Post-Psychosis Trauma and non-adherence in Bipolar I Disorder with psychotic features: patients and their families in Gauteng.
Medication non-adherence continues to be one of the biggest challenges in the treatment of psychotic disorders. Bipolar I Disorder with psychotic features is no exception as treatment non-adherence is associated with longer term disability and poorer outcomes. Research has attempted to explore predictors of non-adherence with mixed findings. Concurrent with this research have been findings that suggest that psychotic episodes may be extremely distressing and potentially traumatic for patients and their support systems alike. Given the critical role that family members play in the care of people with Bipolar I Disorder with psychotic features, it is important to explore whether this distress is potentially a post-trauma PTSD, and whether this has any impact on drug adherence. This research particularly aimed to explore and document whether or not patients diagnosed with Bipolar I Disorder with psychotic features and their family members experience clinical threshold PTSD after psychotic episodes as well as whether this Post-Psychosis Trauma is associated with treatment adherence. Thirty-five patients and family member dyads (n=70) were recruited to participate in the study. A mixed methods design was employed to gain a better understanding of Post-Psychosis Trauma and non-adherence in the identified population. Using a measure of PTSD, the quantitative portion of the research explored whether there were clinical-threshold symptoms of Post-Psychosis Trauma in the participants. A secondary aim was to explore whether or not the experience of Post-Psychosis PTSD (PP/PTSD) would be associated with treatment adherence status (non-adherent vs adherent). The results found that clinical-threshold Post-Psychosis Trauma was present in 78.6% (n=55) of the total sample. Both patients and family members experienced PP/PTSD, with fewer participants presenting with an absence of PP/PTSD, supporting the first hypothesis of this research. However, no significant association was found between Post-Psychosis Trauma and non-adherence. Participant perceptions indicated that other factors contributing to non-adherence included poor insight, denial, confusion, and altered cognitions. Further, persistent negative emotional states including fear, anger, guilt and shame in relation to psychosis played a major role in how the patients perceived themselves and how they were perceived by those around them.
The report is submitted in partial fulfilment of the requirements for the Degree of Doctor of Philosophy in the Faculty of Humanities at the University of Witwatersrand, August 2019