Prevalence of and Risk Factors for Medication Nonadherence in Patients With Schizophrenia: A Comprehensive Review of Recent Literature
Abstract
OBJECTIVE: Nonadherence to prescribed antipsychotic medications places patients with schizophrenia at a greatly increased risk of illness exacerbation and rehospitalization. Identification of risk factors for nonadherence is an initial step toward designing effective interventions. This article reviews recent literature on the prevalence of and risk factors for medication nonadherence in patients with schizophrenia. DATA SOURCES: We searched the MEDLINE/HealthSTAR and PsycINFO databases using combinations of the keywords risk factor(s), adherence, compliance, antipsychotic, neuroleptic, schizophrenia, and psychosis for articles published since 1980 that identified risk factors for medication nonadherence in schizophrenia patients. We included reports that (1) were published in English and (2) specifically examined risk factors for medication nonadherence. Thirty-nine articles met our selection criteria. DATA SYNTHESIS: Among the 10 reports that met a strict set of study inclusion criteria, we found a mean rate of nonadherence of 41.2%; the 5 reports that met a stricter set of inclusion criteria had a mean nonadherence rate of 49.5%. In the 39 articles reviewed, factors most consistently associated with nonadherence included poor insight, negative attitude or subjective response toward medication, previous nonadherence, substance abuse, shorter illness duration, inadequate discharge planning or aftercare environment, and poorer therapeutic alliance. Findings regarding an association between adherence and medication type were inconclusive, although few studies explored this relationship. Other factors such as age, gender, ethnicity, marital status, education level, neurocognitive impairment, severity of psychotic symptoms, severity of medication side effects, higher antipsychotic dose, presence of mood symptoms, route of medication administration, and family involvement were not found to be consistent predictors of nonadherence. Limitations of the published literature are discussed. CONCLUSION: Efforts to improve medication adherence in patients with schizophrenia should target relevant risk factors.
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Disruption of treatment coverage has been associated with symptom relapse and increased risk of hospitalization.
“Disruption of treatment coverage has been associated with symptom relapse and increased risk of hospitalization [5–7].”
From Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview (2021) · cites this paper as [6]
Medication non-adherence is consistently associated with patients' behavioral practices (e.g., substance abuse) and patients' socio-demographic characteristics (such as educational status, age, gender, and employment).
“Similarly, medication non-adherence is consistently associated with patients behavioral practices (e.g., substance abuse) [14, 74] and also patients’ socio-demographic characteristics (such as educational status, age, gender, and employment) [14, 72].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [14]
In the present systematic review, medication non-adherence is associated with poor functioning of the health system (including lack of psychotherapy, lack of information, long treatment duration with little health personnel follow-up, inadequate discharge planning, increased hospitalizations, poor support and care environment, access barriers to high-quality care, health care providers unable to提供
“In the present systematic review, medication non-adherence is associated with poor functioning of the health system such as lack of psychotherapy, lack of information, long treatment duration with little health personnel follow-up, inadequate discharge planning, increased hospitalizations, poor support and care environment, experiencing access barriers to high-quality care and health care”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [14]
This systematic review of factors influencing psychotropic medication non-adherence, consistent with other systematic reviews, has shown that medication adherence is mainly affected by patients' negative attitude toward their medication, lack of insight, negative health belief, and perceived stigma.
“This systematic review of factors influencing psychotropic medication non-adherence which is consistent with other systematic reviews [14, 72, 73, 77] has shown that medication adherence is mainly affected by patients’ negative attitude toward their medication, lack of insight, negative health belief, and perceived stigma.”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [14]
The present systematic review and meta-analysis finding is consistent with a finding from a comprehensive systematic review on schizophrenia which reported that a mean rate of non-adherence was 41.2%.
“The present systematic review and meta-analysis finding is consistent with a finding from a comprehensive systematic review on schizophrenia which reported that a mean rate of non-adherence was 41.2%.”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [14]
Medication non-adherence is associated with clinical- or medication-related factors.
“In addition, medication non-adherence is associated with clinical- or medication-related factors [14, 72–74, 77].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [14]
A sub-group analysis indicated that a mean non-adherence rate was 49.5%.
“The sub-group analysis indicated that a mean non-adherence rate was 49.5% [14]”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [14]
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“Coexisting alcohol dependence and substance abuse are common among patients with schizophrenia and, in agreement with previous studies (Owen et al., 1996; Kamali et al., 2001; Hunt et al., 2002; Lacro et al., 2002; Ascher-Svanum et al., 2006b), are associated with medication non-adherence.”
