APPROACHING THE ADHERENCE CHALLANGE

Stephen R. Marder, M.D., 11301 Wilshire Boulevard, Building 210A, Los Angeles, CA 90033; Donna A. Wirshing, M.D.; William C. Wishing, M.D.

As many as 30%, and perhaps an even higher proportion of patients with schizophrenia, have serious problems with medication adherence. Moreover, there is evidence that noncompliance with medication regimes may be the most common reason for rehospitalization in schizophrenia. This report will focus on factors that can contribute to nonadherence such as medication side effects, lack of insight, substance abuse, and an inadequate continuity of care. A number of interventions have been found to improve adherence. Pharmacological approaches include managing medication side effects and the use of long-acting formulations of antipsychotics. Psychosocial approaches include forms of psychoeducation for both patients and families, specialized programs for patients who have comorbid substance abuse disorders, the use of behavioral skills training methods such as the Community Re-entry Module, and intensive case management strategies. The data supporting the effectiveness of each of these methods will be reviewed. Taken together, the findings from controlled studies indicate that there are effective strategies that can be individualized to the needs of patients who are at a high risk for nonadherence.