Antipsychotic medications: compliance and attitudes towards treatment

Purpose of review A review of a number of selected reports published during one year, from September 2002, about compliance and attitudes towards antipsychotic medication revealed several clinical and research themes. Recent findings Adherence to antipsychotic medications in schizophrenia continues to be a significant and challenging question in terms of its prevalence as well as its significant impact on the rate of relapse and resource utilization. Most of the published reports, again, confirm the significant contribution of attitudes towards treatment and its impact on adherence and clinical outcomes. Negative critical attitudes can be enduring and may require specific targeted behavioural interventions in addition to optimization of medication-based treatment. Systematic reviews and a meta-analysis of various approaches to enhance adherence with medications in schizophrenia have yielded inconsistent results, reflecting the many shortcomings of the studies included in the review and meta-analysis. Most of the interventions tend to be rather complex and resource-intensive. One of the consistent findings has been the lack of impact of approaches based on psychoeducation alone, without the additional behavioural, family and economic support. Not only does the content of any adherence intervention approach seem to be important, but the time-course of outcome evaluation is also relevant. The need for 'booster therapy' seems to be important for maintaining some of the beneficial effects of adherence-improvement therapies. Summary Although second-generation antipsychotics are better tolerated subjectively than first-generation antipsychotics, their impact on adherence behaviour and improved attitudes towards treatment has not yet been systematically demonstrated in well-controlled studies. Similarly, differences between individual second-generation antipsychotic medications, in terms of impact on adherence behaviour, need to be explored.