Citation

Patel MX, David AS. Psychiatry 2007; 6(9): 357-361.

Copyright

(Copyright © 2007, Medicine Publishing Company Ltd.)

DOI

10.1016/j.mppsy.2007.06.003

PMID

unavailable

Abstract

Medication adherence is crucial in psychiatry, especially for chronic disorders. Both clinician and patient share responsibility for adherence, which is rarely an all-or-none phenomenon. For psychiatric drugs, non-adherence rates are approximately 40-60%. Such non-adherence explains much of the difference between drug efficacy and effectiveness, as demonstrated by higher relapse rates in non-adherent patient groups. Thus, non-adherence impacts profoundly on clinical and economic burdens for health services. During clinical assessment, predictive factors of non-adherence should be considered, including: a prior history of non-adherence; alcohol or substance misuse or where treatment is during an asymptomatic phase. Similarly, drug dose and formulation polypharmacy, side effects and the therapeutic relationship also affect adherent behaviour. Psychoeducational interventions aiming to enhance adherence focus primarily on imparting knowledge, rather than on attitudinal and behavioural change, and have proved largely ineffective. Individual psychological interventions are more effective as they specifically target the patient's beliefs and attitudes concerning the illness and medication by utilizing cognitive-behavioural or motivational interviewing techniques. Compliance therapy combines all of these. All clinicians should routinely use simple adherence-enhancing techniques, particularly as dedicated resources for specialist interventions remain rare. Moreover, in an attempt to further reduce the adverse clinical and economic impact of non-adherence, it is imperative that patients are given the opportunity to have their personal individual perspectives adequately heard. © 2007 Elsevier Ltd. All rights reserved.

Language: en

Keywords

human; interventions; health belief model; suicide attempt; predictive factors; polypharmacy; psychoeducation; review; substance abuse; alcohol abuse; adherence; mental disease; priority journal; behavior therapy; cognitive therapy; economic aspect; patient compliance; drug efficacy; relapse; cost of illness; disease duration; compliance therapy; measurement tools