Optimizing Adherence to Treatment in Patients with Schizophrenia: Based on an Interview with Jonathan Lacro, PharmD

Behavioral Healthcare Executive, August 2006 | Go to article overview

Optimizing Adherence to Treatment in Patients with Schizophrenia: Based on an Interview with Jonathan Lacro, PharmD


Antipsychotic medications have been shown to be effective in treating patients with schizophrenia. (1) But if these patients do not follow their prescribed medication regimens, their chances of successful treatment are severely diminished. (2,3) The following article, based on an interview with Jonathan Lacro, PharmD, examines some of the reasons patients with schizophrenia do not adhere to prescribed medication regimens and discusses ways to increase adherence rates. Dr. Lacro is a program manager and clinical pharmacist at the VA San Diego Healthcare System, a research scientist at the Veterans Medical Research Foundation, and an associate clinical professor of psychiatry at the University of Califomia, San Diego.

[ILLUSTRATION OMITTED]

Long-term adherence to antipsychotic therapy is the cornerstone of contemporary management of psychosis, and patients who stop therapy have a markedly increased risk of exacerbation of disease. (4) Patients with schizophrenia who take their medications as prescribed are much more likely to have positive outcomes, including a decreased likelihood of rehospitalization and better daily functioning and quality of life, compared with those who do not adhere to their prescribed medication regimens. (5) In an analysis of Medicaid refill and medical claims data collected in California between 1999 and 2001 (N=4,325), risk of hospitalization among patients with schizophrenia correlated significantly with gaps in medication adherence (see Figure 1). (6) Further, a review of the literature between 1995 and 2002 found that, for schizophrenia and for mental disorders generally, the most significant direct costs were related to hospitalization. (7) This was true for initial episode costs as well as for subsequent relapses. The authors concluded that poor adherence with medication treatment "is likely to result in an increased frequency of relapse, more intense symptoms, and longer inpatient stays." (7)

[ILLUSTRATION OMITTED]

Almost every patient with schizophrenia is at risk for relapse at some point. In a study of individuals who had responded to treatment for their first psychotic episode, up to 82% had at least one psychotic relapse within 5 years, and 78% had a second relapse within that time. (8) Patients who discontinued medication were almost five times more likely to relapse than patients who continued taking medication, whether it was the first or the second relapse. (8) Therefore, in addition to other treatments that have been prescribed for patients with schizophrenia, such as cognitive behavioral therapy and social skills training, it is essential for these patients to take their medications as prescribed.

Unfortunately, like many patients with psychiatric disorders, those with schizophrenia generally do not adhere well to their prescribed medication regimens. While rates of medication nonadherence may reach as high as 40% for patients with chronic medical conditions in general, (9) medication nonadherence rates in patients with schizophrenia can reach 50%. (10) In a recent study of Medicaid beneficiaries with schizophrenia, 24% were found to be nonadherent, 16% were partially adherent, and 19% were "excess fillers"--they received more days of medication than necessary for a given period. (11) Medication nonadherence refers to any deviation from the prescribed regimen. While the more common pattern involves skipping doses or not taking medication for several days or even weeks, some patients may actually take extra doses of medications. Excess medication fills may result from overuse of antipsychotics to reduce symptoms or from confusion about the dosing regimen. Excess fills also may occur when a patient receives prescriptions for antipsychotic medications from several healthcare providers who are unaware that the person is seeing other prescribers. Overuse of medications increases the risk of adverse events.

When discussing medication nonadherence among patients with schizophrenia, it is important to understand that there is no such thing as a "typical" patient with schizophrenia. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Optimizing Adherence to Treatment in Patients with Schizophrenia: Based on an Interview with Jonathan Lacro, PharmD
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.