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12 March 2004

Half of patients don’t stick to their psychiatric medication

Studies show that patients do not follow one out of every three prescriptions written for psychiatric disorders. For many years, adherence rates have been as low as 50%.

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Studies show that patients do not follow one out of every three prescriptions written for psychiatric disorders. For many years, adherence rates have been as low as 50%.

There are a variety of new drugs with fewer side effects and, in some cases, greater effectiveness, but these medications are ineffective if patients do not take them.

One of the strongest predictors of outcome in psychiatry is adherence to pharmacological (medication) treatment. When patients do not adhere to their medication regimes, studies have shown that higher relapse rates occur, as does increased number and duration of hospitalisations.

Early discontinuation of antidepressant medication is associated with relapse and recurrence of depression. Violence in psychotic patients is strongly associated with the co-occurrence of medication non-compliance and substance abuse.

Why do people stop taking medication?
Studies have shown that medication-related issues, such as side effects and inappropriate doses, and environmental issues such as inadequate interpersonal support, transportation or money play a role.

When asked why they discontinued their medication, patients most frequently reported:

  • disliking side effects (62%)
  • believing medication was unnecessary (56%)
  • feeling better (50%)
  • believing the medication was not working (32%).

Elderly patients have distinct issues that influence medication adherence. These issues include:

  • difficulties reading medication labels
  • opening safety caps
  • understanding instructions
  • paying for expensive drugs

Additionally, many elderly patients are prescribed multiple medications and many suffer from dementia and/or depression.

How to combat the problem
All these reasons are addressable in treatment. Adherence can be improved by:

  • discussing the diagnosis
  • simplifying the medication regime
  • patient education about how long the medication takes to have effect, side effects to be expected, duration of side effects and the recommended duration of treatment
  • involving family members where appropriate
  • arranging follow-up appointments
  • inviting patients to call they experience problems

Cultural factors can also influence adherence. Curiosity about patients’ cultural beliefs and practices, as well as empathic understanding of their predicaments in culturally alien settings, can often help clinicians reduce or eliminate these barriers.

New cognitive techniques such as motivational interviewing help physicians examine medication priorities from the patient's perspective and elicit the patient's participation in selecting and adhering to treatment. Some evidence exists that patients who feel actively involved in choosing treatment alternatives are more likely to adhere to treatment.

Groups have also long been used to promote treatment adherence. Techniques vary from lectures to group psychotherapy and behavioural skills training. Self help groups have for many years provided education, support and advocacy for individuals with psychiatric illnesses and their families.

For more information contact the Depression and Anxiety Support Group at (011) 783-1474/6 or (011) 884-1797

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