MEDICATION ADHERENCE AND RELAPSE RISK IN PATIENTS WITHSCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS: A CROSS-SECTIONAL STUDYFROM A TERTIARY CARE PSYCHIATRIC SETTING IN KHYBER PAKHTUNKHWA,PAKISTAN

Abstract

Poor adherence to antipsychotic medication is one of the most consistently identified risk factors for clinical relapse in schizophrenia and other psychotic disorders. The adherence-relapse relationship remains relatively understudied in low-resource South Asian settings. This cross-sectional correlational study examined medication adherence and 12-month relapse in 180 adult outpatients with schizophrenia-spectrum disorders attending a tertiary psychiatric clinic in Khyber Pakhtunkhwa, Pakistan. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS). Relapse was defined as psychiatric rehospitalization or clinically significant worsening of symptoms requiring treatment intensification within the preceding 12 months. Covariates included insight, antipsychotic side-effect burden, family support, substance use, illness duration, and age. Mean adherence was 4.52 (SD 1.89); 38.3% of participants were poorly adherent. Relapse occurred in 28.9% of the sample and differed markedly by adherence category: 52.2% among poorly adherent patients, 16.7% among partially adherent patients, and 0% among well-adherent patients, χZ(2, N = 180) = 31.29, p < .001. Adherence was significantly associated with relapse status, r(178) = -.40, p < .001, and positively correlated with insight, r(178) = .51, p < .001. In multivariable logistic regression, each one-point increase in MARS score was associated with a 34% reduction in the odds of relapse (OR 0.66, 95% CI 0.50-0.89, p = .006). Side-effect burden independently predicted relapse (OR 1.41, 95% CI 1.11-1.78, p = .004). The model explained approximately 31% of the variance in relapse (Nagelkerke RZ = .31) and correctly classified 77.8% of cases. These findings support adherence-focused, side-effect-sensitive relapse-prevention strategies, including structured psychoeducation, family-inclusive care, and consideration of long-acting injectable antipsychotics where clinically appropriate.

Keywords:

Schizophrenia; Medication Adherence; Relapse; Insight; Antipsychotic Side Effects; Pakistan.