Other strategies for improving adherence

Switching from an oral antipsychotic regimen to a long-acting injectable agent is just one strategy for curbing nonadherence. Other interventions aim to identify and address the reasons for poor adherence. A systematic literature review by Hagashi and colleagues found that lack of insight, negative beliefs about medication, and substance abuse are “key drivers” of medication nonadherence, while a positive therapeutic relationship and the belief that medication is beneficial are positively associated with adherence.8 Clinicians should therefore assess for and address these and other factors influencing adherence, including cognitive impairment and lack of social support, income, and other resources. The prompt identification and management of unpleasant side effects, such as weight gain, is also critical to promoting adherence.6  

Studies have identified attention to the therapeutic relationship, examination of the patient’s attitudes and behaviors concerning medication use, and consideration of the patient’s expectations and treatment goals as essential to facilitating adherence.9,10 Cognitive behavioral therapy is effective in increasing adherence, as patients can be encouraged to examine their negative perceptions of medication and to make the connection between adherence and desired outcomes.6 Clinicians can also promote adherence by cultivating the therapeutic relationship through clear communication, trust building, and continuity of care—by ensuring that injectable medication is administered by the same healthcare professional each time, for example. Zygmunt and colleagues found that providing clear, concrete instructions, including strategies for problem-solving, is helpful in promoting adherence.10 An alarm or timer can remind a forgetful or preoccupied patient to take his or her oral medication, and a pill box can help with organization.1 As Bayle and others have noted, understanding and addressing nonadherence and its contributing factors can help clinicians and patients better manage schizophrenia and improve patient outcomes.2