Noncompliance remains one of the greatest challenges when prescribing psychotropic medication and can render any treatment regimen wasteful and ineffective. While rates reported in studies of noncompliance vary widely, noncompliance can clearly increase treatment costs and prolong the duration of hospitalisation. Furthermore, noncompliance has a human cost in terms of morbidity and mortality. The reasons for noncompliance can be divided into 3 categories: medication-, patient- and provider-specific factors. Adverse effects are likely to be the most common reason for patients to not comply with prescribed medication regimens. Ineffectiveness, complexity of the regimen and cost are also important medication-related factors contributing to noncompliance. The use of newer effective medications that have fewer adverse effects, drug holidays and low-dose treatment strategies may ameliorate adverse effects. In addition, the aggressive treatment of adverse effects such as antipsychotic-induced extrapyramidal syndromes and akathisia and tricyclic antidepressant-induced anticholinergic effects can increase compliance. In some cases, the complexity of regimens and the cost of medications can be reduced. The symptoms of a psychiatric disorder, the presence of substance abuse, and culture and attitude are patient-specific factors that may interfere with compliance. Noncompliance related to patient attitudes can be remedied through improving the patient-provider relationship, using depot antipsychotics and possibly medicating patients by force of judicial orders. Treatment of dual diagnosis, greater understanding of a patient's culture and the involvement of families in treatment can all be used to foster increased compliance. Psychosocial rehabilitation can also help increase compliance. Noncompliance increases when practitioners' views of their patients' prognosis or the effectiveness of treatment differ from that of their patients. How physicians communicate and what information they present to their patients and families plays a significant role in determining compliance. Physicians who believe in the medications they are prescribing and actively involve their patients in treatment decisions are likely to increase compliance. Expressing an understanding, empathic and caring manner will further promote compliance. Compliance should increase when good and clear lines of communication exist and patients feel free to ask questions. Specialised treatment options that practitioners can use to increase compliance include education, cognitive behavioural interventions, behaviour modification techniques, and using direct rewards for compliance. Psychotherapy can also be used as a tool to improve the practitioner-patient relationship..
