Cited by 1,383Medication Adherence and ComplianceSchizophrenia research and treatmentMental Health Treatment and Access

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Prevalence of and Risk Factors for Medication Nonadherence in Patients With Schizophrenia: A Comprehensive Review of Recent Literature

Lacro, Jonathan P., Dunn, Laura B., Dolder, Christian R., Leckband, Susan G., Jeste, Dilip V.·2002·The Journal of Clinical Psychiatry

DOI 10.4088/jcp.v63n1007

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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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“…costs, treatment complexity, and side effects (as adapted from Balkrishnan 1998; DiMatteo, Lepper, and Croghan 2000; Okuno et al. 2001; Ammassari et al. 2002; Lacro et al. 2002; Perkins 2002; Servellen et al. 2002; Farley et al. 2003; Sewitch et al. 2003; Ellis et al. 2004; Stilley et al. 2004).”
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“Other factors repeatedly reported are high treatment costs and negative attitudes among patients and caregivers.(15,16) However, results are inconsistent about the role of hospitalization length and a number of sociodemographic factors, including age, sex, education level, and whether the patient lives in a rural or u…”
BackgroundMethodResultInfluential
Inpatient prescribing patterns of long-acting injectables and their oral or short-acting injectable equivalent formulations
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“Underutilization can result in negative health outcomes by reducing symptom control, worsening symptoms, increasing hospitalization or readmission, and increasing healthcare expenditures related to non-adherence and associated psychiatric decompensation (Lacro et al., 2002; Nosé et al., 2003).”
Background
Proportion of Antipsychotics with CYP2D6 Pharmacogenetic (PGx) Associations Prescribed in an Early Intervention in Psychosis (EIP) Cohort: A Cross-Sectional Study
Jameson, A., Faisal, M., Fylan, B., Bristow, G. C., Sohal, J., Dalton, C., Sagoo, G. S., Cardno, A. G., & McLean, S. L. (2024) · Journal of Psychopharmacology · doi:10.1177/02698811241238283 · Cited by 8
“Adherence rates to drugs for psychosis are estimated to be less than 50% (Haddad et al., 2014; Lacro et al., 2002).”
BackgroundResult
Targeted psychological and psychosocial interventions for auditory hallucinations in persons with psychotic disorders: Protocol for a systematic review and meta-analysis
Fässler, L., Bighelli, I., Leucht, S., Sabé, M., Bajbouj, M., Knaevelsrud, C., & Böge, K. (2024) · PLoS ONE · doi:10.1371/journal.pone.0306324 · Cited by 11

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)
ORCID: Lacro, Jonathan P.
Dunn, Laura B.
Leckband, Susan G.
Jeste, Dilip V.
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)
DOI: 10.4088/jcp.v63n1007
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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Prevalence of and Risk Factors for Medication Nonadherence in Patients With Schizophrenia: A Comprehensive Review of Recent Literature

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