Compliance with antipsychotic drug treatment: influence of side effects

Abstract

In addition to other factors such as type and duration of treatment, patient‐ and illness‐related variables and other psychosocial features, side effects are known to exert a significant influence on the compliance with antipsychotic treatment. This has been demonstrated for extrapyramidal motor side effects and akathisia, sedation, weight gain and sexual dysfunctions. Other adverse events interfering with the patients' social roles also interfere with the patients' willingness to comply with treatment. It is important to acknowledge this not only in the acute treatment of schizophrenia but especially during maintenance and prophylactic treatment. Compliance can be considerably improved by a) adequately informing the patient about the risks and nature of side effects and b) by recognizing and treating side effects, since prevention of adverse events is not easily achieved. An underestimation of the influence of side effects on compliance will often lead to treatment failures that are erroneously attributed to treatment resistance.

Antipsychotics modulate the expression of the 5’ ecto-nucleotidase NT5E (CD73) in the brains of patients with schizophrenia.

“…However, it is not clear that a dopaminergic hypothesis can explain the totality of OF schizophrenia pathogenesis as drugs with markedly different dopamine blockade capacity do not differ in efficacy of symptom resolution (9). Moreover, current treatment regimens possess undesirable side effect profiles and leave room for improvement in terms of efficacy and compliance (17)(18)(19)22). To assess the transcriptional landscape of the brain in psychotic disorders and of the anti-psychotic treated brain in an unbiased manner, we mined two microarray datasets, published and public (10,11), to identify genes whose expression was most significantly different.…”

“…A major issue in understanding how this class of drugs, as a group, exert their therapeutic function in ameliorating positive symptoms of patients with psychotic disorders, beyond dopamine and serotonin receptor blockade, is a lack of understanding as to the etiology of psychotic disorders (20). The development of enhanced pharmacological management tools for psychotic disorders, with an increase in therapeutic efficacy and a decrease in undesirable side effects such as akathisia (21) that drive non-compliance (22) in patients, can be significantly facilitated by an understanding of which genes and gene expression programs are specifically affected by antipsychotic medications. The question of which genes and gene expression programs are modulated by antipsychotic medications is one in psychopharmacology that has yet to be fully answered (23).…”

Psychiatrists’ Disclosure of the Side Effects of Medications to Patients with Schizophrenia in A Major Hospital in Nigeria

“…This is at least to the extent that this dearth of information from physicians to patients deprives them the fundamental right to understanding the inherent risks of the doctor's prescription and making an informed choice as to whether or not they prefer this mode of treatment, which reflects patient's autonomy. Although, a lot has been done in understanding the critical issues of side effects and patients' wellbeing, most of these studies have focused on its association with treatment variables such as medication compliance behaviour [41][42][43][44] . Research that specifically elicits the knowledge of side effects in patients with schizophrenia are very scanty.…”

Prevalence of Extrapyramidal Symptoms in In-Patients With Severe Mental Illnesses: Focus on Parkinsonism

“…Patients with Severe Mental Illnesses (SMI) can present Extrapyramidal Symptoms (EPS) as part of primary neurological disorders or following psychotropic treatment. EPS are linked to lower treatment adherence, poorer psychiatric prognosis and increased mortality (1,2) and are more severe and frequent in patients with SMI than in other psychiatric disorders, with higher prevalence (68-74%) among hospitalized patients (3,4). Patients with bipolar disorder are particularly likely to develop Parkinson's Disease (PD) (5).…”