BackgroundResultSubstance Abuse and Psychiatric Disorders in HIV-Positive Patients
Chander, G., Himelhoch, S. S., & Moore, R. D. (2006) · Drugs · doi:10.2165/00003495-200666060-00004 · Cited by 376 · see citing works
Kishimoto, T., Hagi, K., Kurokawa, S., Kane, J. M., & Correll, C. U. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00039-0 · Cited by 369 · see citing works
Adherence to Antipsychotic Medication in Bipolar Disorder and Schizophrenic Patients
García, S., Martínez‐Cengotitabengoa, M., López-Zurbano, S., Zorrilla, E. P., López‐Mahía, P., Vieta, E., & González-Pinto, A. M. (2016) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000000523 · Cited by 363 · see citing works
“Regarding modifiable factors, a psychological model has been proposed, the Health Belief Model, which aims to explain and predict health behaviors, focusing on attitudes and beliefs of individuals that may have an influence on adherence.(16) This model indicates 2 behaviors that play a very important role in medicatio…”
Barnes, T. R. E. (2011) · Journal of Psychopharmacology · doi:10.1177/0269881110391123 · Cited by 357 · see citing works
“…and aversive subjective side effects, is particularly important at this stage given that they can be a short-term disincentive for medication adherence and have an impact on attitudes to drug treatment and mental health care over the longer term (Perkins et al., 2008; Robinson et al., 2002).”
BackgroundMethodHow often do patients with psychosis fail to adhere to treatment programmes? A systematic review
Nosè, M., Barbui, C., & Tansella, M. (2003) · Psychological Medicine · doi:10.1017/s0033291703008328 · Cited by 353 · see citing works
“This finding was lower than figures quoted in other studies (Fenton et al. 1997; Cramer &Rosenheck, 1998; Kampaman & Lehtine, 1999; Oehl et al. 2000; Lacro et al. 2002).”
ResultDiBonaventura, M., Gabriel, S., Dupclay, L., Gupta, S., & Kim, E. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-20 · Cited by 333 · see citing works
“Prior evidence has suggested that longer illness duration is associated with greater adherence [30]; therefore, age may be serving as a proxy for years diagnosed.”
BackgroundFalkai, P., Wobrock, T., Lieberman, J. A., Glenthoj, B. Y., Gattaz, W. F., Möller, H., & WFSBP Task Force on Treatment Guide (2006) · The World Journal of Biological Psychiatry · doi:10.1080/15622970500483177 · Cited by 331 · see citing works
Velligan, D. I., Sajatovic, M., Hatch, A., Kramata, P., & Docherty, J. (2017) · Patient Preference and Adherence · doi:10.2147/ppa.s124658 · Cited by 333 · see citing works
“Thirteen studies analyzed the relationship between substance abuse and adherence: 6 were prospective, 7 were cross-sectional, and all demonstrated a significant association.”
Medication Adherence: A Review of the Literature and Implications for Clinical Practice
Julius, R. J., Novitsky, M. A., & Dubin, W. R. (2009) · Journal of Psychiatric Practice · doi:10.1097/01.pra.0000344917.43780.77 · Cited by 301 · see citing works
Hallucinations: The science of idiosyncratic perception.
Aleman, A., & Larøi, F. (2008) · American Psychological Association eBooks · doi:10.1037/11751-000 · Cited by 283 · see citing works
Falkai, P., Wobrock, T., Lieberman, J. A., Glenthoj, B. Y., Gattaz, W. F., Möller, H., & WFSBP Task Force on Treatment Guide (2005) · The World Journal of Biological Psychiatry · doi:10.1080/15622970510030090 · Cited by 269 · see citing works
“…antipsychotic treatment, unemployment, homelessness, violence, incarceration, suicide and HIV infection (e.g., Mueser et al. 1990; Olivera et al. 1990; Soyka et al. 1993; Linszen et al. 1994; Blanchard et al. 2000; Mueser et al. 2000; Goldham et al. 2002; Hunt et al. 2002; Lacro et al. 2002).”
BackgroundLambert, M., Conus, P., Eide, P., Mass, R., Karow, A., Moritz, S., Golks, D., & Naber, D. (2004) · European Psychiatry · doi:10.1016/j.eurpsy.2004.06.031 · Cited by 268 · see citing works
“[30] cite several factors that have been variously linked with adherence to medication.”
