Today, I found that a news-site of psychiatry introduced a research regarding discontinuation of psychiatric service by the patients with mental disorder.
Psychiatric News Alert: One-Third of Patients With First-Episode Psychosis May Disengage From Treatment
According to this article, nearly one-third of the patients with psychosis are dropped out from continuous medical service.
First-Episode Psychosis and Disengagement From Treatment: A Systematic Review
The journal Psychiatric Service is one of the leading journals in this region. Unfortunately, I have no account to open the original article above at home, so I cannot investigate the whole article. Nonetheless, I think that this result is realistic referring to my own experience. Patients with a first episode psychosis should be followed up for a certain period, even after remission. It is certain that continuous medication helps them to avoid recurrence. However, some of them hesitate, even refuse, to meet a psychiatrist on a regular basis.
The authors seem not to be able to conduct a systematic review, because the definition of disengagement in original surveys is various. In addition, I wonder how many patients with substance misuse are included in the original surveys gathered in this research. In Japan, patients with substance misuse disorders are seldom diagnosed as psychosis. Such patients also tend to be excluded from clinical research. In my sense, the rate of discontinuation of treatment in the patients with substance abuse reaches more than 50%. We should be cautious when reading a result of combined data across countries.
Finally, I have to mention that some patients with a history of psychotic episode never repeat second one. There is no way to distinguish them from patients with risk of recurrence. It is a challenge still now.