Interventions to Improve Adherence to Antipsychotic Medications

Nonadherence to antipsychotic medication regimens is a common problem with serious consequences. As many as 60% of patients with schizophrenia do not take medications as prescribed.1-6 The consequences of poor adherence are particularly severe in schizophrenia; they can lead to hospitalization, derail the process of recovery, and contribute to the high cost of treating the illness.5,7,8 Compliance problems complicate the treatment picture for prescribers. Psychiatrists may unnecessarily discontinue medications, increase doses, or add concomitant medications to address what appears to be a poor medication response in a patient who actually has an adherence problem.4,9,10 Nonadherence can be viewed as either inadvertent or intentional. Inadvertent nonadherence occurs when signs or symptoms get in the way of taking medication (eg, cognitive deficits prevent the organization necessary to maintain compliance). Intentional nonadherence results from a conscious decision on the part of the patient to discontinue his or her medication. Different interventions may be needed to address these different types of nonadherence. A number of review articles have summarized the data on interventions to improve adherence to medications.2,11-13 In this article, we describe 2 new and promising approaches for individuals with schizophrenia: first, the use of environmental supports and cognitive adaptation training and, second, cognitive-behavioral therapy.