The challenges and consequences of non-adherence to treatment in schizophrenia, and some novel ways to address these, were the subject of a fascinating discussion between Prof John Kane, and Dr Ralph Aquila at ECNP.
Being human: non-adherence is normal, but the consequences are profound
The costs of schizophrenia and non-adherence to medication are profound
Both speakers agreed that the burden of schizophrenia itself, and of non-adherence to medication, are high. Dr Aquila (Fountain House, New York, USA) discussed the individual and public-health costs of schizophrenia. Schizophrenia can have profound consequences for the individual – in terms of their relationships, ability to work, living environment, stigmatization and long-term well-being. There are also public health costs associated with schizophrenia and in particular relapse, including direct medical costs associated with rehospitalization and need for social services. These costs contrast with a relative lack of support for this disorder in the general population, both in recognition of the disease and its consequences, and in allocation of resources.
Around 50% of patients taking medication will be non-adherent
Prof Kane (The Zucker Hillside Hospital, New York, USA) described non-adherence to antipsychotic medication as the elephant in the room – mostly unacknowledged. In the past, physicians have simply assumed patients will take their medication as prescribed. However, we know that around 50% of patients taking medication will be non-adherent. This is not a failing on the part of the patient, he pointed out, it is simply human nature to have trouble remembering to take medications regularly. However, a large proportion of hospitalizations of patients with schizophrenia are a result of poor or non-adherence. Moreover, each relapse can result in a slower recovery, accumulation of disease burden, the evolution of treatment resistance, a loss of self-esteem, and the potential for psychosocial consequences such as relationship breakdown and homelessness.
Remembering to take medication was my problem .I guess I remembered 40-50% of the time. Going on a LAI boosted that to 95%+ at my old address . Since being here, with the nurse coming to me , compliance is 100%.