Adherence to Therapy in Multiple Sclerosis and Schizophrenia A Comparison of Adherence and Approaches for its Improvement in the Treatment of two Relapsing Chronic Diseases of the Central Nervous System

The extent, to which a patients behavior corresponds with agreed recommendations from a health care provider is described as "adherence". Although the concept of adherence is more and more addressed in the context of clinical studies, yet the relevant factors for adherence are hardly systematically examined in neurological and psychiatric diseases. In addition to various different published definitions of adherence, the sample periods constantly differ between publications, thus contributing to inconsistent data on adherence rates, e.g. in specific diseases. Taking the wide range of published data into account, it seems reasonable to assume an averaged adherence rate of 50 percent for patients suffering from schizophrenia and roughly 50-60 percent for multiple sclerosis (MS) patients. Approaches for improvements comprise psychoeducational programs and antipsychotic depot formulations in the therapy of schizophrenia. In the therapy of MS, MS nurse services have been established. In the therapy of schizophrenia, there exists limited positive evidence for the effectiveness of psychoeducational measures and depot formulations on adherence, but approaches for improving medication adherence are accessible only to a part of schizophrenic patients. The usefulness of MS nurse services and other measures for coping mechanisms in MS patients is acknowledged, but further research is preferable in order to optimize adherence supporting activities in this clinical field. In summary, adherence rates in both diseases are comparably low emphasizing a further need for the establishment and scientific evaluation of measures to improve adherence in MS and schizophrenia.