Strategies for Improving Treatment Adherence in Schizophrenia and Schizoaffective Disorder

Harvard University, Cambridge, Massachusetts, United States
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 12/2010; 71 Suppl 2(Suppl 2):20-6. DOI: 10.4088/JCP.9096su1cc.04
Source: PubMed


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.

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    • "Poor adherence impairs clinical health outcomes (Lindenmayer et al. 2009), causes persistent psychotic symptoms or relapses and increases psychiatric hospitalizations (Morken et al. 2008). An estimated 50% of schizophrenia sufferers do not take their medication as needed (Goff et al. 2010), 40% miss appointments with healthcare personnel (Killaspy et al. 2000) and relapses are common (Robinson et al. 1999, Ascher-Svanum et al. 2010). Poor adherence increases mental healthcare costs, which are three times higher among relapsing patients than those who do not relapse (Ascher- Svanum et al. 2010). "
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    ABSTRACT: AimsTo explore patients' and mental healthcare professionals' perceptions of supportive and restrictive indicators of adherence to treatment in patients with mental health problems.Background People with mental health problems may have difficulties adhering to their treatment, causing relapses and hospitalizations. It is, therefore, important to learn more about how patients' treatment adherence can be supported and what jeopardizes adherence.DesignA descriptive qualitative study.Methods Nine focus groups and semi-structured interviews were conducted in Finland during 2010-2011. The patients (n = 19) were recruited from patient associations and the healthcare professionals (n = 42) from healthcare organizations. The data were analysed using inductive content analysis.FindingsParticipants agreed that treatment adherence can be supported. Suggestions focused on treatment planning mindful of both patient involvement and needs. A structured daily routine helps patients manage their everyday issues and further facilitates adherence. On the other hand, patients found that their adherence was affected by factors related to the mental health system, including arrangements for follow-up care, access to services, the receptiveness of providers to meet patient needs and a disconnect time between hospital and community life.Conclusion Patient adherence should already be taken into account when treatment is planned. The content of treatment should be individually designed according to the patient's activities of daily life. In addition, stressing the importance of medication and listening to the patient's opinions and experiences of taking medication may improve the patient's willingness to adhere.
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    • "Fear of stigma connected to the diagnosis and being prescribed antipsychotics and fear of rejection due to revealing psychotic symptoms have been suggested to further increase non-adherence to both psychiatric and physical treatment (Freudenreich et al., 2004; Goff et al., 2010; Thornicroft, 2008). In a qualitative study patients reported that the stigma of taking antipsychotics caused them to hide their medication from others and to take it only in privacy (Jenkins and Carpenter-Song, 2009). "
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    ABSTRACT: The aims of this naturalistic non-interventional study were to quantify the level of stigma and discrimination in persons with schizophrenia and to test for potential associations between different types of stigma and adherence to antipsychotics. Antipsychotic medication use was electronically monitored with a Medication Event Monitoring System (MEMS(®)) for 12 months in 111 outpatients with schizophrenia and schizophrenia-like psychosis (DSM-IV). Stigma was assessed at endpoint using the Discrimination and Stigma Scale (DISC). Single DISC items that were most frequently reported included social relationships in making/keeping friends (71%) and in the neighborhood (69%). About half of the patients experienced discrimination by their families, in intimate relationships, regarding employment and by mental health staff. Most patients (88%) wanted to conceal their mental health problems from others; 70% stated that anticipated discrimination resulted in avoidance of close personal relationships. Non-adherence (MEMS(®) adherence≤0.80) was observed in 30 (27.3%). When DISC subscale scores (SD) were entered in separate regression models, neither experienced nor anticipated stigma was associated with adherence. Our data do not support an association between stigma and non-adherence. Further studies in other settings are needed as experiences of stigma and levels of adherence and their potential associations might vary by a healthcare system or cultural and sociodemographic contexts. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Oct 2014 · Psychiatry Research
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    • "). Psychiatrists have recognized this problem and there is an urgent need in clinical practice for an effective communication tool for patients to describe their subjective beliefs about the side effects of medications and their likelihood to alter or discontinue treatment (Cabeza et al., 2000; Dott et al., 2001; Dassori et al., 2003; Goff et al., 2010). "
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    ABSTRACT: Side effects of psychotropic medications are important determinants of adherence to treatment. Discussion between the patient and clinician facilitated through the use of a side effect self-report questionnaire (SRQ) could lead to improved communications and treatment adherence. The aim of this review was to 1) identify all currently available side effect SRQs used in the assessment of mental health patients׳ subjective experiences, 2) evaluate the characteristics of the studies and 3) assess the psychometric properties of each of the questionnaires. Eight electronic databases were searched for peer-reviewed published articles. Six side effect SRQs were identified. Two independent reviewers assessed the quality of the study designs and psychometric properties of the identified SRQs. All questionnaires consisted of closed questions relating to antipsychotic side effects and completion times ranged from 5 to 20min. Five questionnaires had undergone some form of psychometric testing, ranging from basic to comprehensive. There is a need in everyday clinical practice for a side effect communication tool applicable to all psychotropic medications, which allows the patient to express their subjective beliefs about their medications. This could provide an important contribution to the working relationship between patients and clinicians leading to informed decision-making and improved adherence.
    Full-text · Article · Jun 2014 · Psychiatry Research
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