Compliance with antipsychotic medication: From theory to practice

Exploring the Complexity of Compliance in Schizophrenia

“…Some authors have consistentl y established a link with side effects (Reilly, Wilson, & McClinton, 1967;Renton, Af eck, Carstairs, & Forrest, 1963;Van Putten, 1974;Young, Zonana, & Shepler, 1986) while others have not (Marder, Mebane, Chien, Winslade, & Swann, 1983;Pan & Tantam, 1989). The inconclusiv e nature of these results are further compounded by the conclusions of some researchers that clinicians tend to underestimate the severity of side effects of neuroleptics (Day, Wood, Dewey, & Bentall, 1995) while others argue that it may not be the presence of side effects but the meaning patients give to these side effects that impacts on compliance (Hughes, Hill, & Budd, 1997). It also has been demonstrated that patients who experienced adverse side effects had better compliance than those who didn't (McEvoy, Freter, & Everett, 1989;Willcox, Gillan, & Hare, 1965).…”

“…However, one needs to be aware of problems of de nition when attitude towards treatment is viewed as a crucial component of insight. Insight is used by some authors to imply "lack of disease awareness" and they argue that an awareness of the correlation between taking medication and positive outcomes may be more predictive of compliance than insight (Buchanan & David, 1994;Hughes, Hill, & Budd, 1997;Kemp & David, 1995).…”

“…Here, patients are encouraged to articulate the positive consequences of taking medication (Hughes, Hill, & Budd, 1997). Building on this, Kemp et al (1996) developed a "compliance therapy" that gave patients an opportunity to review the advantages and disadvantages of antipsychotic medication.…”

Why aren't depot antipsychotics prescribed more often and what can be done about it?

“…The theoretical framework of the 'health belief model' indicates that health behaviour is determined by beliefs that fall into four main categories: benefits, costs, susceptibility to relapse and secondary benefits of medication and treatment adherence (Hughes et al, 1997). Even within a relatively compliant group of patients, widely varying degrees of insight and a large range of health beliefs will exist, which, in turn, are important contributors to treatment adherence.…”

To trust or not to trust? Faith issues in psychopharmacological prescribing

“…Non-adherence to pharmacotherapy in mental illness significantly impacts upon the lives and well-being of people with mental health problems (Patel & David, 2005). The causes of poor adherence to treatment are numerous (Robinson et al, 1999) but beliefs regarding mental illness and psychotropic medication are significant factors cited in the literature (Hughes et al, 1997). Although it is generally thought that religious beliefs do not influence medication compliance (Dein, 2004), resolving non-adherence to pharmacotherapy should involve a comprehensive assessment of the patient's demographics, social circumstances, and cultural and religious beliefs (Sattar et al, 2004a;Subach & Abdul-Ezz, 1999).…”