Increasing Treatment Adherence in Schizophrenia
“Adherence is one of the most important issues in illness management,” according to Dawn I. Velligan, Ph.D, director of the Division of Schizophrenia and Related Disorders at the University of Texas Health Science Center. However, research suggests that about half of people with schizophrenia don’t adhere to treatment, she said.
Nonadherence has critical consequences, including worsening of symptoms and hospitalization. “Rates of relapse for those [patients] taking vs. not taking medications are about 44 percent and 20 percent respectively,” Velligan said.
What Predicts Nonadherence
When it comes to adhering to treatment, people with schizophrenia aren’t all that different from individuals with other chronic conditions, including diabetes and high blood pressure, Velligan said. Not taking medication seems to be a problem for conditions that require long-term treatment.
The major difference, however, is that individuals with schizophrenia can have poor insight into their illness, which makes them more likely to skip treatment. In fact, poor insight may be the biggest predictor of nonadherence. “Individuals don’t think they are ill, or don’t understand that when acute symptoms subside medication is still necessary,” Velligan said.
The very nature of schizophrenia can complicate adherence. For instance, consistency is key for following treatment. But people with schizophrenia have a hard time sticking to routines. “There is no regular pattern of behavior that can make adherence easy,” Velligan said.
They also struggle with cognitive impairments. Patients may intend to take their medication but simply forget. “In these cases sometimes as many as half the doses are missed, making the medication less effective,” Velligan said.
But the negative consequences of stopping medication aren’t obvious to patients. If a patient misses a pill, there are no immediate repercussions, she said. “Symptoms may not get worse for days, weeks or even months [which makes it] very difficult for the person to make the connection between poor adherence and rehospitalization,” she said.
Some patients skip doses or stop taking medication because of side effects. For instance, weight gain and movement side effects are especially bothersome to patients, Velligan said.