Non-adherence to medication in patients with psychotic disorders: epidemiology, contributing factors and management strategies
Open accessAbstract
Although non-adherence is common across all branches of medicine, psychotic disorders pose additional challenges that increase its risk. Despite the importance of non-adherence, clinicians generally spend too little time on assessing and addressing adherence attitudes and behaviors. Importantly, how adherence is measured significantly impacts the findings, and the most frequently employed methods of asking patients or judging adherence indirectly based on efficacy or tolerability information have poor validity. Novel technologies are being developed that directly assess adherence and that can also be used to both provide real-time feedback to clinicians and serve as an intervention with patients. Several treatments are available that can positively impact adherence. Among psychosocial interventions, those combining multiple approaches and involving multiple domains seem to be most effective. Although long-acting injectable antipsychotics are theoretically a very powerful tool to assure adherence and signal non-adherence, recent results from randomized controlled trials failed to show superiority compared to oral antipsychotics. These data are in contrast to nationwide cohort studies and mirror-image studies, which arguably include more representative patients receiving long-acting antipsychotics in clinical practice. This disconnect suggests that traditional randomized controlled trials are not necessarily the best way to study interventions that are thought to work via reducing non-adherence. Clearly, non-adherence is likely to remain a major public health problem despite treatment advances. However, increasing knowledge about factors affecting adherence and leveraging novel technologies can enhance its early assessment and adequate management, particularly in patients with psychotic disorders.
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Patients with schizophrenia often have poor adherence to oral antipsychotics, and high relapse rates pose challenges to both patients and clinicians in the management of the disease.
“Patients with schizophrenia often have poor adherence to oral antipsychotics, and high relapse rates pose challenges to both patients and clinicians in the management of the disease [94–97].”
From Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview (2021) · cites this paper as [97]
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Sajatovic, M., Ross, R., Legacy, S. N., Correll, C. U., Kane, J. M., DiBiasi, F., Fitzgerald, H., & Byerly, M. (2018) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s167394 · Cited by 44 · see citing works
Self-citationBossie, C. A., Alphs, L. D., & Correll, C. U. (2015) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000082 · Cited by 33 · see citing works
Self-citationIbrahim, W, A., Pindar, K, S., Yerima, M, M., Rabbebe, B, I., Shehu, S, et al. (2015) · Journal of Neuroscience and Behavioral Health · doi:10.5897/jnbh2015.0128 · Cited by 20 · see citing works
Widschwendter, C. G., Kemmler, G., Rettenbacher, M. A., Yalcin-Siedentopf, N., & Hofer, A. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1791-y · Cited by 18 · see citing works
The pharmacological treatment of schizophrenia: how far have we come?
Rubio, J. M., & Kane, J. M. (2022) · Psychiatry and Clinical Neurosciences Reports · doi:10.1002/pcn5.13 · Cited by 13 · see citing works
“66 Circumstances that increase the risk for nonadherence in schizophrenia are being at an earlier phase of treatment, 67,68 comorbid substance use, 69 social exclusion (i.e., homelessness), and high side effect burden.”
BackgroundMethodInfluentialZolnoori, M., Fung, K. W., Fontelo, P., Kharrazi, H., Faiola, A., Wu, Y. S. S., Stoffel, V., & Patrick, T. (2018) · JMIR Mental Health · doi:10.2196/10726 · Cited by 11 · see citing works
Intentional non-adherence to antipsychotic medication in patients with schizophrenia
Yaegashi, H., Haga, M., Misawa, F., Mizuno, Y., Suzuki, T., & Takeuchi, H. (2024) · Schizophrenia Research · doi:10.1016/j.schres.2024.10.018 · Cited by 1 · see citing works
- Authors
- Kane, J. M., Kishimoto, T., & Correll, C. U.
- Affiliations
- Albert Einstein College of Medicine (US)
- Northwell Health (US)
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2013-10
- Volume
- 12
- Issue
- 3
- Pages
- 216-226
- ISSN
- 1723-8617 (ISSN-L)
- PMC
- PMC3799245
- OpenAlex
- W2092173202
- Cited by
- 520
- References
- 75
- Citations by year
- 2026: 38 · 2025: 51 · 2024: 48 · 2023: 35 · 2022: 48 · 2021: 64 · 2020: 35 · 2019: 54 · 2018: 41 · 2017: 30 · 2016: 35 · 2015: 23 · 2014: 15 · 2013: 1 · 2012: 1
- FWCI
- 20.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (P30MH090590)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Keywords
- medication non-adherence, psychosis, schizophrenia, long-acting injectable antipsychotics, adherence measurement, psychosocial interventions
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