BackgroundResultWhat’s in a name? Compliance, adherence and concordance in chronic psychiatric disorders
Chakrabarti, S. (2014) · World Journal of Psychiatry · doi:10.5498/wjp.v4.i2.30 · Cited by 257 · see citing works
Paliperidone for schizophrenia
Dolder, C. R., Nelson, M., & Deyo, Z. M. (2008) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp070261 · Cited by 254 · see citing works
Self-citationMorrison, A. P., Turkington, D., Pyle, M., Spencer, H. M., Brabban, A., Dunn, G., Christodoulides, T., Dudley, R. E. J., Chapman, N., Callcott, P., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(13)62246-1 · Cited by 250 · see citing works
Sendt, K.-V., Tracy, D. K., & Bhattacharyya, S. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2014.11.002 · Cited by 245 · see citing works
“Interestingly, even antipsychotic-induced side effects do not appear to reliably predict whether patients continue taking medication as prescribed (Lacro et al., 2002; Robinson et al., 2002; Fleischhacker et al., 2003; Marder, 2003; Perkins et al., 2008).”
BackgroundResultInfluentialKaul, I., Sawchak, S. T., Correll, C. U., Kakar, R., Breier, A. F., Zhu, H., Miller, A., Paul, S. M., & Brannan, S. K. (2023) · The Lancet · doi:10.1016/s0140-6736(23)02190-6 · Cited by 255 · see citing works
Interventions to Improve Antipsychotic Medication Adherence: Review of Recent Literature
Dolder, C. R., Lacro, J. P., Leckband, S. G., & Jeste, D. V. (2003) · Journal of Clinical Psychopharmacology · doi:10.1097/01.jcp.0000085413.08426.41 · Cited by 236 · see citing works
“Modifiable factors consistently associated with nonadherence to antipsychotic medications should be considered targets for interventions.(5,6) In this paper, we review the interventions used to enhance antipsychotic adherence in chronic schizophrenia patients.”
BackgroundSelf-citationByerly, M., Nakonezny, P. A., & Rush, A. J. (2008) · Schizophrenia Research · doi:10.1016/j.schres.2007.12.470 · Cited by 229 · see citing works
“The b70% EM adherence cutoff was selected because it was both conservative in detecting nonadherence and consistent with definitions from prior published research (Lacro et al., 2002).”
Staring, A., van der Gaag, M., van den Berge, M., Duivenvoorden, H., & Mulder, C. (2009) · Schizophrenia Research · doi:10.1016/j.schres.2009.06.015 · Cited by 242 · see citing works
“…insight into illness is associatedwith fewer symptoms, better psychosocial functioning, and better compliance with antipsychotic medication (Francis and Penn, 2001; Kozuki et al., 2005; Lacro et al. 2002; Lysaker et al., 1998, 2002; Mohamed et al., 2009; Perkins 2002; Rittmannsberger et al. 2004).”
Tolerability and adherence issues in antidepressant therapy
Masand, P. S. (2003) · Clinical Therapeutics · doi:10.1016/s0149-2918(03)80220-5 · Cited by 215 · see citing works
Medication adherence in schizophrenia
Acosta, F. J. (2012) · World Journal of Psychiatry · doi:10.5498/wjp.v2.i5.74 · Cited by 215 · see citing works
Lecomte, T., Spidel, A. L., LECLERC, C., MacEwan, G. W., GREAVES, C., & Bentall, R. P. (2008) · Schizophrenia Research · doi:10.1016/j.schres.2008.01.024 · Cited by 212 · see citing works
“Other results such as the fact that more men and more individuals who had had trouble with the law did not adhere to medication or had poor engagement, have been found in other studies, though not systematically (Lacro et al., 2002).”
