Poor adherence to drug treatment can have disastrous consequences for patients with mental illness. The aim of this project was to develop recommendations for addressing adherence problems to improve treatment outcomes. Important themes and questions were identified regarding medication adherence problems in serious mental illness that have not been fully addressed in the literature. A 39-question survey was developed asking about defining non-adherence, the extent of adherence problems in schizophrenia and bipolar disorder, risk factors for non-adherence, assessment methods and interventions for specific types of adherence problems. The survey was completed by 41 (85%) of the 48 experts to whom it was sent. The results of the literature review and the survey were used to develop recommendations for assessing and improving treatment adherence in patients with serious mental illness. The majority of experts believe that the average patient with schizophrenia or bipolar affective disorder takes only 51% -70% of prescribed medication in their practices. Experts concluded that weight gain is a side effect that is more likely to lead to medication adherence problems in patients with schizophrenia and bipolar affective disorder; while sedation was identified as a more important contributor to adherence problems in bipolar affective disorder. It is important to identify specific factors that may contribute to a patient's adherence problems in order to tailor interventions to address these problems. Experts recommended personalised interventions focused on causes.
The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness
19 December 2022