Ekta Franscina Pinto1, Swapnajeet Sahoo2, Deepanjali Deshmukh3, Naresh Vadlamani4, Isha Dhingra5, Sagar Karia6, Chittaranjan Andrade1. 1. Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India. E-mail: franscin@gmail.com. 2. Department of Psychiatry, Postgraduate, Institute of Medical Education and Research, Chandigarh, India. 3. Department of Psychiatry, MGM's Medical College and Hospital, Aurangabad, Maharashtra, India. 4. Department of Psychiatry, Columbus Hospital, Hyderabad, Telangana, India. 5. Department of Neurology, Yale University School of Medicine, New Haven, CT, USA. 6. Department of Psychiatry, L.T.M.M.C. and G.H., Mumbai, Maharashtra, India.
Sir,Rao et al.[1] described a large (n = 346) cross-sectional study of factors influencing compliance in patients with psychosis. They included patients with schizophrenia spectrum disorders, bipolar disorder, and unipolar depression in their sample of patients with psychosis. It is debatable whether all patients with schizophrenia spectrum disorder have psychosis and whether mood disorders should be classified under this rubric; and in any case, it is unlikely that disorders so fundamentally heterogeneous could validly be pooled into a single sample for the study of behavior as complex as treatment compliance.The authors classified patients as compliant or noncompliant based on data extracted from case records; it is unlikely that such retrospective ascertainment from chart data could be sufficiently accurate for a valid classification. Patients with incomplete or no data on compliance were not considered, and no information was provided on how many these patients numbered or what their characteristics were; therefore, the reader cannot determine how representative the study sample was. The 26-item study questionnaire was self-designed; no data are presented on its validity and reliability. Finally, medication compliance is a multifactorial construct with variables interacting in complex ways; yet the analysis presented was univariate.Whereas we applaud the authors for addressing an important subject in a large study, we suggest that with better methods and analysis, their efforts could have been more impressive.