ResultCorrell, C. U., Kim, E., Sliwa, J. K., Hamm, W., Gopal, S., Mathews, M., Venkatasubramanian, R., & Saklad, S. R. (2021) · CNS Drugs · doi:10.1007/s40263-020-00779-5 · Cited by 205 · see citing works
Carroll, C. L., Feldman, S. R., CAMACHO, F. T., Manuel, J. C., & Balkrishnan, R. (2004) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2004.01.052 · Cited by 195 · see citing works
Adherence therapy for people with schizophrenia
Gray, R. J., Leese, M., Bindman, J. P., Becker, T. M., Burti, L., David, A. S., Gournay, K., Kikkert, M., Koeter, M. W. J., Puschner, B., et al. (2006) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.105.019489 · Cited by 194 · see citing works
Llorca, P. M., Abbar, M., Courtet, P., Guillaume, S., Lancrenon, S., & Samalin, L. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-340 · Cited by 188 · see citing works
“For example, the majority of patients with schizophrenia (84%) discontinue their index antipsychotic during the follow-up period [2] and in the long-term perspective, 40 to 50% seem to be noncompliant [3], with no real difference in terms of adherence between first-generation antipsychotics (FGA) and second-generation…”
BackgroundConley, R. R., Gupta, S., & Sathyan, G. (2006) · Current Medical Research and Opinion · doi:10.1185/030079906x132613 · Cited by 188 · see citing works
CLINICAL PRACTICE GUIDELINES Treatment of Schizophrenia
Paris, J., Bland, R. C., Goldbloom, D. S., Grof, P., LESAGE, A. D., Streiner, D. L., Addington, D. E., Arboleda‐Flórez, J., Benkelfat, C., Bond, M., et al. (2005) · Cited by 184 · see citing works
Barkhof, E., Meijer, C. J., de Sonneville, L. M. J., Linszen, D. H., & de Haan, L. (2012) · European Psychiatry · doi:10.1016/j.eurpsy.2011.02.005 · Cited by 183 · see citing works
“Also, general beliefs and attitudes towards health and taking medication, based on previous experiences, cultural factors and socioeconomic status, are associated with adherence [56].”
BackgroundResultInfluentialJeste, S., Patterson, T. L., Palmer, B. W., Dolder, C. R., Goldman, S., & Jeste, D. V. (2002) · Schizophrenia Research · doi:10.1016/s0920-9964(02)00314-6 · Cited by 183 · see citing works
Self-citationByerly, M., Fisher, R., Whatley, K., Holland, R., Varghese, F. P., Carmody, T. J., Magouirk, B., & Rush, A. J. (2005) · Psychiatry Research · doi:10.1016/j.psychres.2004.11.002 · Cited by 181 · see citing works
“Thus, we chose to reduce the most conservative definition of non-adherence reported in a recent extensive review of antipsychotic non-adherence in schizophrenia (a threshold of V75% of prescribed antipsychotic) (Lacro et al., 2002).”
MethodAntipsychotic Medication Adherence in Schizophrenia
Byerly, M., Nakonezny, P. A., & Lescouflair, E. (2007) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2007.04.002 · Cited by 177 · see citing works
Lack of Insight in Schizophrenia
Buckley, P. F., Wirshing, D. A., Bhushan, P., Pierre, J. M., Resnick, S. A., & Wirshing, W. C. (2007) · CNS Drugs · doi:10.2165/00023210-200721020-00004 · Cited by 171 · see citing works
Duration of Adjuvant Chemotherapy for Colon Cancer and Survival Among the Elderly
Neugut, A. I., Matasar, M. J., Wang, X., McBride, R. B., Jacobson, J. S., Tsai, W., Grann, V. R., & Hershman, D. L. (2006) · Journal of Clinical Oncology · doi:10.1200/jco.2005.04.5005 · Cited by 171 · see citing works
Rief, W., Avorn, J., & Barsky, A. J. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.2.155 · Cited by 167 · see citing works
“Compared with clinical practice, clinical trials might include patients with higher motivation to tolerate adverse effects and with more optimistic drug attitudes; these patients are likely to report fewer adverse effects and discontinue use of medication less frequently than patients in clinical practice.(52)”
Medication Adherence in Schizophrenia: Exploring Patients', Carers' and Professionals' Views
Kikkert, M. J., Schene, A. H., Koeter, M. W. J., Robson, D., Born, A., Helm, H., Nose, M., Goss, C., Thornicroft, G., & Gray, R. J. (2005) · Schizophrenia Bulletin · doi:10.1093/schbul/sbl011 · Cited by 164 · see citing works
Pan, P., Lee, M., & Yeh, C. (2015) · BMC Psychiatry · doi:10.1186/s12888-014-0378-5 · Cited by 159 · see citing works
“However, it is common for patients with schizophrenia to have low adherence to antipsychotics [8-10] and it had been reported that almost half of schizophrenic patients took less than 70% of the expected prescribed doses [11].”
BackgroundMedication nonadherence: health impact, prevalence, correlates and interventions
Stewart, S.-J., Moon, Z., & Horne, R. (2022) · Psychology and Health · doi:10.1080/08870446.2022.2144923 · Cited by 180 · see citing works
“…of a medicine in terms of symptom relief is related to adherence (Costello et al., 2008; Croome et al., 2017; Kardas et al., 2013; Munro et al., 2007; van der laan et al., 2017; Weiner et al., 2008), but this is not consistent across studies (lacro et al., 2002; olthoff et al., 2005).”
