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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InfluentialADHERENCE AND NONADHERENCE TO ANTIPSYCHOTIC MEDICATIONS
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“Poor adherence or nonadherence to oral antipsychotic (OA) medications is a major modifiable risk factor for relapse that has been reported in approximately 40–60% of patients with schizophrenia [2–6].”
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“Aggravating is the fact that a substantial number of patients does not take their medication regularly [20, 21], reducing the likelihood for long-standing remission and recovery.”
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Apiquián, R., Córdoba, R., & Louzã, M. R. (2010) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s15911 · Cited by 15
“Although the presence of side effects is not usually considered a factor directly associated with adherence, 49 it does influence the patient’s perception of the benefits of taking the medication.”
A Clinical Monitoring System for Clozapine
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“The Meds-Help intervention consisted of (1) unit-of-use packaging that included all patients’ medications for psychiatric and general medical conditions, (2) a medication and packaging education session, (3) refill reminders mailed 2 weeks before scheduled refill dates, and (4) notification of clinicians when patients…”
BackgroundMethodPerceptions of Psychiatrists Toward the Use of Long-Acting Injectable Antipsychotics
Grover, S., Sahoo, S., & Mehra, A. (2019) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000001109 · Cited by 15
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“One of the principal causes of relapse in the patient with schizophrenia is medication non-adherence,(4) present in more than 40% of the patients.(5) Better adherence has been linked to greater symptomatic and psychosocial remission, as well as integration into the community.”
BackgroundDeveloping and Using Social Capital In Public Mental Health
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“The study followed patients until the first of four events was seen: (1) fill of a prescription for a second, different SGA, (2) discontinuation of the index SGA (refill gap430 days), (3) the end of enrollment, or (4) the end of the study period (12/31/2007).”
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“1 General issues related to dosing and management strategies Developing a collaborative relationship with patients and providing them with relevant information about their disease and its treatment may potentially improve adherence to antipsychotic treatment and increase the chance for a favorable therapeutic outcome…”
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Hernandez, M., & Barrio, C. (2017) · Journal of Mental Health · doi:10.1080/09638237.2016.1222061 · Cited by 14
“Factors attributed to nonadherence include medication side effects, substance abuse, poor illness insight, and illness severity (Beck et al., 2011; Gilmer et al., 2004; Lacro et al., 2002; Yang et al., 2012), among others.”
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“In patients with schizophrenia, the mean rate ofmedication nonadherence approximates 50% [7] and tends to increase after hospital discharge: nearly 25%within 7–10 days, 50% 1 year later, and up to 75%within 2 years [19, 20].”
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Assessing Psychosis in Acute and Chronic Mentally Ill Older Adults
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“Lastly, psychological symptoms and their expression are predictive of adherence, with situationally varying emotional states [11], substance use [11], and positive symptoms [29] predicting nonadherence.”
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Peters-Strickland, T. S., Hatch, A., Adenwala, A., Atkinson, K., & Bartfeld, B. (2018) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s157102 · Cited by 15
Compliance in schizophrenia spectrum disorders
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The Effect of Therapeutic Alliance on Attitudes Toward Psychiatric Medications in Schizophrenia
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“Furthermore, our approach allows for the inclusion of patient compliance which undoubtedly is an important issue in real-world settings of schizophrenia treatment [74].”
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“…on medication adherence have concluded that within all healthcare settings poor adherence or nonadherence to prescribed medication is the rule rather than the exception, particularly immediately prior to admission to an adult acute psychiatric ward [Lacro et al. 2002; Cramer and Rosenheck, 1998].”
BackgroundNoordraven, E. L., Audier, C. H., Staring, A. B. P., Wierdsma, A. I., Blanken, P., van der Hoorn, B., Roijen, L. H., & Mulder, C. L. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0343-3 · Cited by 14
Compliance to follow-up and treatment after discharge among chronic psychotic patients
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“The absence of relationship between non-adherence to treatment and specific factors such as age, neurocognitive disorder, severity of medication-related side effects and family participation in treatment present an opposing view of clinical data and current publications (15).”
BackgroundInfluentialOgunnubi, O. P., Olagunju, A. T., Aina, O. F., & Okubadejo, N. U. (2017) · Mental Illness · doi:10.4081/mi.2017.6889 · Cited by 14
Clinic Appointment Attendance in Adults with Serious Mental Illness and Diabetes
Gunzler, D. D., Morris, N. J., Dalton, J. E., McCormick, R., Dawson, N. V., Thomas, C. L., Kanuch, S. W., Cassidy, K. A., Athey, M., Fuentes‐Casiano, E., et al. (2017) · American Journal of Health Behavior · doi:10.5993/ajhb.41.6.15 · Cited by 14
“Nevertheless, substantial percentages – as many as 40% (eg Lacro et al 2002, Delamater 2006) of patients – fail to adhere to current evidence-based treatments for both of these conditions.12,13 It is estimated that two thirds of the hospitalizations for Medicaid patients with schizophrenia alone…”
BackgroundTranslation and cultural adaptation of Glasgow Antipsychotic Side-effects Scale (GASS) in Arabic
AlRuthia, Y. S., Alkofide, H., Alosaimi, F. D., Alkadi, H., Alnasser, A. A., Aldahash, A., Basalamah, A., & Alarfaj, M. O. (2018) · PLoS ONE · doi:10.1371/journal.pone.0201225 · Cited by 14
“The variability in the reported values may reflect inherent limitations of the different methods that were used to assess adherence in different studies [9].”
