Communicating with patients about antipsychotic drugs

Abstract

T HE QUALITY of communication between doctor and patient on the issue of medication has become the focus of increasing attention in recent years. A number of factors have given impetus to this, including efforts to restore a greater degree of humanity to the practice of medicine, and, from the other side of the relationship, a rising influence of the consumer movement in our society. In the field of clinical drug research, pharmacologists are increasingly recognizing the need to study the so-called “nondrug factors” in pharmacotherapy.’ In the treatment of schizophrenia with antipsychotic medications, communication appears to be of special importance. Despite the fact that clinicians in a wide variety of private-practice, institutional, and academic settings rank the administration of antipsychotic drugs as the most useful treatment available for schizophrenic illness.2 this enthusiasm is not reflected in studies of patient compliance. Studies of inpatients have produced up to a 20% noncompliance figure,” and studies of outpatients show that between 40% and 50% of schizophrenic patients do not take prescribed medications.4*5 In a review of medication compliance problems (which are not limited to schizophrenic patients), Blackwell has cited several high-risk factors, including chronicity of illness, symptom suppressive as opposed to curative action of the medication, delayed relapse with cessation of medications, ambivalent feelings about dependency issues, multiple medications, and social isolation.” Many of these factors are particularly applicable to schizophrenic patients receiving antipsychotic medications. Their relevance is confirmed by the marked dis: crepancy between intention and performance noted in one study of compliance in schizophrenic outpatients.’ These serious compliance problems may represent effects of the schizophrenia itself, the reaction to inevitable aversive drug effects, or reactions to problems within the doctor-patient relationship. The general thrust of much consumer-oriented literature has been that doctors should communicate fully with their patients concerning any proposed treatment, especially being sure that patients at-e aware of the benefits to be derived from the medication, and the side effects and risks involved, so that they can provide a meaningful informed consent and interact with the physician in a participatory model.