The risks and implications of self-medication in psychiatry: exploring the role of the S-DTM model in understanding patient behaviour and mental health outcomes

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A.M. Ajay Aditya

Goa Medical College, India

: Int J Ment Health Psychiatry

Abstract

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Statement of the Problem: In contemporary healthcare, the increasing trend of pharmaceutical self-management, facilitated by the accessibility of medications without prescription, raises significant concerns regarding patient safety and effective care. This is particularly concerning in the realm of psychiatric disorders, where self medication with potent medications, such as antipsychotics, can lead to adverse outcomes. Despite the known risks, patients often resort to self medication, influenced by social networks and ease of access to medications. This case report addresses a unique instance where a patient self-medicated with risperidone (a potent antipsychotic) without medical supervision, leading to partial symptom improvement but raising concerns about potential long-term risks and mismanagement. Methodology and Theoretical Orientation: This case report is based on a comprehensive clinical evaluation of a 30-year-old male who self-diagnosed and self-medicated with risperidone for a 6-month period. The patient presented at an outpatient psychiatry clinic with symptoms suggestive of a psychotic disorder, specifically ideas of reference and aggression. The Self-Diagnosis, Self-Treatment, and Self-Monitoring (S-DTM) model, as presented by Bruce G. Charlton, is employed to understand the patientâ??s behaviour and the decision-making process behind his self-medication. The model emphasizes self-regulation attempts through medication use and the potential risks associated with inadequate professional supervision. Findings: The patient reported a 20-30% improvement in symptoms of irritability and aggression through self medication with risperidone, but did not experience any noticeable side effects such as sedation or extrapyramidal symptoms. However, the lack of professional oversight and personalized treatment raised significant concerns regarding the long-term safety of his self-medication practices. This case also highlighted the ease of access to prescription medications, which contributed to the patientâ??s decision to self-medicate despite the availability of healthcare services. The psycho-diagnostic evaluation indicated a combination of psychotic and affective features, reinforcing the need for a thorough psychiatric assessment and tailored treatment. Conclusion: The patientâ??s self-medication with risperidone underscores a broader issue of medication misuse, inadequate mental health literacy, and regulatory lapses in ensuring prescription medication is dispensed only under professional supervision. While the patient experienced some improvement in symptoms, the potential for misdiagnosis, improper dosing, and exposure to side effects illustrates the importance of professional intervention in psychiatric care. The case further highlights the need for greater public education regarding the risks of self-medication and the importance of seeking professional treatment. Significance: This case presents significant implications for public health policy, emphasizing the need for better regulation of prescription medication access, especially for psychiatric drugs. Strengthening pharmacy regulations, educating patients about the risks of self-medication, and promoting a healthcare system that encourages professional oversight can mitigate the risks associated with self-medication. The use of the S-DTM model in understanding the patientâ??s decision-making process provides valuable insight into the psychology of self-medication and highlights the necessity of professional guidance in managing psychiatric disorders. This report calls for a concerted effort to enhance mental health literacy and reduce the public reliance on self-diagnosis and treatment in managing psychiatric symptoms.

Biography

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Aadhi Mani Ajay Aditya is a highly motivated medical professional with a robust academic foundation and a strong dedication to advancing mental health care. Having completed their MBBS at Kasturba Medical College, Manipal, and MD at Goa Medical College, one of Asiaâ??s oldest medical institutions, Aadhi Mani Ajay Aditya is currently an Advanced Trainee in psychiatry at Goa Medical College. With a passion for continuous learning, I have presented at various prestigious international and national conferences and received a travel grant to attend a significant confer ence in Hong Kong. Aadhi Mani Ajay Aditya has further enhanced their expertise through multiple credential pro grams, staying updated with the latest advancements in mental health. Recognized for their academic excellence, they were honoured with the Amit Bohra Best Psychiatry Undergraduate Student award.