Improving Medication Adherence in Schizophrenia: Research Insight

Schizophrenia is a debilitating mental disorder that affects millions of people worldwide. Antipsychotic medication is the primary treatment for schizophrenia, but nonadherence to medication is a significant problem. The rate of nonadherence to antipsychotics is estimated to be around 50%. Nonadherence can lead to relapse, rehospitalization, high treatment costs, and adverse events.

Several studies and reviews report that patients with a low degree of illness awareness and insight into their illness are more likely to show poor adherence to treatment. Conversely, patient and carer awareness and education can result in improved treatment adherence. Optimization of medication and involvement of caregivers are important to promoting adherence.

Ensuring that treatment is effective and that side effects are managed is a key factor in improving adherence. Another factor influencing adherence is the route of administration. The use of long-acting injectables (LAIs) medication has shown to be effective in preventing nonadherence in studies with a follow-up of 1–7 years. Also, the one-year discontinuation rate for patients using slow-release medication was significantly reduced, compared to the relapse rate of patients receiving oral medication.

Care continuity, such as treatment and discharge planning and follow-up (contact) by health care professionals (HCPs), is positively associated with adherence. Multidimensional treatment is needed to support patient adherence and outcomes. Assertive community treatment (ACT) is one such initiative that has shown promising results. In a study of 763 patients with schizophrenia, patients enrolled in an ACT program were more than twice as likely to have good medication adherence compared with those who did not enroll. Furthermore, evidence suggests that social workers and nurses have an important role to play in identifying and addressing barriers to adherence as part of a treatment-team framework.

Social support, particularly from family or friends in assisting with medication taking, as well as stability of living conditions, has shown to result in better adherence.

Improving medication adherence in schizophrenia requires a multifaceted approach. It involves optimizing medication, educating patients and caregivers, and ensuring care continuity, shared decision-making and HCP and multidisciplinary care and support. However, these would need to be adapted for patient and health-system specific situations and sustainability. By addressing these factors, we can improve adherence and the quality of life for patients with schizophrenia and reduce the burden on society.

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