Article Review: El-Mallakh, P., & Findlay, J. (2015). Strategies to improve medication adherence in patients with schizophrenia: The role of support services.

Antipsychotic medications are effective in 70% to 80% of individuals with Schizophrenia, yet 50% of these individuals are medication non-adherent (El-Mallakh & Findlay, 2015). Medication adherence is associated with medication-related factors along with environmental and provider-related factors. Patient-related factors include newly starting an antipsychotic medication, disordered substance use, early onset of illness, low levels of social support, and financial constraints (inability to afford medication). Some research suggests that patient’s with higher IQs are also less adherent when compared to patients with higher levels of medication adherence (El-Mallakh & Findlay, 2015). Medication-related factors affecting medication adherence include metabolic side effects such as weight gain. Patient’s experiences in the admissions process to psychiatric hospitals was also found to be a significant predictor of medication non-adherence, along with the perception of coercion to engage in treatment and lack of collaboration with the patient in treatment. Some predictors of medication adherence in patients with Schizophrenia include initial reduction in positive symptoms when starting an antipsychotic medication, a strong therapeutic alliance, an accurate explanation of potential side effects of newly started medications, and provider collaboration with patients in the treatment process . Psychiatric medication non-adherence was associated with an increased risk of relapse into psychosis, persisting symptoms, and suicide attempts (El-Mallakh & Findlay, 2015).

El-Mallakh and Findlay (2015) found that patients with comorbid medical illnesses demonstrated increased adherence to medications for hypertension, hyperlipidemia, and diabetes was higher among patients who were adherent to antipsychotic medications. This correlation suggests that providers should address psychiatric medication adherence in patients with Schizophrenia prior to addressing adherence to medication for medical illnesses due to the relationships between stable psychiatric symptoms and adherence to medical medications. This study also found that effective methods for improving psychiatric medication adherence include Treatment Adherence Therapy (TAT) that is comprised of motivational interviewing (MI), medication optimization, and behavioral training. Medication adherence was also increased when patients were able to speak with a registered nurse to help identify patient-specific barriers for medication adherence along with active problem solving. The most effective methods of promoting medication adherence involve TAT, active problem solving with providers, and addressing ambivalence toward adherence to psychiatric medications. The preliminary component necessary to achieve effectiveness of any intervention aimed at promoting adherence to psychiatric medications in patients with Schizophrenia is collaboration with the patient and establishment of a strong therapeutic alliance.

References

El-Mallakh, P., & Findlay, J. (2015). Strategies to improve medication adherence in patients with schizophrenia: The role of support services. Neuropsychiatric Disease and Treatment, 1077. doi:10.2147/ndt.s56107

Blake Palmer, MA, LPA
Doctoral Psychology Intern

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