In brief
In a Brazilian study of 48 patients discharged from psychiatric hospitalization, 70. 8% showed low medication adherence, and fewer than half knew their diagnosis or medication names and doses.
What this article is about
Quick Answer
In a Brazilian study of 48 patients discharged from psychiatric hospitalization, 70.8% showed low medication adherence, and fewer than half knew their diagnosis or medication names and doses. The findings point to a strong need for structured discharge psychoeducation, even among patients who say they value treatment.
Student takeaways
Key Takeaways
- 70.8% of the 48 patients discharged from psychiatric hospitalization showed a low level of adherence to psychopharmacological treatment on the Morisky-Green Test.
- More than half of patients reported forgetting medications (56.3%) and being careless about medication timing (58.3%).
- Only 21 of 48 patients (about 44%) could correctly identify their own psychiatric diagnosis.
- A similar minority of patients could correctly name and state the dose of all their prescribed medications, with about a quarter unable to name any medication.
- Despite these adherence and knowledge gaps, about 81% of patients still considered psychopharmacological treatment to be important.
Student summary
Why This Research Matters
This study looks at a problem that comes up again and again in mental health nursing: what happens to patients after they leave the hospital and go home with a bag of psychiatric medications? Researchers in Brazil followed 48 patients who had just been discharged from psychiatric hospitalization at a Mental Health Service. The study was exploratory, descriptive, and prospective, meaning the researchers were mapping out a pattern rather than testing one specific intervention.
The team used two tools: a Sociodemographic Questionnaire to understand who the patients were, and the Morisky-Green Test, a well-known four-question tool that screens for medication non-adherence (forgetting doses, being careless about timing, stopping when feeling better, and stopping because of side effects). They also asked patients directly whether they knew their own psychiatric diagnosis and whether they could correctly name and state the dose of each medication they had been prescribed.
The results were sobering. Among the 48 participants, 70.8% showed a low level of adherence to their psychopharmacological treatment, according to the Morisky-Green Test. Looking at the specific behaviors behind that number, more than half of patients admitted to forgetting medications (56.3%) or being careless about the timing of doses (58.3%). Knowledge was just as concerning as behavior: only 21 of the 48 patients (about 44%) could correctly state their own psychiatric diagnosis, and a similar share could correctly name and give the dose of all their prescribed medications. Many patients could not name any of their medications at all. Interestingly, despite these gaps, a large majority of patients (around 81%) said they believed medication treatment was important — they valued treatment even when they did not fully understand what they were taking or why.
The sample was mostly female (62.5%), with an average age around 39, and most patients lived with family (93%) rather than alone. More than half had only primary-level education or less, and most were not currently employed. About 62.5% of the group had been hospitalized more than once, meaning this was not their first psychiatric admission, and diagnoses were split fairly evenly between schizophrenia-spectrum disorders, mood disorders, and cases with more than one diagnosis.
The authors connect these findings to real risks: poor adherence and poor understanding of one's own treatment are strongly linked to relapse and re-hospitalization in psychiatric care. They point to a mix of contributing factors described in the discussion, including cognitive difficulties related to the illness itself, incomplete acceptance of the diagnosis, medication side effects, and a lack of structured health education before and after discharge. Because many of these patients had been hospitalized before, the study also raises the question of whether discharge teaching is actually reaching patients in a way they can absorb and use.
For nursing students, the value of this study is in what it says about the gap between clinical intention and patient reality. A nurse or physician can write a clear discharge plan and medication list, but if the patient walks out the door unable to name their diagnosis or their pills, that plan will likely fail. The study points toward nursing's role in structured discharge teaching, psychoeducation, and follow-up, especially for patients who have already been through multiple hospitalizations. It is a good reminder that adherence is not simply a matter of willpower; it is shaped by understanding, cognitive state, family support, and how well health information was communicated in the first place.
As with any single-site study, the findings come from one Mental Health Service with a modest sample of 48 patients, so they describe a pattern worth taking seriously rather than a number that applies everywhere. Students should read the specific percentages as evidence from this particular group, while treating the broader message — that psychoeducation and confirmed patient understanding are essential parts of safe discharge from psychiatric care — as the transferable lesson.
