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Drug Compliance Among Schizophrenic Patients

Paper Type: Free Essay Subject: Psychology
Wordcount: 5074 words Published: 23rd Sep 2019

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Drug compliance among schizophrenic patients in Benin City, Nigeria: a preliminary critique on language and communication.

Running title: Drug Compliance Among Schizophrenic Patients.


Background: This study employs the technique of motivational interview to evaluate the compliance of schizophrenic patients on administered drug and the corresponding effect of this on the language and communication abilities of the schizophrenic patients.

Objective: The study is aimed to view drug compliance among schizophrenic patients, with respect to language and communication competence. It considers the Pharmacist and linguist point of view, to see how drug compliance affects the language and communication abilities of schizophrenic patients. Thus, the main theoretical concern emphasizes drug compliance of patients from the pharmacist point of view and language and communication abilities from the linguist point of view.

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Methods: This research was conducted in 2017 at the Federal Neuro – Psychiatric Hospital (FNPH), Benin City, Edo State, Nigeria, where Ethical clearance for this study was as well obtained. This study was conducted in the Department of Pharmacy where the Pharmacist and Linguist used motivational interview to collect data for analysis from the patients and recorded the reactions of the patients.

Results: Based on what the Pharmacist observed, the two patient (designated OS and OZ) examined in conversation 1 and 2 were on different psychotic drugs, the patient OS is no Chlorpromazine 50mg twice daily. The observation from patient OS clearly shows non – drug adherence. This could probably be as a result of incorrect timing of the medication as well as wrong dosage. Patients may probably forget a dose completely or stop the drug because of Extrapyramidal side effects experienced like akathisia, dystonia, parkinsonia symptoms, tardive dyskinesia and hyperprolactinemia. In contrast to the patient OZ examined in conversation 2, the patient was on Olanzapine 10mg daily. The observation from patient OZ clearly shows drug adherence which could be related to a correct timing of drug once daily. However, from the patient OZ it is shown in the table that the patient’s linguistic compliance was successful. The patient level of compliance is different from the first patient. More so, from the linguist’s point of view, it was observed from the patient OS, that there is omission of phonemes as evident in table 1, while table 2 shows the correct rendition of the patient and 3 shows that words in which certain syllables or sounds were omitted. As shown in table 4, we observe some mis – articulations, which are due to addition of speech sounds and words. Table 5 shows whole words distortion in the patient’s speech, in the production or pronunciation of the above shown combination, evident in the process of substitution, deletion, omission and insertion in earlier tables replaced as /in/ respectively. The patient was able to show speech realization of numbers, and correct rendition for the target phonemes determined sometimes, as shown in table 2.

Conclusion: The schizophrenic patient that was drug compliant showed positive speech coherence.

Keywords: Schizophrenia, drug compliance, language, communication and patient process.




Significant Outcome:


Schizophrenic Patients Partial drug compliance.


Incorrect timing of the medication by schizophrenia patients.

Schizophrenic Patients Partial speech compliance.


Limited population and sample size.

Limited data for analysis.

The Patients linguistic communicative competency is partial.



Schizophrenia is a chronic mental disorder that has a multifactor etiology. Its global prevalence is 0.3% to 0.7% (Herraez, 2009) and the incidence is higher in men though the definitions that include more symptoms and brief clinical events show an equivalent risk for both sex (America Psychiatric Association, 2013). The early symptoms occur usually between 15 and 49 years, often emerging at the beginning of youth (15-25) years (Holder, 2014).

Recent academic literature has proposed measuring disorganized speech with semantic coherence, where larger amounts of concept overlap between two text segments is interpreted as more coherent (Bidi et al., 2015). Nevertheless, some patterns do emerge. The studies of speech comprehension seem to attribute reduce comprehension to deficient working memory (Grove and Andreasen 1985; Condray et al; 1996). On the other hand, deficits found in semantic processing (Karenken et al; 1966) fluency (Rochester and Martins 1979) and complexity (Thomas et al; 1966) are interesting because they have a relationship to the cerebral organization of language. More so, patient with schizophrenia present semantic memory problems, that are evident in semantic priming and verbal fluency texts, deficit in word association, in the use of language, in the production of contexts – dependent meaning and in social interaction.

Moreover, many studies focused on speech impairment, furthermore, Rodriguez – Ferrera et al. (2001) examine the language impairment in thought disorder schizophrenia whose general intellectual ability is preserved. DeLis (2001) was the first to note that syntactic simplification in schizophrenia is relevant to theories of evolution of language. See also Corcoran and Frith (1996) and Tenyi et al. (2002) Further experimentation in this area could yield sensitive test for there is a gap on the area of drug compliance which they did not look at in their work which is the focused of preliminary study. On the other hand, we adopt the method of pharmacist, linguist and patient interview to collect data for analysis to determine the level, and improvement on the area of speech.



