Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies

Abstract

Nonadherence with medication occurs in all chronic medical disorders. It is a particular challenge in schizophrenia due to the illness’s association with social isolation, stigma, and comorbid substance misuse, plus the effect of symptom domains on adherence, including positive and negative symptoms, lack of insight, depression, and cognitive impairment. Nonadherence lies on a spectrum, is often covert, and is underestimated by clinicians, but affects more than one third of patients with schizophrenia per annum. It increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life. It results from multiple patient, clinician, illness, medication, and service factors, but a useful distinction is between intentional and unintentional nonadherence. There is no gold standard approach to the measurement of adherence as all methods have pros and cons. Interventions to improve adherence include psychoeducation and other psychosocial interventions, antipsychotic long-acting injections, electronic reminders, service-based interventions, and financial incentives. These overlap, all have some evidence of effectiveness, and the intervention adopted should be tailored to the individual. Psychosocial interventions that utilize combined approaches seem more effective than unidimensional approaches. There is increasing interest in electronic reminders and monitoring systems to enhance adherence, eg, Short Message Service text messaging and real-time medication monitoring linked to smart pill containers or an electronic ingestible event marker. Financial incentives to enhance antipsychotic adherence raise ethical issues, and their place in practice remains unclear. Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive therapeutic alliance and good communication between the clinician and patient. These elements remain essential for all patients, not least for the small minority where vulnerability and risk issue dictate that compulsory treatment is necessary to ensure adherence.

Factors affecting adherence in patients with schizophrenia

“…Nonadherence to medication can lead to relapse, which can mean more visits to the emergency room, rehospitalizations and increased need for clinician intervention -all of which lead to increased costs to healthcare systems. 1 Rates of non-compliance in psychotic disorders have been reported to vary from 11 to 80% and in most of the cases it would result in relapse. 2,3 Nonadherent patients have an average risk of relapse that is 3.7 times greater than that of adherent patients.…”

Nonadherence Effective Factors in Bipolar Disorder With Previous Rehospitalization

“…Treatment nonadherence may have some effects on patients, clinicians, and treatment centers (Haddad, Brain, & Scott, 2014). These effects are discussed below:…”

A Vivência Do Portador De Transtorno Mental No Uso De Psicofármacos Na Perspectiva Do Pensamento Complexo

“…12 These side effects favor the non-continuity of the use of psychotropic medication and the low adherence to the treatment. [15][16] In experiencing the duality of these effects, participants are constantly feeling a sense of ambivalence. A research developed with 36 relatives and 36 people with schizophrenia undergoing treatment in mental health services in the interior of São Paulo (Brazil) has shown that medicinal therapy is constantly marked by ambivalence, since the mental disorder patient is aware of the necessity of its use to stabilize the clinical picture, while simultaneously presenting unpleasant effects.…”