The True Cost of Non-Adherence in Schizophrenia

Emsley R; The True Cost of Non-Adherence in Schizophrenia. Mind & Brain, the Journal of Psychiatry, August  2010; 1(2):  17-22

REVIEW ARTICLE


Robin Emsley

Affiliation : Department of Psychiatry, University of Stellenbosch in Cape Town, South Africa

ABSTRACT

Non-adherence to prescribed antipsychotic drugs by schizophrenia patients is a major cause of treatment failure and poor functional outcomes, and increases the likelihood of psychiatric hospitalization, which in turn increases the overall cost of care. Non-adherence to therapy has also been associated with a greater propensity to violent acts, including suicide, substance abuse, and related behavior. Moreover, with persistence of symptoms, people with schizophrenia find it hard to remain employed and become increasingly socially excluded. It is particularly important to ensure adherence to therapy during the early phase of the disease process, as this may greatly impact long-term treatment outcomes. As treatment adherence is a complex phenomenon affected by interacting parameters, such as psychopathology, poor insight, medication-related factors, social support, comorbidities, associated substance abuse, and patient–physician relationship, a multifaceted approach to improving treatment compliance that includes both psychosocial and pharmacological therapeutic measures is required. Long-acting injectable (LAI) formulations of antipsychotic drugs have the potential to reduce non-adherence and consequently improve clinical outcomes. In particular, LAI risperidone, a second-generation antipsychotic agent, has yielded significant improvements in overall symptoms, quality of life and patient satisfaction, and reduced hospitalization, compared to oral antipsychotics, in patients with schizophrenia. When used in early psychosis, LAI risperidone has been associated with sustained remission in a majority of cases. Inadequate adherence to antipsychotic drugs compromises treatment outcomes in schizophrenia patients. LAI preparations of antipsychotic drugs have the potential to improve adherence to therapy and treatment outcomes in these patients.

Keywords: adherence, antipsychotic, depot, hospitalization, injectable, non-adherence, schizophrenia
Correspondence: Robin Emsley, Department of Psychiatry, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, 7500 Cape Town, South Africa. Tel: +27 21 9389227; Fax: +27 21 9389738; e-mail: rae@sun.ac.za