This study adopted the Motivational interview (MI) approach to evaluate responses from interviewed patients. According to Dobber (et al. BMC Psychiatry 2018), Motivational interviewing (MI) may be an effective intervention to improve medication adherence in patients with schizophrenia. Two schizophrenic out – patients (designated OS and OZ) in Federal Neuro – Psychiatric Hospital in Benin City, Edo State Nigeria where enlisted for this study in August 2017. Ethical clearance for the study was obtained from Federal Neuro – Psychiatric Hospital (FNPH) and participation was voluntary with informed consent obtained from the participants and all information obtained kept confidential.


The two patients (designated OS and OZ) studied were on different anti-psychotic drugs. Patient OS was on Olanzapine while OZ was on Chlorpromazine during this study. Motivational interviewing was adopted to access, explore, and discover the level of patient drug compliance and the corresponding effect it has on their language. The motivational interview comprised of two phases: single case analysis, and cross case analysis. Each phase consisted of: (1) audio records of at least two MI- Sessions, (2) coded transcripts; and (3) test comparisons of language competencies and speech quality. The analysis of these, provided a platform for comparative evaluation between the patients.




Evaluation of Sentence Structure

From our interview we could infer meaning that the patient sentence structure or word order could not hold together with patient OS, but for patient OZ we could infer some meaningful progress and level of language and drugs compliance as directed by the Pharmacist. We observe that patient OZ sentence structure is rather better when compared with patient OS.

Speech Accuracy Task

We discovered from the Pharmacist patient interaction in course of the recording, the schizophrenic patient OS could not accurately link an ongoing discourse, there was loss of ideas and deviation from the speech content due to failure to take the recommended drug dosage, but patient OZ we observe drug compliance and speech improvement.

Object Span Memory

From our observation, we noted, that when the pharmacist brought in two satched drug as an objective and he ask patient OS to differentiate between the Paracetamol and Panadol we realized loss of ideas, loss of control and could not comprehend and understand what he was asked to do, but when patient OZ was ask by the pharmacist to differentiate between the two drug, we noted a quick response and he recognized both and differentiated them.


Phonological Structure

We observed from the schizophrenic patient OS speech was characterized with speech anomalies like flattened intonation (aprosody), more pauses, and hesitations, but on the other hand, patient OZ speech intonation was obstinately normal. Even the most unintelligible utterances conform to the arrangement of speech sounds permitted in the patient’s language. Phonetic anomalies like flattened intonation (aprosody), more pauses, and constricted pitch/timbre (Stein, 1993).


Voice Quality

Spoerri did pioneering work on both prosody and voice quality in schizophrenia (Spoerri, 1961, 1964, 1966). On our part we observed that the schizophrenia patient OS manifested choking voice quality in course of the pharmacist-patient interaction, while the schizophrenia patient OZ on the other hand, expressed quality voice control and clear utterances.

Clinical Interview 1

Interpretation of result and descriptions of language in schizophrenic based on the structure and sequential pattern in the schizophrenic level of drug compliance between the pharmacist, linguist and the patient.

Conversation 1

P: OS Patient just came into the pharmacist consulting room for interview based on the medical adherence, the patient complaining bitterly that he did not understand his body chemistry

(p: interviewer, O: patient)

P: good morning # how were you able come for clinical checkup?

O: hun?(1)

P: Do you forget to take your drugs?

O: Forget ……. forget once forget (2)

P: apart from forgetting # is there any other reason why you don’t take it?

O: (confused) (3)

P: Hope there is no problem

O: (nods) (4)

P: When you travel # do you remember to take your medicine

O: Laugh …. Laugh (confused) (5)

P: Now do you feel boarder worry # by taking your medicine

O: Yes! (6)

P: Do you forget your medicine

O: (confused) (7)

P: what make you to forget

O: over excitement (8)

P: what do you mean by over excitement

O: (confused) (9)

P: what is the recommended medicine

O: I don’t like it (10)


Clinical Interview 2

Conversation 2


P: you are sitting here # when did you come?

O: [laugh] not too long (11)

P: how is your health?

O: am getting better? (12)

P: Have you completed the recommended drugs

O: Yes!

P: now that you are feeling better # do you still take your drugs

O: Yes!

P: What drug are you taking now?

O: Tab Olanzapine 10mg daily.

We can see from the interaction between the pharmacist and the first patient, that the patient could not link the conversation or utterance with the early one. Also, it is only clear that the second patient understood and flowed with what the pharmacist explained. This is evident in the overlap that we use in the speech of the patient.


