Challenges in Managing Disorganized Schizophrenia with Comorbid Treatment Non-Adherence: A Case Study from Indonesia
DOI:
https://doi.org/10.61194/jrkpk.v5i2.906Keywords:
schizophrenia, non-adherence, anosognosia, long-acting injectables, cultural adaptation, family psychoeducation, IndonesiaAbstract
Schizophrenia is a severe and chronic psychiatric disorder in which long-term adherence to antipsychotic medication is essential for relapse prevention, yet non-adherence remains highly prevalent, particularly in resource-limited settings such as Indonesia where families serve as primary caregivers. We report the case of an adult male with disorganized-type schizophrenia who experienced repeated relapses precipitated by persistent non-adherence driven by profound anosognosia and treatment fatigue. Upon admission, he presented with prominent persecutory, grandiose, and nihilistic delusions, marked disorganization, and complete lack of insight. This case illustrates a critical clinical paradox: the core symptom of schizophrenia—anosognosia—directly undermines its primary treatment modality when delivered in oral form. The case also reflects cultural and systemic challenges unique to Indonesian mental healthcare, including high caregiver burden and limited continuity of community-based services. Drawing from current global and regional evidence, we propose an integrated management model that positions long-acting injectable (LAI) antipsychotics as the pharmacological foundation to bypass daily adherence barriers, enabling more effective implementation of culturally adapted psychosocial interventions such as family psychoeducation and motivational interviewing. The novelty of this report lies in demonstrating how the interplay between neurobiological deficits, treatment fatigue, and sociocultural dynamics contributes to non-adherence, while highlighting how an LAI-based, culturally responsive, and system-aware strategy can disrupt the cycle of relapse and rehospitalization. This case underscores the importance of incorporating LAIs earlier in treatment planning and strengthening family-centered care within Indonesia’s mental health system.
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