Identifying - and Resolving - Compliance Issues
People with schizophrenia often have difficulty regularly taking their psychiatric medication, despite studies suggesting the great potential benefits of compliance to medication regiments. This issue is not limited to patients with psychotic disorders; in fact, several studies have found that a significant percentage of people with diabetes, heart conditions and neurologic disorders fail to take their medication regularly. The result is that these individuals end up in poorer health overall.
Research suggests that the picture is even worse in individuals suffering from mental illnesses. Approximately half of patients with depression and schizophrenia stop taking their medication as directed after three-six months. Patients undergoing treatment for non-psychiatric disorders, on the other hand, typically uphold a 75% compliance rate.
One common problem with compliance in schizophrenia is that many patients suffer from paranoia. This symptom is not well understood and can manifest itself in several peculiar ways. A person suffering paranoia may feel like there are people outside their door trying to break in. Some patients believe a government agency is spying on their every move. I have had patients who were concerned that the people they viewed on the television set were going to come out of the screen and try to kill them. Another way paranoia manifests itself is that a person may feel they are being poisoned. This particular form of paranoia can be a huge barrier to treatment, as the patient may categorically refuse to take any medication at all. Incidentally, this symptom can improve dramatically with medication, and the patient can come to understand that the antipsychotic medication is what's keeping him or her lucid. But if one or two dosages are missed, the paranoia can return and the patient may stop their medication altogether.
Several strategies have been used to improve compliance in patients with psychotic disorders. Educational interventions seem to be helpful, particularly when they are combined with supportive services and reinforcement techniques like a voucher or reward system. This system works best when there is frequent contact with a mental health worker. Sometimes it may be necessary for a patient to have a daily visit to a nurse, doctor, social worker or psychiatrist, in order to maintain compliance.
Patients today have the benefit of newer antipsychotic medications that tend to have fewer side effects. These newer medication have been shown to result in greater compliance. Additionally, several antipsychotic medications have a depot form which can be very useful for patients who have difficulty taking medications daily. Depot medications come in forms that require once-weekly or once-monthly injections. These options can profoundly improve a patient's compliance and well being. If you or a loved one have difficulty taking medication as prescribed, it's in your best interest to talk to the prescribing physician about alternative medication or alternative routes of administration.