Compliance in psychoses.
OBJECTIVE
To review the literature on compliance in psychoses and to evaluate the significance of the different compliance components presented.


METHODS
Different definitions of the term compliance were first gathered. A search covering the years 1974-1997 was conducted in Medline and PsycLit databases using the keywords 'schizophrenia' or 'psychosis' and 'compliance'. The studies that took compliance into account as a separate variable were collected for further analysis.


RESULTS
Unpleasant side-effects of medication, attitudes towards medication, delusional symptoms, substance abuse, insight, and supportive family environment were found to have the strongest correlation with compliance. The influence of cognitive impairment is not clearly proven. Integrated, cognitive-behavioural and psychoeducational treatment models include several methods to improve therapeutic alliance and compliance.


CONCLUSIONS
As the majority of the studies have concentrated on neuroleptic treatment, the medication-related factors are best documented. In clinical practice, treatment compliance is based on patient-related, medication-related and interactional factors, such as treatment model and therapeutic alliance. Difficulties with insight and cognitive functioning are specific patient-related factors in the treatment of psychoses.
Kampman
O
O
Tampere University, Medical School, and Tampere University Hospital Department of Psychiatry, Finland.
Lehtinen
K
K
D014150:Antipsychotic Agents / Q000009:adverse effects; D001294:Attitude to Health; D003072:Cognition Disorders / Q000150:complications; D006801:Humans; D010349:Patient Compliance; D010817:Physician-Patient Relations; D011618:Psychotic Disorders / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D012944:Social Support
D014150:Antipsychotic Agents