It is thought that up to half of individuals with schizophrenia or bipolar disorder do not follow treatment recommendations. Non-adherence is associated with poor outcomes: the risk of psychotic relapse is increased by a factor of three to five and the risk of suicide nearly by four times . Studies of adherence therapy for schizophrenia have shown moderate or no effect on medication adherence, and none on symptom reduction or quality of life . Studies in bipolar disorder is very much inconclusive. Many factors might be responsible for poor adherence, an important one is what the individual think about treatment recommendations.
Susanne Gibson, Sarah L Brand , Sarah Burt, Zoë V R Boden and Outi Benson gathered information about how often, in what way, and why patients deviate from their treatment recommendations. 42 multiple choice and open ended questions were used to get the reasons related to a variety of prescribed possible ways of regulating their medication. 35 individuals with either schizophrenia or bipolar disorders receiving medications participated in this study.
Though 46% reported following recommendations exactly, 77% did something different to recommendations. 71% reported unintentional non-adherence. Nearly a third of service users did not take medication as recommended and were happy with their level of adherence.Those satisfied with current clinical support were more likely to be satisfied with medication as well. Being listened to and understood appears to be an important part of feeling supported. Where service users had discussed their non- adherence, this mostly resulted in a positive outcome.
The reasons given for following recommendations were perceived efficacy of medication in controlling symptoms and enabling wellness, and a desire to avoid negative outcomes, including relapse and negative social consequences.
Thematic analysis show that patients made decisions about their treatment recommendations in order to “live as well as possible “with the symptoms and the side-effects, with decision-making taking place in response to the demands of everyday living. Those who took more medication tended to frame their reasons in terms of managing symptoms; those who took less mediation tended to frame their reasons in terms of managing side-effects . Forgetting to take medications was common, but this was more related to remission of symptoms and/or being busy or generally engaged with everyday life .
Decision-making and behaviour tends to be in response to the day-to-day challenges and demands of living with a severe and enduring mental illness, rather than on longer term considerations. Many attempt to balance the symptoms and side effects. Understanding what recovery means for a patient requires an understanding of the everyday experiences that the person go through. Providing supportive clinical relationship is crucial in improving adherence.
Summary of the article:
Gibson S, Brand SL, Burt S, Boden ZV, Benson O. BMC Psychiatry. 2013 May 29;13:153