Schizophrenia treatment adherence

Educate patients and families about schizophrenia, treatments, and the importance of adherence to antipsychotic treatment. 

Stress the importance of medication and treatment adherence for improving long-term outcomes in schizophrenia. 

Since early detection and intervention in schizophrenia is important for maximizing outcomes, treatment with antipsychotic medications should begin as soon as psychotic symptoms are recognized. Antipsychotic medications are the cornerstone of therapy for people with schizophrenia, and most patients are on lifelong therapy since non-adherence and discontinuation of antipsychotics are associated with high relapse rates. If other symptoms are present such as depression and anxiety, these symptoms should also be aggressively treated. Additionally, psychosocial treatments should be used concomitantly to improve patient outcomes. 

When is medication indicated in the treatment of psychiatric illness There is no short answer to this question. At one end of the continuum, patients with schizophrenia and other psychotic disorders, bipolar disorder, and severe major depressive disorder should always be considered candidates for pharmacotherapy, and neglecting to use medication, or at least discuss the use of medication with these patients, fails to adhere to the current standard of mental health care. Less severe depressive disorders, many anxiety disorders, and binge eating disorders can respond to psychotherapy and/or pharmacotherapy, and different therapies can target distinct symptom complexes in these situations. Finally, at the opposite end of the spectrum, adjustment disorders, specific phobias, or grief reactions should generally be treated with psychotherapy alone. 

Sexual dysfunction associated with neuroleptic drugs has been reviewed (526). The authors concluded that sexual dysfunction is common in patients with schizophrenia, but often not reported to doctors nor explored, and may be an unrecognized cause of non-adherence to treatment. 

With the widespread use of second-generation antipsychotics (SCAs) as first-line treatment, the management of schizophrenia has improved with regard to side-effects, adherence with medication, and, in many cases, efficacy in comparison with the first-generation antipsychotics. 

Early detection and adequate treatment of NIA are important because of its negative clinical consequences and serious adverse effects. Akathisia is thought to be a risk factor for the development of tardive dyskinesia, it may be predictive of more severe psychopathology, and it seems to herald a poor response and non-adherence to treatment. Moreover, it may be a contributing factor in the suicidal and violent behavior of patients with schizophrenia. ... 

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