Fatores intrínsecos e extrínsecos relacionados à não adesão do tratamento por pacientes com esquizofrenia

Abstract

Psychiatric reform in Brazil has brought several advances to mental health care, but there are still barriers to progress in this context. Especially for those illnesses that are difficult to understand and manage clinically, such as schizophrenia. Therefore, adherence to treatment is essential for a good prognosis. Objective: To identify and describe the intrinsic and extrinsic factors related to non-adherence to treatment by patients with schizophrenia. Method: This is an integrative literature review carried out in August 2024 in the Virtual Health Library (VHL) and PubMed Central (MEDLINE) databases. The search strategy combined keywords and/or synonyms, Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) in combination with Boolean operators. An independent double review was adopted. The publications were organized into a summary table for analysis of the results. Regarding the inclusion criteria adopted: original articles, available online and in full, published in Portuguese, English or Spanish and that answer the research question. Review articles, theoretical essays and methodological studies were excluded. Duplicate studies were included only once Results: 11 articles were included in this review, which highlighted the following intrinsic factors related to non-adherence to treatment by patients with schizophrenia: difficulty in self-managing treatment, older age, being male, single, unemployed, having comforts, using alcohol and drugs, living in urban areas, not seeking help from alternative and complementary therapies, lack of information about the illness, difficulty in balancing work and study, and being aware of the illness. In addition, negative experiences in relation to the disease and professional treatment can also affect adherence. The main extrinsic factors include: difficulties encountered in hospitals and mental health services, the role of politics, rejection from the family network and community, the threat of stigma, the convenience of medical resources and the acquisition and use of social support, and the side effects of medication. Final considerations: there is a need to strengthen patients' self-care and the work of professionals, as well as investing in health services and public policies that promote safe and effective care.