Antipsychotic treatment and adherence in schizophrenia

Abstract

This chapter falls into two main sections. In the first section we provide an overview of schizophrenia and antipsychotic treatment. This includes the course of schizophrenia, the relationship between duration of untreated psychosis and relapse and disease progression, the role of antipsychotics in relapse prevention, and current treatment guidance for antipsychotic treatment in schizophrenia. Unfortunately the goals of antipsychotic treatment are frequently undermined by poor medication adherence. The second section of the chapter provides a comprehensive review of adherence with antipsychotic medication in schizophrenia. Many of the issues will apply to other disorders where long-term maintenance antipsychotic treatment is required such as bipolar disorder. We start by considering how adherence is defined and measured before considering its predictors, an area that is best understood by considering a health belief model. This is followed by a review of the extent and consequences of poor adherence in schizophrenia. We then consider interventions that can be employed to improve antipsychotic adherence, including psychosocial interventions, changes to the oral medication regimen, and a switch to a long-acting injection. The strategy or strategies that are adopted will depend on the individual patient and should be based on full discussion between the patient and doctor. The chapter ends with a brief summary of key points.