, Malhi GS, Whiteford HA, Hall WC. Stimulant and other substance use disorders in schizophrenia: prevalence, correlates and impacts in a population sample. Aust N Z J Psychiatry. 2014;48(11):1036-47.

Hunt GE, Large MM, Cleary M, Lai HMX, Saunders JB. Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990-2017: Systematic review and meta-analysis. Drug Alcohol Depend. 2018;191:234-58.

Aich TK, Sinha VK, Khess CR, Singh S. Demographic and clinical correlates of substance abuse comorbidity in schizophrenia. Indian J Psychiatry. 2004;46(2):135-9.

Mueser KT, Yarnold PR, Levinson DF, Singh H, Bellack AS, Kee K et al. Prevalence of substance abuse in schizophrenia: demographic and clinical correlates. Schizophr Bull. 1990;16(1):31-56.

Mahmood KT, Khalid N, Makhdum Z. Adherence T0 Drug Therapy In Psychiatric Patients. J Pharmaceutical Sci Res. 2010;2(11):700.

Kikkert MJ, Dekker J. Medication Adherence Decisions in Patients With Schizophrenia. Prim Care Companion CNS Disord. 2017;19(6).

Owen RR, Fischer EP, Booth BM, Cuffel BJ. Medication noncompliance and substance abuse among patients with schizophrenia. Psychiatr Serv. 1996;47(8):853-8.

Okpataku CI, Kwanashie HO, Ejiofor JI, Olisah VO. Medication compliance behavior in psychiatric out-patients with psychoactive substance use comorbidity in a Nigerian tertiary hospital. Niger J ClinPract. 2015;18(3):371-6.

Hunt GE, Bergen J, Bashir M. Medication compliance and comorbid substance abuse in schizophrenia: impact on community survival 4 years after a relapse. Schizophr Res. 2002;54(3):253-64.

Olfson M, Mechanic D, Hansell S, Boyer CA, Walkup J, Weiden PJ. Predicting medication noncompliance after hospital discharge among patients with schizophrenia. Psychiatr Serv. 2000;51(2):216-22.

Chandra IS, Kumar KL, Reddy MP, Reddy CM. Attitudes toward Medication and Reasons for Non-Compliance in Patients with Schizophrenia. Indian J Psychol Med. 2014;36(3):294-8.

Baby RS, Gupta S, Sagar R. Attitudes and subjective reasons of medication compliance and noncompliance among outpatients with schizophrenia in India. Internet J Epidemiol. 2009;7(1).

Kovasznay B, Fleischer J, Tanenberg-Karant M, Jandorf L, Miller AD, Bromet E. Substance use disorder and the early course of illness in schizophrenia and affective psychosis. Schizophr Bull. 1997;23(2):195-201.

Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261-76.

Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res. 2000;42(3):241-7.

De Las Cuevas C, Peñate W. Psychometric properties of the eight-item Morisky Medication Adherence Scale (MMAS-8) in a psychiatric outpatient setting. Int J Clin Health Psychol. 2015;15(2):121-9.

Xiao J, Mi W, Li L, Shi Y, Zhang H. High relapse rate and poor medication adherence in the Chinese population with schizophrenia: results from an observational survey in the People's Republic of China. Neuropsychiatr Dis Treat. 2015;11:1161-7.

Schoeler T, Petros N, Di Forti M, Klamerus E, Foglia E, Murray R, Bhattacharyya S. Poor medication adherence and risk of relapse associated with continued cannabis use in patients with first-episode psychosis: a prospective analysis. Lancet Psychiatry. 2017;4(8):627-33.

Julius RJ, Novitsky MA Jr, Dubin WR. Medication adherence: a review of the literature and implications for clinical practice. J Psychiatr Pract. 2009;15(1):34-44.

Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO et al. Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. N Engl J Med. 2005 Sep 22; 353(12):1209-23.

Eticha T, Teklu A, Ali D, Solomon G, Alemayehu A. Factors associated with medication adherence among patients with schizophrenia in Mekelle, Northern Ethiopia. PLoS One. 2015;10(3):e0120560.

Semahegn A, Torpey K, Manu A, Assefa N, Tesfaye G, Ankomah A. Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Syst Rev. 2020;9(1):17.

Chaudhari B, Saldanha D, Kadiani A, Shahani R. Evaluation of treatment adherence in outpatients with schizophrenia. Ind Psychiatry J. 2017;26(2):215-22.




How to Cite

Ahlawat, S., Aggarwal, V., & Kumar, R. (2021). Medication compliance in schizophrenic out patients with psychoactive substance use co-morbidity: a cross-sectional study. International Journal of Research in Medical Sciences, 10(1), 167–172.



Original Research Articles