The DOI matches its Crossref record; 74 of the 74 references it cites were found in a registry or an index.
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 [5–7].”
From Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview (2021) · cites this paper as [6]
In the citing paper
“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 citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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Adherence according to Mary Poppins: strategies to make the medicine go down.
Hardeman, S., & Narasimhan, M. (2010) · Perspectives in psychiatric care · doi:10.1111/j.1744-6163.2009.00233.x · Cited by 5
Bera, R. B., Offord, S. J., Zubek, D., Lau, G., Lin, J., & Karson, C. N. (2013) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e3182a6082a · Cited by 4
“The primary reason for increased symptom severity and schizophrenia relapse is nonadherence to antipsychotic therapy, which is widespread among patients with schizophrenia.(4,5) Long-acting injectable (LAI) formulations of antipsychotics are another option for treating patients with schizophrenia.”
BackgroundLee, Y., Lee, N.-Y., Youn, T., Choi, Y.-S., Kim, Y. S., & Chung, I. (2013) · Korean Journal of Schizophrenia Research · doi:10.16946/kjsr.2013.16.1.14 · Cited by 4
Medication non-adherence in the homeless population in an Intermountain West city
Unni, E., Ashment, R., Miller, E., & Draper, A. M. (2014) · INNOVATIONS in pharmacy · doi:10.24926/iip.v5i2.342 · Cited by 4
“Medication adherence is a challenge for patients with schizophrenia and a literature review on medication adherence with schizophrenic patients showed it at 50% (43).”
BackgroundEarly detection and treatment of patients symptomatically at-risk for psychosis
Schultze‐Lutter, F., Ruhrmann, S., & Schimmelmann, B. K. E. (2012) · Cited by 4
Descriptive study of homeless patients’ perceptions that affect medication adherence
Richler, M., Yousaf, S., Hwang, S. W., & Dewhurst, N. (2019) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/zxz139 · Cited by 4
Assessment of illness representations in mental disorders: A mini review
Averous, P., Charbonnier, É., & Dany, L. (2021) · L Encéphale · doi:10.1016/j.encep.2020.09.011 · Cited by 4
Complete and incomplete recovery from first-episode psychosis
Addington, J., Lambert, T. J. R., & Burnett, P. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511576287.013 · Cited by 4
Lambrelli, D., & O’Donnell, O. (2009) · RePEc: Research Papers in Economics · Cited by 4
Working with People with Mental Health Difficulties to Improve Adherence to Medication
Barnes, T. R. E., & Haddad, P. M. (2020) · doi:10.1002/9781119129530.ch23 · Cited by 4
Leijala, J., Kampman, O., Gunnar, T., & Suvisaari, J. (2025) · Psychiatry Research · doi:10.1016/j.psychres.2025.116780 · Cited by 3
“Research has consistently shown that attitudes significantly influence adherence (Baloush-Kleinman et al., 2011; Brain et al., 2013; Lacro et al., 2002).”
Varese, F., Sudell, M., Morrison, A. P., Longden, E., & Smith, C. T. (2024) · Health Technology Assessment · doi:10.3310/ncfr5074 · Cited by 4
Yan, G., Ding, H., Lin, X., Li, Z., Chen, L., Xiang, L., Chen, X., & Tan, Y. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1698379 · Cited by 3
Ammouri, A. E., & Kisra, H. (2016) · L Encéphale · doi:10.1016/j.encep.2016.02.022 · Cited by 3
Lynum, K. S. B., Henderson, D. C., Wright, H. J., Gogate, J. P., & Kim, E. (2021) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.20m13356 · Cited by 3
Ghatwal, H., Joseph, J., & Jangid, P. (2021) · Journal of Mental Health and Human Behaviour · doi:10.4103/jmhhb.jmhhb_175_20 · Cited by 3
Kochen, S. A., Hakkers, C. S., van Gorp, F., de Lange, D. W., & Haas, L. E. M. (2024) · Emergency Medicine Journal · doi:10.1136/emermed-2024-213972 · Cited by 3
Wang, T., Shang, L., He, Y., Guo, L., Ruan, X., Han, P., Wu, W., Chen, M., Zhang, F., Hu, C., et al. (2025) · Clinical Therapeutics · doi:10.1016/j.clinthera.2025.07.001 · Cited by 3
Antipsychotic treatment and adherence in schizophrenia
Correll, C. U., Abbott, C., Keith, S. J., & Haddad, P. M. (2016) · Oxford University Press eBooks · doi:10.1093/med/9780198729471.003.0001 · Cited by 3
Antipsychotika-Depotbehandlung im Wandel der Zeit
Knecht, G., Kuhn, J., Spittler, S., & Roll, S. (2016) · Nervenheilkunde · doi:10.1055/s-0037-1616350 · Cited by 3
“Nachteile überwiegen (Therapiebereitschaft) (39).”
Adherence to Antipsychotic Drug Measured by an Arabic Version of Morisky Scale
Alhalaiqa, F., Omari, O. A., Wynaden, D., Almusallami, N., ALBashtawy, M., Morisky, D. E., Batiha, A.-M. M., & Alkhawaldeh, A. (2016) · Issues in Mental Health Nursing · doi:10.1080/01612840.2016.1222040 · Cited by 5
“Living alone (Haddad et al., 2014; Wilder, Elbogen, Moser, Swanson, & Swartz, 2010) and side effects of the medication such as weight gain were also reasons for non-adherence (Lacro et al., 2002; Treatment Advocacy Center, 2014).”
BackgroundTherapeutic drug monitoring in psychiatry - possibilities and use in practice
Šilhán, P., Kacířová, I., Hýža, M., Uřinovská, R., Češková, E., & Grundmann, M. (2016) · Psychiatrie pro praxi · doi:10.36290/psy.2016.003 · Cited by 3
Cost-effectiveness of therapeutic interventions in schizophrenia
Diaz‐Castro, L., Cabello-Rangel, H., Arredondo, A., de León, E. M., & Pineda‐Antúnez, C. (2017) · The European Journal of Psychiatry · doi:10.1016/j.ejpsy.2016.12.006 · Cited by 3
Metadata
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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