Interventions to improve oral medication adherence in psychosis: the role of adherence measurement

The benefit of psychotropic medication in the treatment of psychotic disorders depends on patients taking the medication as prescribed. Medication nonadherence is high among individuals with psychotic disorders, leading to substantial disability, relapse and health care costs. The current article reviews the efficacy of interventions to improve adherence with oral medications among individuals with psychotic disorders, paying special attention to the quality of adherence measurement used in the studies. As in previous reviews, most of the 43 studies included in this review used subjective measurement of adherence. Across studies, findings suggest that interventions that do not specifically target medication adherence are unlikely to improve this domain, even if they are delivered in high dosage, such as in case management models. Evidence regarding the benefit of low-intensity interventions that specifically target medication adherence (including cognitive motivational approaches) remains fairly weak. Most positive studies in this category use subjective measurement, which may lead to overestimation of benefit. Finally, newer research suggests that individualized environmental supports delivered through home visits may improve medication adherence. More research is needed using objective measurement approaches, and evaluating lower intensity treatments using environmental supports, behavioral principles and strategic problem solving.