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The Challenge of Nonadherence in Schizophrenia

  • Ryan E. LawrenceEmail author
  • Lisa Dixon
Chapter

Abstract

An estimated 75–90% of persons with schizophrenia become nonadherent to medications within two years of hospital discharge. Adherence challenges divide into five factors: social and economic factors (unmarried and male persons have less adherence), health-care team- and system-related factors (lower adherence rates correlate with less trust in physicians and lower expectations that physicians will be helpful), condition-related factors (less insight is associated with less adherence), therapy-related factors (complicated regimens reduce adherence), and patient-related factors (less education and less positive attitudes toward medication are associated with less adherence). Interventions exist to address each of these factors. Social and economic interventions address obstacles of poverty and access to health care. Health-care team and health system interventions (court-ordered treatment, assertive community treatment, and digital health technologies) enhance opportunities for engaging with treaters. Condition-related interventions (treating symptoms and comorbidities) aim to prevent symptoms from interfering with the treatment. Therapy-related interventions (medication selection) aim to optimize and individualize the treatment regimen. Patient-related interventions (psychotherapy, financial incentives) help to shape the patient’s beliefs and motivations. Helping patients to engage in therapy is not straightforward and requires a multifaceted approach. In the end the goal is not only to improve adherence but to improve outcomes.

