Pharmacological and Psychosocial Treatments in Schizophrenia by David Castle & David L. Copolov & Til Wykes & Kim T. Mueser

Author:David Castle & David L. Copolov & Til Wykes & Kim T. Mueser
Language: eng
Format: mobi
Tags: Psychiatry, Medical, Psychology, General
ISBN: 9781842145340
Publisher: CRC PRESS
Published: 2003-01-01T22:00:00+00:00

c h a p t e r 1 0

Understanding and

enhancing adherence to

treatment in people with

schizophrenia

Peter Hayward, Diane Agoro, Sarah Swan, and Til Wykes Medication is clearly a critical part of the treatment of people with schizophrenia. Regrettably, as in many other conditions, patients do not always take their medication in the doses and regimens prescribed, and this can have adverse consequences, including psychotic relapse. This chapter outlines the extent of this problem and suggests ways to understand and manage it. We do not here specifi cally address the role of long-acting injectable antipsychotics in ensuring people receive their medication: this is addressed in chapter 1.

Suffi ce to say here that even such strategies should be used in as collaborative and noncoercive manner as possible.

Defi nitions

Traditionally, the term “compliance” has been used to refer to the degree to which a patient follows medical advice and complies with treatment recommendations. A patient who takes his medication is said to be “compliant,”

while one who refuses or forgets is called “noncompliant,” or described as showing “poor compliance.” It has been suggested that these labels promote a one-sided view of the consultation process: the doctor offers wise and correct advice and the sensible patient obeys without question. The term “adherence”

has been advocated recently as suggesting a more active role for the patient, while the Royal Pharmaceutical Society of Great Britain (1) advocates the term

“concordance” as promoting the idea of collaboration between the patient and the prescriber. Ideally, the consultation process and the devising of treatment recommendations, whether they involve pharmacological, psychosocial, or

152 PHARMACOLOGICAL AND PSYCHOSOCIAL TREATMENTS IN SCHIZOPHRENIA other types of treatment, should be a process of collaborative empiricism where the patient is treated as an equal partner. There is some empirical evidence that this approach leads to superior treatment outcome and a greater patient satisfaction; more importantly, this approach respects the autonomy of the patient.

How to ensure adherence in practice is what we will expand on throughout this chapter.

Factors affecting adherence

A variety of factors can either promote or undermine treatment adherence (Box 10.1). As a rule, adherence to treatment regimens is far lower for most medical conditions, than professionals might wish. It has been suggested that only around half of patients adhere to a variety of long-term treatment regimens, for illnesses including heart disease, asthma, and AIDS. Consider for a moment the well-established rules of a healthy lifestyle: avoidance of alcohol, tobacco, and fattening foods; regular exercise; low levels of stress; daily fl oss-ing of the teeth; etc.: do you always adhere to all these practices?

People in general tend to take treatment when they are in distress, while preventive interventions are often forgotten. This is, of course, especially true of patients who do not believe that they are ill, but have other explanations for their problems, such as paranoid or grandiose delusional beliefs.

Low IQ and disorganized thinking may interfere with adherence, especially if medication regimens are complicated. Side effects may also be a problem, although a patient may fi nd one particular side effect intolerable and another much less problematic.

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