Source abstract
Study Overview
This exploratory, descriptive and prospective study aimed to identify the degree of adherence to psychopharmacological treatment of patients who were discharged from psychiatric hospitalization and their knowledge about their prescription and diagnosis. The study was carried out at a Mental Health Service. The sample consisted of all service clients who were discharged from psychiatric hospitalization in the data collection period. A Sociodemographic Questionnaire and the Morisky-Green Test were the instruments used. Data were analyzed through central trend measures. In total, 48 patients participated in the study. Regarding adherence, 70.8% of them showed a low adherence level to psychopharmacological treatment. Moreover, only twenty-one patients knew what their diagnosis was and most did not know or partially knew the name and dose of all prescribed medications.<br>El objetivo de este trabajo fue identificar el grado de adhesión al tratamiento psicofarmacológico de los pacientes egresados de internación psiquiátrica y evaluar su conocimiento en cuanto a su prescripción y diagnóstico. Se trata de un estudio exploratorio, descriptivo, prospectivo, realizado en un Núcleo de Salud Mental. La muestra fue compuesta por todos los clientes de este servicio que tuvieron alta de internación psiquiátrica en el período de recolección siendo utilizado un Cuestionario sociodemográfico y la Prueba de Adhesión de Morisky-Green como instrumentos. Los datos fueron analizados por medidas de tendencia central. Hicieron parte de la muestra 48 pacientes; en relación a la adhesión, se observó que 70,8% de ellos fueron clasificados con bajo grado de adhesión al tratamiento psicofarmacológico. Además de eso, apenas veintiún pacientes sabían informar cual era su diagnóstico y la mayoría de ellos no sabía o sabía parcialmente el nombre y dosis de todos los medicamentos que le fueron prescritos.<br>O objetivo deste trabalho foi identificar o grau de adesão ao tratamento psicofarmacológico dos pacientes egressos de internação psiquiátrica e seu conhecimento quanto à sua prescrição e diagnóstico. Trata-se de estudo exploratório, descritivo, prospectivo, realizado em um núcleo de saúde mental. A amostra foi composta por todos os clientes desse serviço que tiveram alta de internação psiquiátrica, no período de coleta, sendo utilizado um questionário sociodemográfico e o teste de adesão de Morisky e Green como instrumentos. Os dados foram analisados por medidas de tendência central. Fizeram parte da amostra 48 pacientes e, em relação à adesão, observou-se que 70,8% deles foram classificados como baixo grau de adesão ao tratamento psicofarmacológico. Além disso, apenas vinte e um pacientes sabiam informar qual era seu diagnóstico, e a maioria deles não sabia, ou sabia parcialmente, o nome e dosagem de todos os medicamentos a eles prescritos.
Evidence appraisal
Main Findings
- 70.8% of the 48 patients discharged from psychiatric hospitalization showed a low level of adherence to psychopharmacological treatment on the Morisky-Green Test.
- More than half of patients reported forgetting medications (56.3%) and being careless about medication timing (58.3%).
- Only 21 of 48 patients (about 44%) could correctly identify their own psychiatric diagnosis.
- A similar minority of patients could correctly name and state the dose of all their prescribed medications, with about a quarter unable to name any medication.
- Despite these adherence and knowledge gaps, about 81% of patients still considered psychopharmacological treatment to be important.
Practice transfer
Clinical Relevance
- Nurses should verify, before discharge, that patients can state their diagnosis and correctly name and dose their medications, since knowledge gaps were common even among patients who valued treatment.
- Structured discharge teaching and psychoeducation may need to be repeated and confirmed with teach-back methods rather than delivered once, given the high rate of low adherence found here.
- Patients with a history of multiple hospitalizations (62.5% of this sample) may need more intensive follow-up planning, since prior admissions did not appear to prevent low adherence.
- Because forgetfulness and careless timing were the most common adherence problems, simple supports such as medication reminders, pillboxes, or scheduled follow-up calls may be worth prioritizing in care planning.
- Assessing a patient's belief that treatment is important should not substitute for directly checking their factual knowledge of the diagnosis and regimen, since the two were clearly mismatched in this sample.
Critical appraisal
Limitations
- The study relied on a small convenience sample of 48 patients from a single Mental Health Service, which the authors themselves note limits generalizability.
