Adherence with Medication Treatment in Psychiatric Disorders

While pharmacological treatment is effective for a number of psychiatric disorders, medication adherence has been a clinical concern for a long time since nonadherence is a major cause of ineffectiveness. Ensuring medication adherence is particularly difficult in cases in which medication is taken to prevent the recurrence of symptoms. Given the preponderance of data supporting the high prevalence of medication nonadherence across all age, racial, and disease groups, health-care providers need to accept the reality that perfect medication adherence is unattainable and conduct regular assessments, including asking about the patients’ real-life barriers, feelings, beliefs, and attitudes regarding medication, all of which contribute to both unintentional and intentional nonadherence. These assessments are best performed in the context of a favorable therapeutic alliance. Maintaining a collaborative relationship is crucial, and the concept of concordance is gaining attention as a patient-centered advanced approach, which reflects patients’ preferences and values regarding medication regimens. This concept overlaps shared decision-making, which involves discussion and collaboration between patients and health-care providers. Evidenced-based interventions such as environment support, new technologies, and smartphone applications appear to be promising for the promotion of medication adherence and should be further investigated and implemented in treatment settings. This chapter describes measurement of medication adherence, the risk factors for nonadherence, and evidenced-based intervention strategies to improve adherence, along with descriptions of the related key concepts such as concordance, shared decision-making, and therapeutic alliance.