MethodMatthijssen, S. J. M. A., Heitland, I., Verhoeven, L. C. M., & van den Hout, M. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00637 · Cited by 16
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Level of Function at Discharge as a Predictor of Readmission Among Inpatients With Schizophrenia
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“…& Frangou, 2007), male gender (Lin et al., 2006), substance abuse (Linszen, Dingemans, & Lenior, 1994), marital status (i.e., being unmarried; Lacro, Dunn, Dolder, Leckband, & Jeste, 2002), higher number of previous hospitalizations (Roick et al., 2004), and short length of previous hospital…”
Social Context and Health Consequences of the Antipsychotics Introduction
Kirkby, K. C. (2005) · Annals of Clinical Psychiatry · doi:10.1080/10401230591002066 · Cited by 13
Gianfrancesco, F. D., Sajatovic, M., Rajagopalan, K., & Wang, R. (2008) · International Clinical Psychopharmacology · doi:10.1097/yic.0b013e32830b0f88 · Cited by 14
“Patients with comorbid psychiatric disorders have been found to be less adherent (Corriss et al., 1999; Leslie and Rosenheck, 2001; Lacro et al., 2002; Russo et al., 2002) Nonpsychotic mental disorders present Binary variable (ICD-9-CM codes for nonpsychotic mental disorders = 1) A marker for illness severity.”
BackgroundInfluentialKutcher, S., Brooks, S. J., Gardner, D. M., Honer, B., Kopala, L. C., Labelle, A., Lalonde, P., MALLA, A. K., Milliken, H., Soni, J., et al. (2005) · Neuropsychiatric Disease and Treatment · doi:10.2147/nedt.1.2.89.61042 · Cited by 14
“Poor adherence to medication early in treatment also predicts poor adherence in the longer term (Lacro et al 2002).”
Ishii, M., Okumura, Y., Sugiyama, N., Hasegawa, H., Noda, T., Hirayasu, Y., & Ito, H. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-111 · Cited by 13
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“Given these adverse effects, poor medication adherence is a major treatment barrier, with an estimated mean adherence rate of only 50% (45).”
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“…(0.948, 0.195) Effect size – FI vs. standard carea,b Li and Arthur (2005), Pharoah, Marit, Rathbone, and Wong (2006) Normal (0.561, 0.481) Adherence Lacro et al. (2002) Lognormal (0.473, 0.074) Parameters to estimate changes in percentage of patients having ÉPS People with typicals, no…”
BackgroundInfluentialThe Role of OROS®Hydromorphone in the Management of Cancer Pain
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“One of the major causes of suboptimal therapy outcomes is poor adherence to prescribed treatment regimens.(45) Non- or partial adherence is common in patients with chronic disease requiring long-term maintenance treatment(46) and poor adherence rates as high as 90% have been reported for both psychiatric illness and p…”
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“Oral atypical anti-psychotic adherence with the MEMS device was defined as consistency between the number of pill bottle openings (regardless of the hour) and the prescribed regimen on at least 75% of the days of the study period, as per Lacro et al.(31).”
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“However, non-adherence remains a significant clinical problem, with rates of nonadherence approximately 50%.(34) Numerous studies have provided evidence of the negative impact of non-adherence to medication on severity of disease, likelihood of relapsing episodes, and need of hospital admission for in-patient care.”
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“However, nonadherence is quite common; approximately 40% of patients with schizophrenia exhibit inconsistent medication adherence (Lacro et al., 2002).”
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“, 2009) and the high reported rates of medication non-adherence (Lacro et al., 2002).”
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“In terms of compliance, in other words, how often patients take medications correctly, several studies estimate that only approximately half of patients comply optimally with long-term treatment, regardless of their therapeutic area [3,4].”
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“Unfortunately, an effective continuity of pharmacological treatment is often difficult to achieve, mainly due to poor adherence,(11,12) manifested in an average of 41% of patients affected by schizophrenia; in studies adopting more stringent criteria to evaluate treatment adherence, this percentage increases to 50% of…”
Exploring personal recovery in mental illness through an Arabic sociocultural lens
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“Like indigenous New Zealanders (Lapsley et al. 2002), this belief system influences treatment-seeking practices of people with psychiatric symptomology.”
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“, poor clinician-patient alliance, poor aftercare environment, and family support, among others) (Lacro et al. 2002; Sajatovic et al. 2009).”
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“High levels of non-adherence are found with antidepressants (Cantrell et al., 2006), antipsychotics (Lacro et al., 2002, Sun et al., 2007), and other classes of psychotropics (Bulloch & Patten, 2010), with prevalence rates of around 40% or greater.”
BackgroundPredictors for Starting Depot Administration of Risperidone in Chronic Users of Antipsychotics
Vehof, J., Postma, M. J., Bruggeman, R., den Berg, L. T. W. D. J., van den Berg, P. B., Stolk, R. P., & Burger, H. (2008) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e31818a6d10 · Cited by 12
“It can be hypothesized that men are thought to have a lower compliance than women, although this cannot be confirmed by empirical evidence.(22) One could expect that new users of depot antipsychotics are not only less compliant patients but also more severely ill patients than new users of oral antipsychotics.”
Result
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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