BackgroundResultMojtabai, R., Fochtmann, L. J., Chang, S.-W., Kotov, R., Craig, T., & Bromet, E. J. (2009) · Schizophrenia Bulletin · doi:10.1093/schbul/sbp045 · Cited by 159 · see citing works
“A large number of clinical studies have specifically examined the impact of clinical and sociodemographic characteristics on treatment patterns in general and on adherence with medication treatments in particular.(68,69)”
BackgroundLiu‐Seifert, H., Adams, D. H., & Kinon, B. J. (2005) · BMC Medicine · doi:10.1186/1741-7015-3-21 · Cited by 153 · see citing works
Predictors of medication adherence in patients with schizophrenia and bipolar disorder
Jónsdóttir, H., Opjordsmoen, S., Birkenaes, A. B., Simonsen, C., Engh, J. A., Ringen, P. A., Vaskinn, A., Friis, S., Sundet, K. S., & Andreassen, O. A. (2012) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2012.01911.x · Cited by 152 · see citing works
“This finding is in line with earlier results in schizophrenia (7), even though some have found an association between lower adherence and psychotic symptoms (77), or depressive symptoms (34).”
BackgroundMethodResultInfluentialBrain delivery of olanzapine by intranasal administration of transfersomal vesicles
Ha, S., Mahmoud, A. A. K., Kamel, A. O., Hady, M. A., & Awad, G. A. S. (2012) · Journal of Liposome Research · doi:10.3109/08982104.2012.700460 · Cited by 151 · see citing works
“Olanzapine has five times the affinity for 5-HT2 receptors than for D2 receptors, resulting in fewer extrapyramidal side effects (Lacro et al., 2002) and minimal perturbation of prolactin levels (Callaghan et al., 1999).”
BackgroundMasand, P. S., Roca, M., Turner, M. S., & Kane, J. M. (2009) · The Primary Care Companion to The Journal of Clinical Psychiatry · doi:10.4088/pcc.08r00612 · Cited by 151 · see citing works
“Based on a review of 39 studies, however, Lacro et al.(24) found no association between adherence and either age or gender.”
MethodSeale, C. F., Chaplin, R., Lelliott, P. T., & Quirk, A. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.11.002 · Cited by 148 · see citing works
Clinical guideline recommendations for antipsychotic long-acting injections
Kane, J. M., & García-Ribera, C. (2009) · The British Journal of Psychiatry · doi:10.1192/bjp.195.52.s63 · Cited by 147 · see citing works
Hasan, A., Falkai, P., Wobrock, T., Lieberman, J. A., Glenthoj, B. Y., Gattaz, W. F., Thibaut, F., Möller, H., & on behalf of the WFSBP Task Force on Treatment Guidelines for Schizophrenia (2015) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2015.1009163 · Cited by 146 · see citing works
“…non-complicance, elevated rates of motor side-effects in general and during antipsychotic treatment, unemployment, homelessness, violence, incarceration, suicide and HIV infection (Mueser et al. 1990; Soyka et al. 1993; Drake et al. 2001; Hunt et al. 2002; Lacro et al. 2002; Wobrock et al. 2008).”
BackgroundOlivares, J. M., Rodriguez-Morales, A., Diels, J., Povey, M., Jacobs, A., Zhao, Z., & Lam, A. (2009) · European Psychiatry · doi:10.1016/j.eurpsy.2008.12.002 · Cited by 141 · see citing works
“A number of studies have associated low patient insight with poor medication compliance [19,20].”
BackgroundMontes, J. M. G., Medina, E., Gómez-Beneyto, M., & Mauriño, J. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.07.034 · Cited by 140 · see citing works
“Some known factors consistently associated with a lack of adherence were found to be associated with a lesser improvement with the intervention: larger numbers of hospitalisations, previous need for hospitalisation or worse previous adherence (Lacro et al., 2002).”
BackgroundSelf-disorders and Schizophrenia: A Phenomenological Reappraisal of Poor Insight and Noncompliance
Henriksen, M. G., & Parnas, J. (2013) · Schizophrenia Bulletin · doi:10.1093/schbul/sbt087 · Cited by 143 · see citing works
Yang, J.-W., Ko, Y., Paik, J., Lee, M., Han, C., Joe, S.-H., Jung, I., Jung, H.-G., & Kim, S. (2011) · Schizophrenia Research · doi:10.1016/j.schres.2011.11.008 · Cited by 138 · see citing works
“Lacro et al. (2002) reported that age, gender, marital status, education, neurocognitive impairment, dose of medication, or mood symptoms were not associated with non-adherence.”
