Directly observed therapy (DOT) in a psychiatric consulting dispensary, long term practice and retrospective study of patients coming every day

Abstract

Compliance with medication represents a major stake in the treatment of chronic diseases, especially in psychiatric disorders such as schizophrenia and mood disorder. Directly observed therapy (DOT) has been promoted in recent years by the WHO for ambulatory treatment of tuberculosis, since for many years psychiatric nurses have used this therapeutic strategy for hospitalized patients.

We use DOT in a psychiatric consulting dispensary to prevent relapses linked to non-compliance. Currently, more than 60 patients come once or twice per day, weekends included.

First, we describe our organization, the clinical indications, the nurses' work and a new architectural project to facilitate the delivery and observation of the treatment. DOT is not only a mechanical procedure of dropping medication into the patient's mouth, it is also a real way of establishing a therapeutic link and a very good clinical observation point to care for psychotic patients, for example. We also propose this strategy instead of hospitalization to patients who present an acute psychiatric disorder but with good insight.

Secondly, we present a retrospective study to show the efficacy in prevention of a relapse, and the reduction of the number of hospitalizations.