Our use of MI in this study reveals the difference in the level of drugs compliance by the two schizophrenic Patient, with respect to their language and communication abilities. As examined, patient 1 (OS) in the first conversation was on Chlorpromazine 50mg twice daily.  The observation from patient (OS) clearly shows non – drug adherence. This could probably be as a result of incorrect timing of the medication as well as wrong dosage which is the cause of deletion of phoneme in the patient speech. Patients may probably forget a dose completely or stop the drug because of the Extrapyramidal side effects experienced, like akathisia, dystonia, parkinsonia symptoms, tardive dyskinesia and hyperprolactinemia. In contrast to the patient 2 (OZ), we observed a different level of speech impairment which demonstrated that the patient’s response was right on the drug he was currently taking. The observation of patient OZ as illustrated in the conversation above, showed that he was on tab Olanzapine 10mg daily. The conversation of OZ has clearly shown drug adherence which could be related to a dosage of once daily. This was captured in the patient’s speech which portrayed partial compliance, hesitation, overlaps, errors in spellings, phonological disorder, pronunciation problems, which are prominent in the patient’s discourse. It is not surprising to observe all those errors in a schizophrenic patient because the central problem in them – schizophrenic patients – is abnormality with illogical thinking and we know speech is externalized thoughts.  Similar to other psychoses, schizophrenia has been studied extensively on the neurological and behavioral levels. Covington et al. (2005) noted the existence of many language abnormalities (in syntactic, semantic, pragmatic, and phonetic domains of linguistics) comparing patients to controls. They observed the following: reduction in syntax complexity, (Fraser et al. 1986) impaired semantics, such as the organization of individual propositions into larger structures (Rodriguez-Ferrera et al., 2001); abnormalities in pragmatics which is a level obviously disordered in schizophrenia (Covington et al., 2005); phonetic anomalies like flattened intonation (aprosody), more pauses, and constricted pitch/timbre (Stein, 1993).


In this study, we explored two patients (designated OS and OZ) who were on different psychotic drug and our findings showed that both patients reacted and responded in different ways or levels due to the level of medication compliance: the first patient (OS) showed and manifested disorganized speech and non- medication compliance, in contrast with the second patient who showed organized speech and medication compliance. These studies systematically described with MI, a strategy to improve the overlaps in speech and drug compliance. We present this findings for further studies on reliable and objective methods of assessing speech impairment among schizophrenics for the purpose of clinical relevance.

In the next research, we will be focusing on the extent of drug compliance among schizophrenic patient, that will show the most promise in this study and also add new features such as level of committed belief for pragmatics. Finally, we are collecting more data and we will expand our analysis to more on mental health.

Direction for Future Research

Except for semantic priming and discourse cohesion, hardly any aspect of schizophrenic language is well explored. Thus, this study is practically an agenda for future research. Nonetheless, a few possibilities stand out:

-          Current psycholinguistics, advancing rapidly, can shed light on old issues. The work Pulvermuller (2002) and Jackendoff (2002) has not yet been applied to schizophrenic research.

-          The paroxysmal nature of schizophrenic language disturbance should be investigated. Can schizophrenia be induced by particular cognitive tasks (Cohen et al, 1974), stimuli or drugs? What is known about the state of the brain during the paroxysms?

-          The heredity of schizophrenic language impairment (Delisi. 2001) should also be investigated further. It may provide a solid biological basis for differentiating types of schizophrenia.

-          Prodromal and subclinical case of schizophrenia may be detectable by measuring language impairment. This is a public health issue because drug treatment is apparently more effective if started early and early detection of schizophrenia can save the patient from a wider range of personal misfortunes.


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Clinical characterizations of language output in schizophrenic

The clinical interview shows the successful and unsuccessful inability of the patient to pronounce the correct phonemes in the process of the interview and conversation with the pharmacist and the linguist as show below.


Table 1: Phonemes Deletion by patient OS


Phoneme Substitution

In which one phoneme is substituted for another

Orange [Dr, Inʤ]


Simplification Errors

Where a phoneme or syllable is deleted.

Drip [dip]


Addition Errors

Where extra phoneme (s) is or are add.

New [une]


Environment Errors

Where a particular phoneme is influence by another in the environment.

X-ray [ray]

We went further to say that an analysis of these error gives us an insight into the organization of the phonological system in schizophrenia patients.

The next task in a feature analysis is to show the target phonemes and the number of correct occurrence in the data collected from the patients as show below.

Table 2: Accurate Production by patient OZ








[brush ]

/ b/

r – w,  – S



[that ]


ə – d



[pencil ]

/pent. s ə/

P– b, s – d



[sugar ]

/:sug ər/

s – d



[speak ]


s – Ø, p – b

The number of correct renditions for these target phonemes should be determined sometimes. This number will be Zero for a particular target, as it will be rendered erroneously all the times following this, the substitutes for the targets in question with number of time for each substitute.

In the patient’s speech there are some words in which certain syllables or sounds were omitted as shown below.

Table 3: Omission Errors by patient OS




Patient’s Production


Transcription of Patient Speech


























We will observe from (6) to (10) above the patients deleted a number of syllable in her English words in the initial position. Some speech sound too are deleted within the words. For example, /L/ in live (g) /l/ in Lagos (7) in the syllable

In the patient’s speech, we will also observe some mis-articulations, which are due to the addition of speech sounds some words as shown in (11) and (12) below, the patients inserted the alveolar liquid /l/ into the two words – just and case.

Table 4: Addition of Errors by patient OS





Transcription of patient’s Production











These are the case in which the patient pronounced some words in such a way that they sounded totally strange or like some other words. They include the following:

Table 5: Whole Word Distortion by patient OS





Transcription of patient’s Production







with me

with in


[wit in]

The patterns in the pronunciation of the above shows a combination of the process of substitution, deletion/omission and insertion as observed earlier. In (13) and (14) replaced /in/ respectively.


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