Understanding and Addressing Adherence Issues in Schizophrenia: From Theory to Practice
J Clin Psychiatry 2007;68(suppl 14):14-19
© Copyright 2015 Physicians Postgraduate Press, Inc.
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If an easy answer to the problem of medication nonadherence in
schizophrenia existed, it would have already been found. Despite the magnitude
of the problem, in the past decade, significant advances have been made in
understanding the nature of the adherence problem in schizophrenia. Just as
there is no single adherence intervention but a range of interventions that
can be matched to the specific challenges of the individual patient, there is
not a single theory that explains adherence and nonadherence. Rather, there
are a range of theories and concepts, with their own strengths and
limitations. The goal of this article is to help provide a crosswalk from some
of the emerging theories and concepts to practical clinical management
approaches. To enhance understanding of this complex issue and help
practitioners implement practical therapeutic interventions that encourage
adherence, the following 5 theories regarding medication adherence are
presented and suggestions made for applying them in clinical practice: (1)
Adherence is not a clinical outcome and only matters as it interferes with
outcome. (2) In schizophrenia, adherence problems are often entangled with
efficacy limitations of antipsychotics. (3) Adherence can be viewed as a
behavior (taking/not taking) or an attitude (prefers taking/prefers stopping).
(4) When considering adherence attitudes, patient belief is always reality.
(5) Adherence behavior changes and fluctuates over time and should be
considered as part of the illness in the context of the long-term trajectory
of desired clinical outcomes such as recovery.