Chapter

Antipsychotic treatment and adherence in schizophrenia*

Chris Abbott and Sam Keith

in Antipsychotic long-acting injections

Published on behalf of Oxford University Press

Published in print October 2010 | ISBN: 9780199586042
Published online February 2013 | e-ISBN: 9780191754708 | DOI: http://dx.doi.org/10.1093/med/9780199586042.003.0001
Antipsychotic treatment and adherence in schizophrenia*

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Schizophrenia follows a highly variable course but for most patients it is a chronic relapsing condition. The benefit of antipsychotic medication in preventing relapse is shown by both discontinuation studies and intermittent versus continuous maintenance studies. Despite this, poor adherence to antipsychotic medication is common in schizophrenia, as it is, with ‘maintenance medication’ in many chronic medical disorders such as hypertension and chronic obstructive airways disease. Adherence exists on a spectrum with most patients showing intermittent adherence. Non-adherence can be unintentional or intentional. Antipsychotic non-adherence leads to an increased risk of relapse, hospitalization, and self-harm. Relapse also worsens the longer-term prognosis of patients with schizophrenia; both relapse and duration of untreated psychosis are associated with increased disability and treatment resistance. Poor adherence is best understood in the context of a health belief model. Disease-related symptoms such as cognitive impairment and poor reality testing may limit a patient's ability to perceive the benefits of antipsychotic therapy; however side-effects may also promote non-adherence. The clinician can use a range of interventions to improve adherence including psychosocial interventions, programmatic treatments, and pharmacological strategies including an LAI. Often a combination of these approaches will be appropriate. The approach that is adopted will depend on the individual patient and should be made jointly by the patient and clinician.

Chapter.  9916 words.  Illustrated.

Subjects: Psychiatry

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