InfluentialInsight and medication adherence in schizophrenia: An analysis of the CATIE trial
Kim, J., Ozzoude, M., Nakajima, S., Shah, P., Caravaggio, F., Iwata, Y., Luca, V. D., Graff‐Guerrero, A., & Gerretsen, P. (2019) · Neuropharmacology · doi:10.1016/j.neuropharm.2019.05.011 · Cited by 138 · see citing works
The Therapeutic Relationship and Adherence to Antipsychotic Medication in Schizophrenia
McCabe, R., Bullenkamp, J., Hansson, L. I., Lauber, C., Martínez‐Leal, R., Wulf Rössler, A., Salize, H. J., Svensson, B., Torres‐González, F., van den Brink, R., et al. (2012) · PLoS ONE · doi:10.1371/journal.pone.0036080 · Cited by 136 · see citing works
Medication adherence and its determinants in patients after myocardial infarction
Pietrzykowski, Ł., Michalski, P., Kosobucka, A., Kasprzak, M., Fabiszak, T., Stolarek, W., Siller-Matula, J. M., & Kubica, A. (2020) · Scientific Reports · doi:10.1038/s41598-020-68915-1 · Cited by 136 · see citing works
Byerly, M., Thompson, A. K., Carmody, T. J., Bugno, R., Erwin, T., Kashner, M. T., & Rush, A. J. (2007) · Psychiatric Services · doi:10.1176/ps.2007.58.6.844 · Cited by 134 · see citing works
Tsang, H. W. H., Ching, S., Tang, K. H., Lam, H., Law, P. Y. Y., & Wan, C. N. (2016) · Schizophrenia Research · doi:10.1016/j.schres.2016.02.013 · Cited by 129 · see citing works
“Unfortunately, poorer treatment adherence was related to poorer treatment outcomes, more re-hospitalization, and increased health costs (Lacro et al., 2002).”
BackgroundNon-adherence with psychotropic medications in the general population
Bulloch, A. G. M., & Patten, S. B. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-009-0041-5 · Cited by 129 · see citing works
Relating Therapy for distressing auditory hallucinations: A pilot randomized controlled trial
Hayward, M., Jones, A.-M., Bogen-Johnston, L., Thomas, N., & Strauss, C. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2016.11.019 · Cited by 128 · see citing works
“Despite evidence for its benefits, antipsychotic medication is often not fully effective, and 40–50% of patients are nonadherent (Lacro et al., 2002).”
Beck, E., Cavelti, M., Kvrgic, S., Kleim, B., & Vauth, R. (2011) · Schizophrenia Research · doi:10.1016/j.schres.2011.07.019 · Cited by 125 · see citing works
“However, it seems to be the rule rather than the exception (Lacro et al., 2002; Nose et al., 2003; Velligan et al., 2010).”
Medication Adherence in Outpatients With Severe Mental Disorders
Jónsdóttir, H., Opjordsmoen, S., Birkenaes, A. B., Engh, J. A., Ringen, P. A., Vaskinn, A., Aamo, T. O., Friis, S., & Andreassen, O. A. (2010) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e3181d2191e · Cited by 122 · see citing works
“Rates of nonadherence to antipsychotics in schizophrenia patients have been reported in the range from 11% to 89%,(4,5) and a recent review found a mean rate of 41% (range, 20%Y56%).(6) In bipolar disorder, adherence to long-term prophylactic pharmacotherapy ranges from 20% to 66%,(7) and the importance of improving a…”
BackgroundResultRelational Agents in Clinical Psychiatry
Bickmore, T., & Gruber, A. (2010) · Harvard Review of Psychiatry · doi:10.3109/10673221003707538 · Cited by 112 · see citing works
Acosta, F. J., Bosch, E., Sarmiento, G., Juanes, N., Caballero-Hidalgo, A., & Mayans, T. (2008) · Schizophrenia Research · doi:10.1016/j.schres.2008.09.007 · Cited by 119 · see citing works
“To date, the main risk factors for noncompliance include: previous noncompliance (Lacro et al., 2002; Ascher-Svanum et al., 2006), poor insight, negative attitudes or subjective responses to medication, substance abuse and poor therapeutic alliance (Lacro et al.”
