Coping with adherence problems in longterm psychiatric treatments

Adherence to the treatment regime is an important issue for all disciplinces of medicine but especially in Psychiatric treatments rate of treatment non- adherence especially high. Chronic psychiatric patients with psychotic symptoms (schizophrenia, bipolar disorder e.q.) treatment non-adherence is not an exception but as a rule. 80% of schizophrenic patients who were being treated as outpatients with, and up to 50% of bipolar patients will have trouble in compliance to drug regime. On the other hand physicians’ awareness of this condition is very low. in controlled trials 55% of clinicians’ estimates regard to drug compliance were found to be incorrect. The ineffectiveness of treatment, lack of insight, failure to establish a good therapeutic relationship, complex treatment regimens are the main causes of failure to comply with the treatment regimes. Among the factors associated with psychopathology craving for mania is an important factor in patients with bipolar diorder. On the other hand lack of insight is the most important factor in psychotic patients. Medication non adherence in patients with psychotic illness (bipolar or schizophrenic patients), has a very negative impact, on the disease process and cause to exacerbations and frequent hospitalizations. Factors associated with the clinician, the patient’s physician confidence in the patient, to listen, to understand, encouraging collaboration and open discussion of speech-pharmacological approach as a holistic approach to the patient than important. In this panel talk my main focus will be on lack of insight which is a most important and patient related factor in drug adherence. Motivational techniues and cognitive behavioral approach in combination can improve to adherence to treatment regime. I will also discuss how clinicians can handle this issue of non adherence with cognitive behavioral therapeutic techniques.