Medication Adherence Among Psychotic Patients Before Admission to Inpatient Treatment

Promoting insight seems to be the most important lesson from our study, given that patients who gained insight had a much more favorable course in terms of hospitalization during the next year. Psychoeducation seems to hold some promise (45), yet effect sizes in terms of improvement in insight or adherence are mostly modest (8,46). Beyond this we are convinced that improvement in insight and further adherence is not only a matter of distinct treatment techniques but also a matter of convincing patients that the therapeutic efforts are aimed at achieving the very best outcomes for them, which requires a broad array of interventions and attitudes. Clearly there is much more research to be done, and further improvement in quality of treatment facilities is warranted.

Nonadherence has not only therapeutic implications but also important economic ones. Considering together both patients with poor adherence and patients who were adherent but whose dosage was too low, 71 percent had no adequate therapy before admission. There is much room for improvement given that patients who are receiving a sufficient dosage of antipsychotics have only about a fifth the risk of relapse of patients who are not taking antipsychotics (47). Weiden and Olfson (48) estimated that the costs of hospitalization due to nonadherence amounted to $800 million in the United States in 1993 dollars. Improving adherence is thus not only a therapeutic challenge but also a rewarding goal for both therapeutic and economic reasons.