title: Strategies for improving treatment adherence in schizophrenia and schizoaffective disorder.
abstract: Nonadherence with medication treatment is common but difficult to detect in patients with schizoaffective disorder and schizophrenia, almost half of whom take less than 70% of prescribed doses. Like patients in all areas of medicine, patients with schizoaffective disorder weigh the perceived benefits of medications against perceived disadvantages, but this process is complicated by their impaired insight, the stigma of the diagnosis, and the often troubling side effects of antipsychotic medication. Interventions to improve adherence include encouraging acceptance of the illness, drawing analogies with treatment for chronic medical disease, and involving the patient in decision making. Clinicians must remain nonjudgmental, encouraging patients to disclose problems with adherence and anticipating that improvement in adherence may require a prolonged effort. Selection of antipsychotic medication is critical to avoid adverse side effects, and some medications may provide a sense of well-being, such as improvement in insomnia, anxiety, or depression. Depot (rather than oral) antipsychotics can improve adherence and provide the clinician with reliable information about the dosage of medication received, which can be used for purposes of dose adjustments or to guide response to relapse.
authors.affiliation: Schizophrenia Program, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA. goff@psych.mgh.harvard.edu
authors.forename: Donald C
authors.initials: DC
authors.lastname: Goff
authors.forename: Michele
authors.initials: M
authors.lastname: Hill
authors.forename: Oliver
authors.initials: O
authors.lastname: Freudenreich
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001007:Anxiety / Q000188:drug therapy / Q000523:psychology; D002908:Chronic Disease; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D003863:Depression / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D055118:Medication Adherence / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations