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PSYCHOTIC DISORDERS

Medication nonadherence is a significant problem in persons treated with antipsychotic medications; as many as one-fourth may be nonadherent (Nose et al., 2003). Nonadherence is responsible for up to 50% of hospitalizations for patients with schizophrenia (Perkins, 2002). An individualís experience with unpleasant side effects is commonly cited as a reason for discontinuing antipsychotic therapy. Newer antipsychotic agents, which have fewer movement-related side effects, may have a modest impact on improving adherence (Dolder et al., 2002; Lacro et al., 2002).

Interventions to improve adherence to antipsychotic medications are more likely to be successful if they focus on the personís attitudes and beliefs about medications, rather than focusing only on knowledge (Zygmunt et al., 2002). Compliance therapy, which combines cognitive behavioral techniques with moti-vational interviewing, has been shown to improve medication adherence and outcomes (Kemp et al., 1996).

BARRIER STRATEGIES
Patient-related
Cognitive therapy
Education about the illness
Education about the treatment
Memory aids (phone reminders, alarms)
Involvement in therapeutic alliance
Physician-related
Provide information on common side effects and strategies to address
Use of "patient-centered" approach
Address patientís attitudes and beliefs about medications
Social/Environment-related
Involve and educate family
Improve access to mental health services (case management, home visits, convenient clinic hours and locations)
More attractive clinic environment
Improved coordination between service providers
Treatment-related
Minimize complexity of medication regimen
Titration to optimum dose
Provide clear instructions on medication use
Minimize impact of side effects
Select medication with fewer side effects

Source: Perkins, 2002