Treatment Adherence Copy

Maintenance medication is associated with significantly lowered relapse rates but non-adherence to medication occurs in about half of all individuals with psychosis. Lack of insight, negative beliefs about the effects of medications, stigma, and side effects are major contributors to non-adherence. Use of the lowest possible dose of medication improves adherence by minimizing side effects.

Some Common Treatment Adherence Issues include:

• Does not believe one has a psychiatric disorder
  • Exploration of the client’s conceptualization of what they experienced
  • Having the individual discuss the negative impacts and social consequences that resulted from this experience
  • Reframing these negative consequences as the need for continuing with treatment
• Fears about lifelong illness
  • Inspire hope for recovery (e.g., by connecting the person with recovered role models)
  • Avoid premature “sentencing” of person to lifelong treatment and discuss possible plans and timeframe for eventual cessation
• Stigma about taking medication and peer pressure (do not take anything unnatural)
  • Address stigma and misconceptions about the illness and treatment
• Medication side effects or fears about side effects
  • Give information needed to recognize side effects
  • Involve the family and siblings in information session to gain their assistance
  • Use the lowest effective dose
  • Be open to negotiating treatment that minimizes side effects
• Perception that the medication does not work
  • Help the person see the relationship between improvements and medication
  • Family plays a key role in the identification of improvements
  • Teach communication strategies on how to monitor improvements (e.g., mood charts)
  • Monitor whether medication does in fact work
  • Address the possibility of relapse and the importance of avoiding relapse or minimizing its duration
  • Complete a relapse prevention plan
• “Feeling better”
  • Help the person anticipate this feeling and see the need to maintain treatment
  • Consider patient suitability for intermittent targeted approach to medication
• Complexity of treatment taking
  • Minimize polypharmacy
  • Use behavioural strategies, reminders, and environmental cues (e.g., keeping medication next to the bed, using weekly pill boxes) to help the individual remember to take the medication
  • Engage the family members in aiding with memory cues and strategies for normalizing this activity
  • Suggest that the client/family discuss with their family doctor and their local pharmacist strategies on ensuring medication is available and well managed
• Missing the euphoric mood
  • Remind the person of the deleterious consequences of the behaviours that accompany the elated mood
  • Explore safer activities that promote mood elevation