Strategies for Improving Treatment Adherence in Schizophrenia and Schizoaffective Disorder

Nonadherence with medication treatment is common but difficult to detect in patients with schizoaffective disorder and schizophrenia, almost half of whom take less than 70% of prescribed doses. Like patients in all areas of medicine, patients with schizoaffective disorder weigh the perceived benefits of medications against perceived disadvantages, but this process is complicated by their impaired insight, the stigma of the diagnosis, and the often troubling side effects of antipsychotic medication. Interventions to improve adherence include encouraging acceptance of the illness, drawing analogies with treatment for chronic medical disease, and involving the patient in decision making. Clinicians must remain nonjudgmental, encouraging patients to disclose problems with adherence and anticipating that improvement in adherence may require a prolonged effort. Selection of antipsychotic medication is critical to avoid adverse side effects, and some medications may provide a sense of well-being, such as improvement in insomnia, anxiety, or depression. Depot (rather than oral) antipsychotics can improve adherence and provide the clinician with reliable information about the dosage of medication received, which can be used for purposes of dose adjustments or to guide response to relapse.

From the Schizophrenia Program, Harvard Medical School and Massachusetts General Hospital, Boston.

This article was supported by an educational grant from Janssen, Division of Ortho-McNeill-Janssen Pharmaceuticals, Inc. administered by Ortho-McNeill Janssen Scientific Affairs, LLC.

Dr Goff is a consultant for Schering-Plough, Eli Lilly, F. Hoffman-La Roche, Takeda, Biovail, Solvay, and Dainippon Sumitomo; has received grant/research support from GlaxoSmithKline, Novartis, and Pfizer; and has received other financial support from Otsuka (Data Safety Monitoring Board). Dr Freudenreich is a consultant for Beacon Health Strategies, has received grant/research support from Pfizer, has received honoraria from Reed Medical Education, and has received other financial support from Lippincott Williams & Wilkins. Dr Hill has no personal affiliations or financial relationships with any commercial interest to disclose relative to this article.

Corresponding author: Donald C. Goff, MD, Freedom Trail Clinic, 25 Staniford St, Boston, MA 02114 (goff@psych.mgh.harvard.edu).