“[...] Focus group discussion (FGD) findings
This is a qualitative study done to gather the knowledge, information and experiences regarding schizophrenia in Bangladesh perspective in three different groups (psychiatrists, general practitioners and patients/caregivers’ group). The study was done in National Institute of Mental Health (NIMH), Sher-e-Bangla Nagar, Dhaka from 15th October 2021 to 20th December 2021. The participation in the focus group was voluntary, anonymous and confidential.
[...] Risperidone (30%) was the most frequently consumed medication according to the respondent patients (and also their care givers). Tremor (28%), sleep disturbance (17%) and increased salivation (10%) were the commonest side effects of medication reported. 75% of the respondent patients were noncompliant to medication. Advice for oral medication (28%) and medicine with minimum side effects (28%) were the most frequent expectation from drugs followed by effectiveness (19%).”
The Bangladesh Association of Psychiatrists provides further information on antipsychotic medications available in Bangladesh, and their relative adverse effects in the Annexures of its “BAP Guidelines for the management of schizophrenia, 1st Edition”.
“Although antipsychotics, anxiolytics, antidepressants, mood stabilisers and anti-epileptic drugs are included in the list of essential medicines recommended by the WHO, psychotropic drugs are not widely available in Bangladesh. Only a few patients visiting the government healthcare facilities have access to these psychotropic medications.”
“Stocks of psychotropic medications, including antipsychotics, antidepressants, anxiolytics, mood stabilizers, and antiepileptics are held and dispensed from hospitals, health centres, and health posts. Prescribing of these medications can be carried out by doctors, nurses, medical officers, and community health officers. One Facility Checklist completed in a rural health center reported having only one psychotropic medication (diazepam) in stock.”
“Mental health expenditures by the Bangladeshi government are 0.44% of the total health budget. Of all the expenditure on mental health, 67% is dedicated to mental hospitals. Less than 0.11% of the population have access to free essential psychotropic medications. Daily out-of-pocket expenses for the lowest-priced antipsychotic and antidepressant medication is 5.00 taka (US$ 0.07) and 3.00 taka (US$ 0.04) respectively. Health insurance is a rarity and, in any case, typically does not cover drugs for mental illness.”
“Three facilities were visited during the assessment process. […] All noted a lack of qualified staff to provide psychosocial interventions. The general hospital had some essential psychotropic medications but had no injectable antipsychotic medication and inadequate supplies of the other medicines.”
“There is almost no availability of psychosocial interventions in Bangladesh outside of the national psychiatric hospital and national medical teaching hospital. A total of 17 psychologists in these two settings provide a wide range of psychotherapies, including problem-solving therapy, cognitive-behavioral therapy, behavioral activation, and supportive counseling.”