Keywords

Schizophrenia Adherence Nonadherence Engagement Disengagement 

References

  1. 1.
    Kreyenbuhl J, Nossel IR, Dixon LB. Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature. Schizophr Bull. 2009;35(4):696–703.CrossRefGoogle Scholar
  2. 2.
    Kessler RC, Berglund PA, Bruce ML, Koch JR, Laska EM, Leaf PJ, et al. The prevalence and correlates of untreated serious mental illness. Health Serv Res. 2001;26(6 pt 1):987–1007.Google Scholar
  3. 3.
    Large M, Farooq S, Nielssen O, Slade T. Relationship between gross domestic product and duration of untreated psychosis in low- and middle-income countries. Br J Psychiatry. 2008;193(4):272–8.CrossRefGoogle Scholar
  4. 4.
    Perkins DO, Gu H, Boteva K, Lieberman JA. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry. 2005;162(10):1785–804.CrossRefGoogle Scholar
  5. 5.
    Dixon LB, Goldman H, Srihari VH, Kane J. Transforming the treatment of schizophrenia in the United States: the RAISE initiative. Annu Rev Clin Psychol. 2018;14:6.1–6.22.CrossRefGoogle Scholar
  6. 6.
    Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97.CrossRefGoogle Scholar
  7. 7.
    Sendt KV, Tracy DK, Bhattacharyya S. A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders. Psychiatry Res. 2015;225(1–2):14–30.CrossRefGoogle Scholar
  8. 8.
    PhenX Toolkit Data Collection Worksheets. Brief Adherence Rating Scale (BARS). 2018. https://www.phenxtoolkit.org/toolkit_content/PDF/PX661801.pdf. Accessed 2/9/2018.
  9. 9.
    Tiihonen J, Mittendorfer-Rutz E, Majak M, Mehtälä J, Hoti F, Jedenius E, et al. Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29 823 patients with schizophrenia. JAMA Psychiatr. 2017;74(7):686–93.CrossRefGoogle Scholar
  10. 10.
    Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014;20(11):CD000011.Google Scholar
  11. 11.
    World Health Organization. Adherence to long-term therapies: evidence for action. 2003. http://www.who.int/chp/knowledge/publications/adherence_report/en/. Accessed 2/5/2018.
  12. 12.
    Brain C, Sameby B, Allerby K, Quinlan P, Joas E, Lindström E, et al. Stigma, discrimination and medication adherence in schizophrenia: results from the Swedish COAST study. Psychiatry Res. 2014;220(3):811–7.CrossRefGoogle Scholar
  13. 13.
    Higashi K, Medic G, Littlewood KJ, Diez T, Granström O, De Hert M. Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Ther Adv Psychopharmacol. 2013;3(4):200–18.CrossRefGoogle Scholar
  14. 14.
    Lysaker PH, Pattison ML, Leonhardt BL, Phelps S, Vohs JL. Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry. 2018;17:12–23.CrossRefGoogle Scholar
  15. 15.
    Maughan D, Molodynski A, Rugkasa J, Burns T. A systematic review of the effect of community treatment orders on service use. Soc Psychiatry Psychiatr Epidemiol. 2014;49:651–63.CrossRefGoogle Scholar
  16. 16.
    Valenstein M, McCarthy JF, Ganoczy D, Bowersox NW, Dixon LB, Miller R, et al. Assertive community treatment in veterans affairs settings: impact on adherence to antipsychotic medication. Psychiatr Serv. 2013;64(5):445–51.CrossRefGoogle Scholar
  17. 17.
    Batra S, Baker RA, Wang T, Forma F, DiBiasi F, Peters-Strickland T. Digital health technology for use in patients with serious mental illness: a systematic review of the literature. Med Devices (Auckl). 2017;10:237–51.Google Scholar
  18. 18.
    Velligan D, Mintz J, Maples N, Xueying L, Gajewski S, Carr H, et al. A randomized trial comparing in person and electronic interventions for improving adherence to oral medications in schizophrenia. Schizophr Bull. 2013;39(5):999–1007.CrossRefGoogle Scholar
  19. 19.
    Kane JM, Perlis RH, DiCarlo LA, Au-Yeung K, Duong J, Petrides G. First experience with a wireless system incorporating physiologic assessments and direct confirmation of digital tablet ingestions in ambulatory patients with schizophrenia or bipolar disorder. J Clin Psychiatry. 2013;74(6):e533–40.CrossRefGoogle Scholar
  20. 20.
    Peters-Strickland T, Pestreich L, Hatch A, Rohatagi S, Baker RA, Docherty JP, et al. Usability of a novel digital medicine system in adults with schizophrenia treated with sensor-embedded tablets of aripiprazole. Neuropsychiatr Dis Treat. 2016;12:2587–94.CrossRefGoogle Scholar
  21. 21.
    Food and Drug Administration. FDA approves pill with sensor that digitally tracks if patients have ingested their medication. 2017. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm584933htm. Accessed 1/13/2018.
  22. 22.
    Jaeger S, Pfiffner C, Weiser P, Langle G, Croissant D, Schepp W, et al. Long-term effects of involuntary hospitalization on medication adherence, treatment engagement and perception of coercion. Soc Psychiatry Psychiatr Epidemiol. 2013;48:1787–96.CrossRefGoogle Scholar
  23. 23.
    Dibonaventura M, Gabriel S, Dupclay L, Gupta S, Kim E. A patient perspective of the impact of medication side effects on adherence: results of a cross-sectional nationwide survey of patients with schizophrenia. BMC Psychiatry. 2012;12:20.CrossRefGoogle Scholar
  24. 24.
    Czobor P, Van Dorn RA, Citrome L, Kahn RS, Fleischhacker WW, Volavka J. Treatment adherence in schizophrenia: a patient-level meta-analysis of combined CATIE and EUFEST studies. Eur Neuropsychopharmacol. 2015;25(8):1158–66.CrossRefGoogle Scholar
  25. 25.
    Kishimoto T, Robenzadeh A, Leucht C, Leucht S, Watanabe K, Mimura M, et al. Long-acting injectable vs oral antipsychotics for relapse prevention in schizophrenia: a meta-analysis of randomized trials. Schizophr Bull. 2014;40(1):192–213.CrossRefGoogle Scholar
  26. 26.
    Barkhof E, Meijer CJ, de Sonneville LM, Linszen DH, de Haan L. The effect of motivational interviewing on medication adherence and hospitalization rates in nonadherent patients with multi-episode schizophrenia. Schizophr Bull. 2013;39(6):1242–51.CrossRefGoogle Scholar
  27. 27.
    Byerly MJ, Fisher R, Carmody T, Rush AJ. A trial of compliance therapy in outpatients with schizophrenia or schizoaffective disorder. J Clin Psychiatry. 2005;66(8):997–1001.CrossRefGoogle Scholar
  28. 28.
    Chien WT, Mui JH, Cheung EF, Gray R. Effects of motivational interviewing-based adherence therapy for schizophrenia spectrum disorders: a randomized controlled trial. Trials. 2015;16:207.CrossRefGoogle Scholar
  29. 29.
    Bechdolf A, Knost B, Kuntermann C, Schiller S, Klosterkötter J, Hambrecht M, et al. A randomized comparison of group cognitive-behavioural therapy and group psychoeducation in patients with schizophrenia. Acta Psychiatr Scand. 2004;110(1):21–8.CrossRefGoogle Scholar
  30. 30.
    Bechdolf A, Köhn D, Knost B, Pukrop R, Klosterkötter J. A randomized comparison of group cognitive-behavioural therapy and group psychoeducation in acute patients with schizophrenia: outcome at 24 months. Acta Psychiatr Scand. 2005;112(3):173–9.CrossRefGoogle Scholar
  31. 31.
    Noordraven EL, Wierdsma AI, Blanken P, Bloemendaal AF, Staring AB, Mulder CL. Financial incentives for improving adherence to maintenance treatment in patients with psychotic disorders (Money for Medication): a multicentre, open-label, randomised controlled trial. Lancet Psychiatry. 2017;4(3):199–207.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Columbia University Medical Center, New York – Presbyterian Hospital Allen HospitalNew YorkUSA
  2. 2.Division of Behavioral Health Services and Policy Research and Center for Practice InnovationsColumbia University Medical Center, New York State Psychiatric InstituteNew YorkUSA

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