Why do psychiatric patients stop antipsychotic medication? A systematic review of reasons for nonadherence to medication in patients with serious mental illness
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BACKGROUND: Antipsychotic medication reduces the severity of serious mental illness (SMI) and improves patient outcomes only when medicines were taken as prescribed. Nonadherence to the treatment of SMI increases the risk of relapse and hospitalization and reduces the quality of life. It is necessary to understand the factors influencing nonadherence to medication in order to identify appropriate interventions. This systematic review assessed the published evidence on modifiable reasons for nonadherence to antipsychotic medication in patients with SMI. METHODS: Articles published between January 1, 2005, and September 10, 2015, were searched on MEDLINE through PubMed. Abstracts were independently screened by 2 randomly assigned authors for inclusion, and disagreement was resolved by another author. Selected full-text articles were divided among all authors for review. RESULTS: A qualitative analysis of data from 36 articles identified 11 categories of reasons for nonadherence. Poor insight was identified as a reason for nonadherence in 55.6% (20/36) of studies, followed by substance abuse (36.1%, 13/36), a negative attitude toward medication (30.5%, 11/36), medication side effects (27.8%, 10/36), and cognitive impairments (13.4%, 7/36). A key reason directly associated with intentional nonadherence was a negative attitude toward medication, a mediator of effects of insight and therapeutic alliance. Substance abuse was the only reason consistently associated with unintentional nonadherence, regardless of type and stage of SMI. DISCUSSION: Although adherence research is inherently biased because of numerous methodological limitations and specific reasons under investigation, reasons for nonadherence consistently identified as significant across studies likely reflect valid existing associations with important clinical implications. CONCLUSION: This systematic review suggests that a negative attitude toward medication and substance abuse are consistent reasons for nonadherence to antipsychotic medication among people with SMI. Adherence enhancement approaches that specifically target these reasons may improve adherence in a high-risk group. However, it is also important to identify drivers of poor adherence specific to each patient in selecting and implementing intervention strategies.
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A systematic review revealed a significant correlation between attitude towards medication, insight into illness, and non-adherence in psychiatric patients, regardless of diagnosis and stage of disease.
“A systematic review revealed a significant correlation between attitude towards medication, insight into illness, and non-adherence in psychiatric patients, regardless of diagnosis and stage of disease [37].”
From Patients’ perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors (2021) · cites this paper as [37]
A negative attitude towards medication does not represent a symptom of psychotic disorders.
“This confirms the assumption that a negative attitude towards medication does not represent a symptom of psychotic disorders.”
From Patients’ perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors (2021) · cites this paper as [37]
Poor insight is a predictor of poor adherence in most studies.
“A summary of the literature published between 2005 and 2015 found that poor insight was a predictor of poor adherence in 20 of 26 studies reviewed 36 .”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [36]
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- Authors
- Velligan, D. I., Sajatovic, M., Hatch, A., Kramata, P., & Docherty, J.
- Affiliations
- The University of Texas at San Antonio Health Science Center (US)
- Case Western Reserve University (US)
- Ohio Department of Health (US)
- Corresponding author
- Velligan, Dawn I
- Venue
- Patient Preference and Adherence
- Publisher
- Informa UK Limited
- Published
- 2017-03
- Volume
- Volume 11
- Pages
- 449-468
- ISSN
- 1177-889X (ISSN-L)
- PMC
- PMC5344423
- OpenAlex
- W2594212608
- Cited by
- 333
- References
- 77
- Citations by year
- 2026: 28 · 2025: 32 · 2024: 41 · 2023: 45 · 2022: 39 · 2021: 48 · 2020: 45 · 2019: 31 · 2018: 17 · 2017: 7
- FWCI
- 4.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Patient Preference and Adherence (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Scholarly Commons @ Case Western Reserve University (submittedVersion, cc-by-nc)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Funders
- Otsuka America Pharmaceutical
- Otsuka America
- Otsuka Pharmaceutical
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- antipsychotic drugs, medication non-adherence, severe mental illness, reasons for non-adherence, lack of insight, substance abuse, adverse drug reactions, cognitive impairment, intentional non-adherence, unintentional non-adherence, therapeutic relationship
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