The Impact of Nonadherence in the Management of Schizophrenia

DR. ALVA: Shifting over to talk about management, as providers our top goals when it comes to treating our adult patients with schizophrenia include delaying time to relapse and improving their functioning.

As we both know, the typical treatments for schizophrenia are antipsychotic medications, with oral medications being an important first-line therapy, demonstrating efficacy in up to 80% of adult patients with schizophrenia. However, I want to point out that these results are often hindered by a high rate of non-adherence, with estimates that approximately half of adult patients are not taking their medication as prescribed. And that percentage may be even higher, according to market research.

In this survey, 200 healthcare professionals responded that only 37% of their adult patients with schizophrenia receiving a daily oral therapy were adherent over a 6-month period, meaning they took 80% or more of their medication as scheduled. Additionally, on average, those HCPs believed their adult patients on a daily oral medication for their schizophrenia missed 7 doses per month, which can cause potential problems.

MATTHEWS: The prevalence of non-adherence is important to highlight, in part because it is one of the main predictors of a future relapse, but also, because LAIs are administered by healthcare professionals, treatment teams have greater insight into when an adult patient has missed a dose and can therefore provide additional support to get them back on therapy.

Risk factors for non-adherence are broad and complex and, of course, vary patient to patient. They can include a fear of side effects, perceptions about treatment, financial difficulties, education level, stigma, poor social support systems, and certain psychopathological symptoms associated with schizophrenia, such as delusions and impaired insight.

How a medication is administered can also affect adherence. For example, oral therapy non-adherence can take shape in different ways, such as deviating from the prescribed schedule, taking the incorrect dose, or discontinuing treatment without an HCP’s knowledge.

DR. ALVA: You’re so right, Desiree. In my personal experience, I’ve noted that a lot of adult patients often times, you know, think lightly of missing 1, 2, 3, 4 doses. But, even a couple of doses missed can really derail the process and evoke, you know, some hardships that people don’t necessarily take into consideration, even more so with a serious mental condition like schizophrenia. Your thoughts?

MATTHEWS: Many of us, even without schizophrenia, we tend to miss that mark with adherence. But in individuals and adults living with schizophrenia, the consequence of nonadherence is great. We’re seeing potential for increase in relapse, and these repeated cycles of crises and reoccurrence of symptoms that ultimately can really negatively affect their future outcomes and their functioning day-to-day.

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