Medication compliance behavior in psychiatric out‑patients with psychoactive substance use comorbidity in a Nigerian tertiary hospital

Background: Psychotropic medication adherence is a major challenge in psychiatric patients with comorbidity.Objective: The objective was to determine medication adherence behavior among psychiatric out‑patients with psychoactive substance use comorbidity in a Nigerian Tertiary Hospital.Settings and Design: A cross‑sectional study of a tertiary hospital in Northern Nigeria.Methods: Adult patients who have been attending the out‑patient clinic for at least 1 year were included. From the routine clinic, each consecutive fourth patient completed a socio‑demographic and drug use questionnaire, a self‑administered medication adherence scale, and a semi‑structured proforma which sought reasons for poor adherence, information on supervision and who keeps patient medications at home; until a calculated sample of 208 was attained.Statistical Analysis: Done by means of descriptive statistics using the Statistical Package for Social Sciences version 16. The level of significance was set at P < 0.05.Results: Totally, 208 patients participated in the study. 61 (29.3%) of them were substance users, out of which 59% never reported missing their medications. No statistically significant relationship was found between substance use and medication adherence. A significant proportion of substance users were compliant with medication use when the drugs were in their possession. For substance users and nonusers, the major reason for poor drug adherence was the unavailability of the medications, while nonsubstance users were more likely to complain about being tired of the medications. No report of side effects in supervised patients.Conclusion: The use of psychoactive substances in patients with other mental disorders influences their medication adherence behavior.Key words: Adherence, hospital, Nigeria, out‑patients, psychoactive, substanc

Persistent Psychosis Occurring in a Patient Receiving Cycloserine for the Treatment of Multidrug Resistant Tuberculosis

A case of cycloserineinduced psychosis persisting after discontinuation of the drug in the treatment of  multidrug resistant tuberculosis in a 26 year old male who was been managed in the hospital for multidrug resistant tuberculosis on daily doses of Cycloserine 500mg, Pyrazinamide 1.2g, Proteonamide 500mg, Kanamy c in 750mg, Levofloxacin 750mg and Vitamin B6 200mg. At the 6th month of treatment, he developed delusional and hallucinatory experiences which subsided with the use of antipsychotics. However, antipsychotic use was not sustained leading to exacerbation of psychotic symptoms and complete abandonment of all his  anti-tubercular medications including cycloserine. Psychiatric symptoms then  progressed into florid psychosis without psychiatric treatment. In conclusion, the case report highlights the enduring psychiatric problems and its consequences that could be associated with the use of cycloserine in the treatment of tuberculosis and the need to integrate effective mental health liaison services for multidrug resistant tuberculosis treatment