Facilitating Compliance With Antipsychotic Medication

Noncompliance with medication is common among patients who have schizophrenia and is a leadingcause of rehospitalization in this population. Both standard and subjective risk-factor assessmentshave been used to identify patients who are likely to refuse or discontinue treatment. Noncompliantpatients who have schizophrenia commonly have been treated with potent D2 dopamine-receptor antagonistsand therefore may have experienced extrapyramidal side effects. The newer antipsychotics(i.e., serotonin-dopamine antagonists) are efficacious in reducing the symptoms of schizophreniawithout associated dysphoria and motor side effects. Clozapine and other newer antipsychotics mayimprove certain aspects of cognition. The improved psychiatric state and cognitive function may facilitate"involved compliance" as a result of increased insight, awareness, and judgment. These cognitivefaculties allow patients to appreciate their improved state and take steps to maintain it. The periodicvisits for blood monitoring mandated for clozapine therapy also facilitate the formation of atherapeutic alliance that allows the clinician to monitor compliance. Facilitating involved compliancethis way among patients who have schizophrenia may reduce the cost of this disorder to society.