- Adherence was measured with a brief self-report tool (the Morisky-Green Test), which is subject to recall and social-desirability bias and has known limits in sensitivity and specificity compared with other adherence measures.
- The design is descriptive and cross-sectional/prospective without a comparison group, so the study cannot establish why adherence was low, only that it was.
Classroom use
Discussion Questions
- Why might a patient believe medication treatment is important (as 81% of this sample did) while still being unable to name their own diagnosis or medications?
- What does the gap between behavioral non-adherence (Morisky-Green results) and knowledge deficits (diagnosis/medication recall) suggest about how discharge teaching should be structured?
- How might cognitive symptoms of schizophrenia-spectrum or mood disorders affect a patient's ability to retain discharge education, and what could nurses do to compensate?
- Given that 62.5% of patients had been hospitalized more than once, what does this suggest about the effectiveness of prior discharge planning for this population?
- What are the strengths and weaknesses of using the Morisky-Green Test as the sole adherence measure in this study?
- How could a nurse use a simple 'teach-back' check (asking the patient to state their diagnosis and medication list) as a discharge safety step based on these findings?
- What role might family living arrangements (93% living with family) play in supporting or failing to support medication adherence after discharge?
- How would you design a follow-up study to test whether structured psychoeducation actually improves adherence in this same population?
- What ethical considerations arise when a patient does not know their own diagnosis but is still expected to adhere to prescribed treatment?
- How might side effects, which the authors mention as a contributing factor, be more systematically assessed and addressed in future adherence research?
Knowledge check
Quiz
1. What percentage of patients showed a low level of adherence to psychopharmacological treatment in this study?
- 43.8%
- 56.3%
- 70.8%
- 81.2%
Rationale: The abstract states: '70.8% of them showed a low adherence level to psychopharmacological treatment.'
2. How many patients participated in this study?
- 21
- 38
- 48
- 62
Rationale: The abstract states: 'In total, 48 patients participated in the study.'
3. What instrument was used to measure medication adherence in this study?
- The Brief Medication Questionnaire
- The Morisky-Green Test
- The Beck Depression Inventory
- The PANSS scale
Rationale: The abstract states the instruments used were 'A Sociodemographic Questionnaire and the Morisky-Green Test.'
4. How many of the 48 patients knew their own psychiatric diagnosis?
- 11
- 21
- 31
- 41
Rationale: The abstract states: 'only twenty-one patients knew what their diagnosis was.'
5. What type of study design was used?
- Randomized controlled trial
- Exploratory, descriptive, and prospective study
- Retrospective cohort study
- Systematic review
Rationale: The abstract describes the study as 'exploratory, descriptive and prospective.'
6. According to the full text, roughly what percentage of patients still considered medication treatment important, despite low adherence and knowledge gaps?
- 25%
- 43.8%
- 58.3%
- 81.2%
Rationale: The fetched full text reports that '81.2% of patients considered medication treatment important,' contrasting with their lower adherence and knowledge scores.
7. What proportion of the sample had a history of more than one psychiatric hospitalization?
- 25%
- 37.5%
- 50%
- 62.5%
Rationale: The full text summary notes 'recurrent hospitalization: 62.5%,' with first-time patients making up 37.5% of the sample.
8. Which of the following was NOT listed as a specific adherence-related behavior assessed in the study?
- Forgetting medications
- Carelessness about timing
- Discontinuing due to side effects
- Sharing medication with family members
Rationale: The full text describes Morisky-Green Test behaviors including forgetting medication, carelessness with timing, and stopping due to feeling better or side effects; sharing medication with family is not mentioned.
9. What limitation did the study authors themselves acknowledge?
- Lack of informed consent procedures
- Use of a single service as reference and a limited number of subjects
- Failure to use any validated instrument
- Exclusion of patients with schizophrenia
Rationale: The full text states the authors noted the 'limited number of subjects' and 'use of one single service as a reference' restricted generalizability.
10. What is the primary clinical implication the authors draw for nursing practice?
- Nurses should reduce the number of prescribed medications
- Nursing has a critical role in systematized care, early intervention, and psychoeducation to prevent relapse
- Adherence testing should be discontinued as unreliable
- Family involvement should be minimized to protect patient autonomy
Rationale: The full text conclusion emphasizes 'nursing's critical role in systematic care, early intervention protocols, and psychoeducation to prevent relapse and improve treatment outcomes.'
