Schizophrenics dropping out of treatment programmes

PUBLISHED : Monday, 17 November, 2003, 12:00am
UPDATED : Monday, 17 November, 2003, 12:00am

Doctors blame 'old drugs' which they say induce more severe side effects

Many of Hong Kong's schizophrenics continue to be prescribed medication that has relatively severe side effects, leading a number of them to drop out of their treatment programmes, doctors have warned.

Michael Wong Ming-cheuk, senior medical officer at Queen Mary Hospital, said of 200 schizophrenia patients scheduled to appear at his clinic every day, about 20 did not show up, and of those about 10 had become untraceable.

Many schizophrenics refuse to seek help because of the side effects associated with the medication they are prescribed, such as trembling, fatigue, sleep problems and memory loss.

Alarmed by the problem, a psychiatrist has urged the Hospital Authority, which manages all 44 public hospitals across Hong Kong, to make wider use of new anti-psychotic drugs that carry milder side-effects.

Dr Wong said a significant number of schizophrenics had dropped out of their treatment programmes despite follow-up letters, phone calls or visits by medical social workers and community psychiatric nurses.

'Even though we try to provide the best possible treatment, all our efforts are in vain if they refuse to come to see us or follow our medication,' he said.

He believed those who disappeared were abandoning their treatment rather than switching to private doctors.

Dr Wong estimated that about 20,000 people in Hong Kong suffer from schizophrenia - a mental disorder that can lead to thought disorders, delusions and hallucinations.

Samuel Keith, a psychology and psychiatry professor at the University of New Mexico's school of medicine in the US, warned that schizophrenics rarely recovered without treatment.

He said 10 per cent of patients became depressed and might develop more severe psychiatric problems that could lead to suicide.

Professor Keith said: 'I have patients who have gone through 10 years without relapse but they thought they no longer needed the medication and stopped it. But they relapsed within six months.'

Lee Sing, a professor of psychiatry at the Chinese University, attributed reports of Hong Kong patients avoiding treatment to the serious side effects associated with drugs still in common use in public hospitals. He said these drugs had dropped out of favour in the west.

Professor Lee estimated that only about 15 per cent of schizophrenia patients under the Hospital Authority were prescribed newer drugs, which have milder side effects. But they cost at least six times more, at between $25 and $75 for each patient a day.

Because of budget constraints, public doctors normally prescribed the older medicine and only resorted to newer drugs if patients failed to respond after 12 to 16 weeks of treatment, Professor Lee said.

Professor Lee said the dropout rate was as high as 20 per cent, with patients complaining of the side-effects of the old drugs. Patients often develop symptoms resembling those of Parkinson's disease.

Professor Lee called on the Hospital Authority to completely replace the use of the old drugs with the new ones.

Another drug, Risperdal Consta, which is injected every two weeks, was approved by the Department of Health last month but has not been used in public hospitals.

Dr Wong said the youngest patient he had seen was a 10-year-old boy whose behaviour included hitting people and screaming.