BackgroundResultInfluentialJónsdóttir, H., Friis, S., Horne, R., Pettersen, K. I., Reikvam, A., & Andreassen, O. A. (2008) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2008.01279.x · Cited by 118 · see citing works
“Adherence has been related to a range of factors, among them insight into illness and into symptoms (2, 3, 5, 22).”
BackgroundMoreno-Pino, F., Porras-Segovia, A., López-Esteban, P., Artés, A., & Baca-García, E. (2019) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.8032 · Cited by 112 · see citing works
Emotional dysfunction in schizophrenia spectrum psychosis: the role of illness perceptions
WATSON, P. W. B., Garety, P. A., Weinman, J. A., Dunn, G., Bebbington, P., Fowler, D. G., Freeman, D. H., & Kuipers, E. (2006) · Psychological Medicine · doi:10.1017/s0033291706007458 · Cited by 114 · see citing works
“Although much research has sought factors predictive of adherence-related behaviour (Pan & Tantam, 1989; Kampmann & Lehtinen, 1999; Lacro et al. 2002), and compliance therapy has been effective in improving medication adherence (Kemp et al.”
BackgroundMental illness stigma: Types, constructs, and vehicles for change.
Corrigan, P. W., & Kosyluk, K. A. (2013) · American Psychological Association eBooks · doi:10.1037/14297-003 · Cited by 115 · see citing works
Remission in Schizophrenia: Critical and Systematic Review
AlAqeel, B., & Margolese, H. C. (2012) · Harvard Review of Psychiatry · doi:10.3109/10673229.2012.747804 · Cited by 113 · see citing works
Czobor, P., Van Dorn, R. A., Citrome, L., Kahn, R. S., Fleischhacker, W. W., & Volavka, J. (2015) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2015.04.003 · Cited by 112 · see citing works
“The other eight studies demonstrated little or no association (Lacro et al., 2002).”
BackgroundResultDassa, D., Boyer, L., Benoît, M., Bourcet, S., Raymondet, P., & Bottaï, T. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048674.2010.493503 · Cited by 111 · see citing works
Ascher‐Svanum, H., Zhu, B., Faries, D. E., Landbloom, R. P., Swartz, M. S., & Swanson, J. W. (2006) · BMC Psychiatry · doi:10.1186/1471-244x-6-8 · Cited by 110 · see citing works
“Most of these socio-demographic and treatment variables have been previously reported to be related to nonadherence with antipsychotic medication in the treatment of schizophrenia [25].”
BackgroundMiller, R., Ream, G. L., McCormack, J., Gunduz‐Bruce, H., Sevy, S. M., & Robinson, D. G. (2009) · Schizophrenia Research · doi:10.1016/j.schres.2009.04.018 · Cited by 110 · see citing works
“, our adherence findings are consistent with other studies of substance abuse and adherence for people with schizophrenia (Lacro et al., 2002) and first-episode psychosis (Coldham et al.”
InfluentialHarrison, T. S., & Goa, K. L. (2004) · CNS Drugs · doi:10.2165/00023210-200418020-00005 · Cited by 109 · see citing works
A Review of Virtual Week for Prospective Memory Assessment: Clinical Implications
Rendell, P. G., & Henry, J. D. (2009) · Brain Impairment · doi:10.1375/brim.10.1.14 · Cited by 109 · see citing works
Tandon, R., Marcus, R. N., Stock, E. G., Riera, L. C., Kostic, D., Pans, M., McQuade, R. D., Nyilas, M., Iwamoto, T., & CRANDALL, D. T. (2006) · Schizophrenia Research · doi:10.1016/j.schres.2005.12.857 · Cited by 108 · see citing works
“This finding is relevant in the context of relatively poor adherence to antipsychotic medications and the increased risk for relapse after treatment discontinuation (Hudson et al., 2004; Keith and Kane, 2003; Lacro et al., 2002).”
BackgroundEffects of age and gender on the serum levels of clozapine, olanzapine, risperidone, and quetiapine
Castberg, I., Westin, A. A., Skogvoll, E., & Spigset, O. (2017) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12794 · Cited by 107 · see citing works
“In a few studies, females have been found to have higher adherence than males (35, 36), but in most studies, no gender effects have been revealed (37).”
