Improving adherence to pharmacological treatment for schizophrenia: a systematic assessment

ABSTRACT

Introduction: Poor adherence to pharmacological treatment is prevalent in schizophrenia, affecting more than half of patients at some time, with increased risks of clinical worsening, adverse outcomes, suicide, and increased resource utilization including hospitalization, with higher costs.

Areas Covered: This review considers factors associated with treatment-nonadherence among schizophrenia patients, with a systematic evaluation of interventions aimed at improving adherence with an emphasis on evidence arising from their testing.

Expert opinion: Several interventions have addressed factors empirically associated with treatment-nonadherence, including various drug-, patient – and clinical services-associated factors. They include long-acting injected (LAI) drug formulations, behavioral interventions, and technology-supported methods. Use of LAI antipsychotics and behavioral techniques aimed at incorporating medicine-taking into daily routines with electronic monitoring have been assessed relatively extensively. Mobile, digital applications including medication monitoring systems and artificial intelligence-based interactions are emerging but have been tested in few trials of limited quality with inconclusive results. Randomized, controlled, blinded trials based on clinically representative samples are needed to evaluate not only adherence, but also to test for clinically meaningful and sustained clinical benefits in schizophrenia patients, who are especially difficult to treat.

KEYWORDS:

• Adherence
• antipsychotics
• enhancement
• treatment
• schizophrenia

Article Highlights

• Nonadherence to medicinal treatment is prevalent among schizophrenia patients and contributes to adverse clinical outcomes, high resource-utilization and increased costs.

• Nonadherence is a complex phenomenon influenced by drug-, patient- and service-related factors.

• Drug-related interventions aimed at improving treatment adherence include use of long-acting injectable agents, simplified regimens, and improved management of adverse effects.

• Patient-related improvements include individualized reminders and other psychosocial and behavioral interventions, with thoughtful pharmacotherapy as well as assertive community treatment.

• Service-related improvements include emerging technology-based monitoring, mobile applications, digital medication systems, and artificial intelligence-based communications.

All of these methods need further assessment with prolonged, randomized, controlled trials to test for impact on clinical outcomes as well as on treatment adherence, with sustained benefits.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors are supported in part by a grant from the Bruce J. Anderson Foundation and the McLean Private Donors Psychiatry Research Fund (to RJ Baldessarini).