Adherence to psychotropics
Adherence describes the extent to which a patient’s behaviours (when it comes to taking medicines or participating in other treatments) align with the treatment regimen agreed with their clinician. Deviation from treatment regimens, whether intentional or unintentional, is referred to as nonadherence. High rates of treatment nonadherence have been reported with psychotropics. Nonadherence to psychotropics increases the risk of relapse, hospitalisation, poor quality of life and suicide.
Adherence is more likely when clinicians and patients have a good working relationship and jointly participate in deciding on treatment regimens—use shared decision making. Ensure the patient understands the potential advantages of adhering to their treatment regimen and the potential disadvantages associated with treatment nonadherence (eg prematurely reducing or stopping treatment). Involving a local mental health team or patient outreach service can help promote adherence.
If treatment nonadherence is identified, raise the issue with the patient in a nonconfrontational manner. Explore the factors that are contributing to treatment nonadherence and implement individualised strategies to improve treatment adherence (see Addressing factors that contribute to nonadherence to psychotropics). Treatment adherence may be monitored by:
- involving a local mental health team or patient outreach service to actively monitor adherence
- checking adherence to drug regimens by tablet counts or by noting the regularity of prescriptions
- measuring drug blood concentration where feasible12.
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Factors that contribute to nonadherence to psychotropics |
Strategies to address nonadherence to psychotropics |
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disagreement between the clinician and patient about the need for treatment or likely benefit |
explore patient’s beliefs about medication; use a shared-decision making approach if the patient consents, involve family, carers or significant others in discussions as appropriate |
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a poor patient–clinician relationship |
establish a positive, trusting, collaborative relationship between the patient and clinician |
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stigma |
address anticipated or perceived stigma around taking medication with motivational or supportive therapy |
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patient understanding about the reason for using medication, the dosing regimen, duration of treatment and expectations of treatment |
promote understanding by:
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conflicting advice about the need for, and potential benefits and harms of, treatment from other healthcare practitioners, family, carers, friends or other sources |
anticipate sources of conflicting advice and discuss these with the patient, and others as appropriate involve a pharmacist ensure continuity of care encourage communication between people involved in the patient’s treatment, including healthcare practitioners, family, carers and significant others |
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adverse experiences with drug treatment (eg adverse effects) or healthcare services |
listen to the patient, acknowledge their experiences and discuss options before starting treatment, advise the patient of potential adverse effects and withdrawal effects [NB1] and, when relevant, how they can be prevented regularly assess for adverse effects, including asking about sexual or other potentially embarrassing adverse effects, and manage as relevant [NB2] |
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financial barriers to accessing treatment |
explore and address financial barriers to access |
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features of the patient’s psychiatric disorder (eg concentration and memory difficulties, paranoia, low motivation) or comorbidities such as problem substance use, and medical disorders or their sequelae (eg low visual acuity, hearing loss, arthritis, limited mobility) other lifestyle or social factors (eg chaotic lifestyle, work demands, homelessness, inadequate follow-up, poor social supports) |
address barriers, as relevant, by:
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complex treatment regimen |
simplify treatment regimens by:
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confusion regarding generic and brand names of drugs |
inform the patient about generic and brand names of drugs provide written consumer medicine information |
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limited health literacy or cultural and language barriers |
promote health literacy through education use appropriate language use interpreters if required utilise culturally appropriate health care providers provide written consumer medicine information in the patient’s first language |
Note:
NB1: For information on antidepressant adverse effects, see here. For information on antipsychotic adverse effects, see here. NB2: For a suggested schedule for monitoring antipsychotic adverse effects, see ../Antipsychotic-adverse-effects/c_ptg8-c73-s1.html#ptg8-c73-s1__tptg8-c73-tbl4. | |