BackgroundSubjective well‐being under neuroleptic treatment and its relevance for compliance
Набер, Д., Karow, A., & Lambert, M. (2005) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2005.00542.x · Cited by 107 · see citing works
Adherence to pharmacotherapy in patients with alcohol and opioid dependence
Weiss, R. D. (2004) · Addiction · doi:10.1111/j.1360-0443.2004.00884.x · Cited by 107 · see citing works
Medication Adherence Among Psychotic Patients Before Admission to Inpatient Treatment
Rittmannsberger, H., Pachinger, T., Keppelmüller, P., & Wancata, J. (2004) · Psychiatric Services · doi:10.1176/appi.ps.55.2.174 · Cited by 106 · see citing works
Factors associated with relapse in schizophrenia
Kazadi, N. J.-B., Moosa, M. Y. H., & Jeenah, F. Y. (2008) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v14i2.158 · Cited by 103 · see citing works
Eticha, T., Teklu, A., Ali, D., Solomon, G., & Alemayehu, A. (2015) · PLOS ONE · doi:10.1371/journal.pone.0120560 · Cited by 103 · see citing works
“A comprehensive review [3] reported that the rate of medication non-adherence in patients with schizophrenia is as high as 40%–50%.”
BackgroundJavadpour, A., Hedayati, A., Dehbozorgi, G., & Azizi, A. (2013) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2012.12.005 · Cited by 102 · see citing works
“On the other hand, as reported by Lacro et al. (2002), it is known that the rate of individual bipolar patients routinely and consciously taking the prescribed medicines is only 35%, which is much lower than that of schizophrenics at 50–60%.”
BackgroundThe relationship between patient satisfaction and treatment outcomes in schizophrenia
Chue, P. S. (2006) · Journal of Psychopharmacology · doi:10.1177/1359786806071246 · Cited by 102 · see citing works
Early Predictors of Nonadherence to Antipsychotic Therapy in First-Episode Psychosis
Rabinovitch, M., Béchard‐Evans, L., Schmitz, N., Joober, R., & MALLA, A. K. (2009) · The Canadian Journal of Psychiatry · doi:10.1177/070674370905400106 · Cited by 99 · see citing works
“We failed to observe previously reported association between adherence and insight into illness(1,3,12,21) and (or) a history of current or past substance use disorder.(1,12) Our measure of insight based on one item on the PANSS may be too limited to detect differences for the various domains of insight.”
ResultBhanji, N. H., Chouinard, G., & Margolese, H. C. (2003) · European Neuropsychopharmacology · doi:10.1016/s0924-977x(03)00109-3 · Cited by 99 · see citing works
“A substantial literature exists on issues relating to compliance in schizophrenia, and has been summarized in recent reviews (Kane and Nemec, 2002; Lacro et al., 2002; Donohoe et al., 2001; Hellewell, 2002; Misdrahi et al., 2002).”
BackgroundPilon, D., Tandon, N., Lafeuille, M., Kamstra, R. L., Émond, B., Lefèbvre, P., & Joshi, K. (2017) · Clinical Therapeutics · doi:10.1016/j.clinthera.2017.08.008 · Cited by 98 · see citing works
“Similarly, a previously published systematic review found mean adherence rates of 51% and 59% depending on the inclusion criteria used.(11) The lower adherence that was observed in our analysis likely stems from the longer observation period used (12 months vs 6 months used by Marcus et al).”
BackgroundResult
- Authors
- Lacro, J. P., Dunn, L. B., Dolder, C. R., Leckband, S. G., & Jeste, D. V.
- Affiliations
- University of California San Diego (US)
- VA San Diego Healthcare System (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2002-10-15
- Volume
- 63
- Issue
- 10
- Pages
- 892-909
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2070893229
- Cited by
- 1,383
- References
- 74
- Citations by year
- 2026: 42 · 2025: 29 · 2024: 43 · 2023: 55 · 2022: 59 · 2021: 58 · 2020: 63 · 2019: 52 · 2018: 56 · 2017: 65 · 2016: 80 · 2015: 74 · 2014: 57 · 2013: 103 · 2012: 97
- FWCI
- 18.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r29mh056938-04)
- National Institute of Mental Health (MH49671, R01MH059101, MH-43693, MH56938, MH59101, P30MH049671, MH-19934, T32MH019934)
- 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
- medication non-adherence, schizophrenia, antipsychotic drugs, risk factors, prevalence, lack of insight, substance abuse, therapeutic relationship, aftercare planning, hospital readmission
- MeSH terms
- Adult, Ambulatory Care, Factor Analysis, Statistical, Female, Hospitalization, Humans, Male, Probability, Research Design, Risk Factors, Schizophrenia, Schizophrenic Psychology, Antipsychotic Agents, Prevalence, Treatment Refusal
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