Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review

Abstract

Background: Nonadherence to medication is a recognized problem and may be the most challenging aspect of treatment. Methods:We performed a systematic review of factors that influence adherence and the consequences of nonadherence to the patient, healthcare system and society, in patients with schizophrenia. Particular attention was given to the effect of nonadherence on hospitalization rates, as a key driver of increased costs of care. A qualitative systematic literature review was conducted using a broad search strategy using disease and adherence terms. Due to the large number of abstracts identified, article selection was based on studies with larger sample sizes published after 2001. Thirty-seven full papers were included: 15 studies on drivers and 22 on consequences, of which 12 assessed the link between nonadherence and hospitalization. Results: Key drivers of nonadherence included lack of insight, medication beliefs and substance abuse. Key consequences of nonadherence included greater risk of relapse, hospitalization and suicide. Factors positively related to adherence were a good therapeutic relationship with physician and perception of benefits of medication. The most frequently reported driver and consequence were lack of insight and greater risk of hospitalization respectively. Conclusions: Improving adherence in schizophrenia may have a considerable positive impact on patients and society. This can be achieved by focusing on the identified multitude of factors driving nonadherence.

Medication-related factors of non adherence among patients with schizophrenia and bipolar disorder: Outcome of a cross-sectional survey in Maiduguri, North-eastern Nigeria

“…The principal treatment-related correlates of non-adherence are attributable to the medications used in the treatment of most of these disorders. These medication-related factors include dosing regimen, side effect profiles, fear of addiction potentials, and concerns about drug-drug interactions (Weiden and Miller, 2001;DiBonaventura et al, 2012;Higashi et al, 2013;Caldeira et al, 2014;Eticha et al, 2015). Most studies conducted in subSaharan that addressed nonadherence among patients with psychiatric disorders principally assessed patientrelated and socio-economic factors, with little or no attempt made at looking at the medication-related factors as significant correlates of nonadherence.…”

Intervenciones Para Mejorar La Adherencia Terapéutica en Sujetos Con Esquizofrenia

“…La falta de adherencia a la medicación incluye una compleja gama de actitudes y comportamientos del paciente, los cuales van desde el rechazo del tratamiento hasta el cumplimiento parcial o irregular de las dosis diarias de medicación (Higashi et al, 2013). Los principales factores que se han asociado a la falta de adherencia son: 1) Insight.…”

“…2) Pronóstico. La falta de adherencia muestra una fuerte relación con el incremento de síntomas psicóticos, periodos de remisión más largos (Higashi et al, 2013), aumento de las tasas de suicidio (Novick et al, 2010;Higashi et al, 2013;), incremento del deterioro cognitivo y peor calidad de vida (Ascher-Svanum et al, 2006). 3) Costes.…”

Efficacy and safety of aripiprazole lauroxil in schizophrenic patients presenting with severe psychotic symptoms during an acute exacerbation

“…In addition, symptom severity has been found to be highly correlated with nonadherence to medication among patients with schizophrenia (Higashi et al, 2013). Research has shown that the greater the severity of symptoms, the more likely a person with schizophrenia is to have impaired clinical insight, poor social adjustment, increased need for medication, and increased use of nicotine (Buckley et al, 2007;Krishnadas et al, 2012;Gerretsen et al, 2013).…”