Study cards
Flashcards
What was the main purpose of this study?
To identify the degree of adherence to psychopharmacological treatment among patients discharged from psychiatric hospitalization and assess their knowledge of their diagnosis and prescriptions.
What type of study design was used?
An exploratory, descriptive, and prospective study.
Where was the study conducted?
At a Mental Health Service in Brazil.
How many patients participated in the study?
48 patients who had recently been discharged from psychiatric hospitalization.
What two instruments were used to collect data?
A Sociodemographic Questionnaire and the Morisky-Green Test.
What does the Morisky-Green Test measure?
It is a brief four-item self-report tool that screens for medication non-adherence behaviors, such as forgetting doses, carelessness about timing, and stopping due to feeling better or side effects.
What percentage of patients showed low adherence to psychopharmacological treatment?
70.8% of the 48 patients showed a low adherence level.
How many patients could correctly state their psychiatric diagnosis?
Only 21 of the 48 patients (about 44%) knew their diagnosis.
What did most patients not know regarding their medications?
Most patients did not know or only partially knew the name and dose of all their prescribed medications.
What percentage of patients reported forgetting their medications?
56.3% of patients reported forgetting to take their medications.
What percentage of patients reported being careless about medication timing?
58.3% acknowledged carelessness with the timing of their doses.
Despite low adherence and knowledge, what did about 81% of patients still believe?
About 81% of patients still considered medication treatment to be important.
What was the average age of participants in the study?
The mean age was approximately 39 years.
What percentage of the sample was female?
62.5% of participants were female.
What percentage of patients lived with family?
93% of patients lived with family rather than alone.
What proportion of patients had been hospitalized more than once?
62.5% had a history of more than one psychiatric hospitalization.
What were the main diagnostic categories represented in the sample?
Schizophrenia-spectrum disorders (33.3%), mood disorders (29.2%), and patients with multiple diagnoses (29.2%).
What limitation did the authors acknowledge about their study?
The limited number of subjects and use of a single service as the reference site restricted the generalizability of the findings.
What factors did the authors suggest may contribute to low adherence?
Cognitive impairments related to illness, incomplete acceptance of the diagnosis, medication side effects, and insufficient health education.
What is the main nursing implication drawn from this study?
Nursing plays a critical role in systematized discharge care, early relapse-sign identification, and psychoeducation to improve treatment outcomes and prevent relapse.
Search-ready answers
Frequently asked questions
What is this study about?
It examines how well patients discharged from psychiatric hospitalization in Brazil adhered to their prescribed psychiatric medications and how well they understood their own diagnosis and treatment.
How many patients were studied?
The study included 48 patients who had recently been discharged from psychiatric hospitalization at a Mental Health Service.
What percentage of patients had low medication adherence?
70.8% of patients were classified as having a low level of adherence to their psychopharmacological treatment, based on the Morisky-Green Test.
What is the Morisky-Green Test?
It is a brief, widely used four-question self-report screening tool that assesses medication-taking behaviors, such as forgetting doses, carelessness with timing, and stopping medication due to feeling better or side effects.
Did patients know their own psychiatric diagnosis?
Only 21 of the 48 patients (about 44%) could correctly identify their own diagnosis; the majority did not know or only partially knew it.
Did patients know the names and doses of their medications?
Most patients did not know or only partially knew the names and doses of all their prescribed medications; about a quarter could not name any medication at all.
Did patients believe their medication treatment was important, even without full knowledge of it?
Yes. Despite gaps in adherence and knowledge, about 81% of patients said they considered medication treatment important.
What are the main limitations of this study?
It used a small convenience sample of 48 patients from a single Mental Health Service, relied on self-report measures, and used a descriptive design without a comparison group, limiting generalizability.
What do the authors recommend for nursing practice?
They emphasize the need for systematized nursing care, early identification of relapse signs, and structured psychoeducation to improve adherence and reduce rehospitalization.
Why does this study matter for mental health nursing?
It highlights that patients can value treatment while still lacking the basic knowledge needed to follow it safely, underscoring the importance of confirmed, teach-back-style discharge education.