Non‐adherence to psychotropic medication assessed by plasma level in newly admitted psychiatric patients: Prevalence before acute admission

Abstract

Aims Non‐adherence or partial adherence to psychotropic medication is found in 18–70% of patients. Many previously used methods for the assessment of adherence (e.g. questionnaires, pill counts, and electronic systems), however, might underreport actual rates of non‐adherence to medication. The aim of this study was to quantify adherence using plasma level. Methods We conducted a 6‐week prospective study of all consecutive admitted patients at the Paracelsus Medical University of Salzburg, Clinics of Psychiatry and Psychotherapy, who had been treated with antipsychotics/antidepressants prior to admission (pre‐medication dosage in 161 of 233). Plasma drug levels were determined and compared with expected levels based on known preadmission dosing regimens and average pharmacokinetic data. Results Seventy‐three percent of the patients had actual plasma levels clearly below or above the intended level. Significantly more patients with schizophrenia (66%) did not take the medication as prescribed, when compared with patients with affective disorders (47%) or those with other psychiatric diagnoses (41%). Only 27% (44 of 161) of the patients had plasma level in the expected range based on the dosage. Conclusion The risk of partial adherence or non‐adherence is expected in two‐thirds of patients with schizophrenia, half of patients with affective disorders, and approximately 40% of patients with other psychiatric diagnoses. Given that admitting psychiatrists could not provide an accurate assessment of patient adherence, it is strongly suggested that clinical judgment be supplemented with the actual monitoring of adherence – and further optimization of pharmacotherapy – by means of therapeutic drug monitoring.

Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views

“…Overall, inconsistent use of psychiatric medications may be a reflection of ineffective or lack of communication between psychiatrists and their patients regarding the harms and benefits of the medications, the range of options and varying side effects, and how psychiatric medications can facilitate recovery (6). Inconsistent use of psychiatric medications is associated with mental health services disengagement, frequent emergency department visits, hospitalizations, and more-severe symptoms over time (3,7).…”

Potential of Mobile Technology to Relieve the Urgent Mental Health Needs in China: Web-Based Survey

“…The higher requirements of patients and their family members for convenient prescription might be the result of the imperfect hierarchical diagnosis and treatment system in China [ 2 ], which leads to large provincial medical institutions often being crowded and inconvenient for rural patients to access. The obvious lower requirements of service demanders for monitoring and access provision could be due to the low adherence to medication, as shown in other research studies [ 17 ], but might also be due to the fact that service demanders believe they can monitor their symptoms and medications without additional mobile tools and instead give higher priority to items that they cannot accomplish alone, such as professional instruction and counseling. In short, this result reflects that the functions professionals think are important for mental health might not be considered of the same importance by patients and family members.…”

Toward therapeutic drug monitoring of citalopram in depression? Insights from a systematic review

“…In the field of psychopharmacotherapy, TDM has been reported to not only improve efficacy and safety but also identify medication adherence issues ( 28 , 29 ). Thus, TDM is considered a valid tool to improve patient outcomes and save healthcare costs in the treatment of depression.…”