Partial adherence to antipsychotic medication impacts the course of illness in patients with schizophrenia: a review.

OBJECTIVE: Although many clinicians acknowledge the occurrence of adherence problems with medication regimens among patients with schizophrenia, the problem shows no sign of improving. This may be because, in thinking about the issue, clinicians have tended to focus on patients who openly refuse or repeatedly discontinue treatment. While this description applies to only a minority of patients, in our experience, full adherence is rare; most patients are only partially adherent at best. This article examines the issue of adherence behavior in schizophrenia, focusing on the impact of partial adherence on treatment outcomes, particularly early in the course of illness. We also review potential strategies for managing the problem. DATA SOURCES: Original research and review articles published in English from 1980 to 2008 were identified using the PubMed database, with the search terms schizophrenia or psychosis combined with compliance, noncompliance, partial compliance, adherence, nonadherence, or partial adherence. STUDY SELECTION: Articles were selected by the authors on the basis of the hypotheses and/or data described. DATA SYNTHESIS: Failure to adhere to medication as prescribed can have a major impact on the course of illness and treatment outcomes in patients with schizophrenia. Even relatively short gaps in medication coverage increase the risk of relapse. Problems with adherence are common early in the course of illness, when the consequences of relapse can be particularly devastating.
CONCLUSION: Clinicians in primary care and psychiatric settings need to be vigilant for signs of adherence problems among their patients and to act when necessary to prevent or alleviate the consequences of inadequate medication cover. Relapse prevention strategies, particularly for patients with early psychosis, should include ensuring that medication lapses are minimized or eliminated.