Treatment adherence in schizophrenia: a literature review

Abstract

Abstract: Introduction: Evaluating adherence to treatment with antipsychotic agents in patients with schizophrenia is a challenge for any psychiatric doctor, given its inherent subjectivity. Despite this, nonadherence to treatment is prejudicial to the clinical course of the disease, resulting in a greater risk of acute exacerbations of illness and hospital admissions. The aim of this study is to review the current literature on factors that influence adherence to antipsychotic treatment in patients with schizophrenia. Methods: The literature, written in English between 2006 and 2016 and available in full in PubMed/MEDLINE, evaluating potential risk factors for treatment compliance in adult patients (over 18 years of age) with schizophrenia, was reviewed by searching on the keywords: adherence, nonadherence, compliance, noncompliance, schizophrenia, psychosis, antipsychotic, neuroleptic. Results: Thirty-nine studies were included in the final review. The average level of treatment adherence was 32%. The following risk factors for nonadherence to treatment were identified: young age, substance abuse, psychotic psychopathology present, absence of insight into the disorder and the need for treatment, negative attitudes to treatment, poor doctor-patient relationship and lack of social and family support. Conclusions: Interventions aimed at improving treatment adherence must be individualised for each patient, on the basis of a full clinical history, so that all the individual aspects contributing to this variable can be appropriately assessed.