Medication Adherence in Schizophrenia

This assignment delves into the critical topic of medication adherence within the context of schizophrenia. It examines various factors influencing adherence, including patient perspectives, healthcare provider roles, and the impact of non-adherence on treatment outcomes. The provided research papers offer insights into the complexities of this issue and highlight strategies for enhancing adherence in patients with schizophrenia.

Running head: FACTORS THAT COMPLICATE ADHERENCE TO MEDICATION 1
Factors That Complicate Adherence to Medication
Student’s Name
University Affiliation

FACTORS THAT COMPLICATE ADHERENCE TO MEDICATION 2
Introduction
This essay explores health factors that might complicate a mentally ill person from not
complying to a prescribed medication. It focuses on a case scenario of George ‘a 27- year old
male patient who has had multiple admissions in the past to a local acute mental health service.
He (George) is admitted to an acute unit on assessment order due to his non-adherence to
Risperidone, a medication he has been prescribed to treat Schizophrenia.’ In earlier past, George
has been diagnosed with Schizophrenia, a condition he has not agreed with nor being
comfortable with that is why he “prefers to use cannabis to treat his condition rather than the
pharmacological medication prescribed by his psychiatrist.” Schizophrenia is a severe mental
illness that affects how a person thinks, manages emotions and relate to others (Minzenberg &
Carter, 2012). Although there are different treatments to patients with Schizophrenia, George is
prescribed Risperidone, an antipsychotic medication usually taken daily either in syrup or pill
form. George has failed to comply with the medication because he believes cannabis works in his
favour than Risperidone. According to Minzenberg and Carter, (2012) adherence to medications
is vital for the alleviation of psychotic symptoms associated with schizophrenia such as distorted
thoughts, paranoia, hallucinations and feelings of fright.
Factors that Might Complicate George’s Compliance to Medication
Non-adherence to medication is a complex as well as a multidimensional health care
challenge that has been witnessed by George during healthcare delivery. Gearing et al., (2011)
holds that the decision on whether to take prescribed medications or not by the people with
schizophrenia is a hard phenomenon involving different patients plus medication related facets.

FACTORS THAT COMPLICATE ADHERENCE TO MEDICATION 3
For the patient related factors, they include population characteristics such as drug and substance
abuse as it is evident in the case of George using Canabis, alcohol dependence, those newly
starting the treatment, younger age at the outset of illness, and low-level involvement in the
social activities (Gearing et al., 2011). Another great contributor to poor adherence to medication
is a membership to the minority ethnic sects. Belief about illness and treatment are also other
crucial factors that determine adherence to medication. For instance, adherence to medicines is
higher among individuals with schizophrenia who are insightful and aware of the purpose of
drugs to alleviate symptoms of an illness or shun from being admitted to the hospital. This is
evident in the case scenario where George prefers to user cannabis than the recommended
medication. According to him, he believes that cannabis can suppress pain and be used to cure
illnesses rather than the prescribed Risperidone. Also the attitude towards mediation and belief
that medications are much effective in lowering symptoms is another aspect that contributes to
adherence to medicines. Intolerable symptoms and side effects are another health factors that
might complicate George’s compliance to the prescribed medication. For instance, adverse
effects due to antipsychotics such as prolactin levels sedation and extra pyramidal symptoms are
somehow problematic. On the other hand, adverse metabolic effects of typical antipsychotics
such as an increase in body mass index also contribute to non-adherence to medications (Teter et
al., 2011). According to research, understanding the benefits of taking medication to alleviate
problematic psychotic symptoms helps to improve willingness to allow the side-effects burden
for mental wellness.
Lots of research holds to the fact that the need for strong plus active therapeutic relations
is vital for the promotion of adherence to medication. Other studies also suggest that therapeutic
alliance is highly connected to medication adherence among the persons with Schizophrenia. On

FACTORS THAT COMPLICATE ADHERENCE TO MEDICATION 4
the same note, other studies suggest that lack of adherence to medication among people increases
with the low level of therapeutic alliance among individuals with schizophrenia (Subotnik et al.,
2011). Research also points out that mentally ill people value help from pharmacologists about
medication especially when they provide them with information concerning the adverse effects
of the drugs show a good understanding of the person’s perspective as well as listens to the
patient’s grievances regarding the medication (Velligan et al., 2010). Also, the experience of
admission to the health centers is another crucial factor that determines willingness to take
medics; lack of involvement in decision making when treating the patients, negative pressure
when entering the health centers and the aspect of coercion are all connected to the lack of
adherence to medications as Velligan et al, (2010) suggests.
Studies also show that people having ‘a small extent of illness awareness’, as well as of a
disease are much likely to demonstrate poor/lack of compliance to medication. Moreover, beliefs
and perceptions towards adhering to drugs is also based on earlier experiences, socioeconomic
and cultural aspects are also associated with lack of compliance to medication. According to
Dunbar-Jacob et al., (2012) “these factors may result in the fact that the younger the age, the
earlier the age of onset of schizophrenia and the shorter the lifespan of illness, the poorer the
compliance rates become.”
Nursing strategies to assist George Gain better adherence to his prescribed
medication
The problem of patient’s non compliance to medication has been widely researched and
the rates of lack of compliance have not changed much for the past decades (Australian, 2017).

FACTORS THAT COMPLICATE ADHERENCE TO MEDICATION 5
For the case of George, Nurse should adopt the following strategies to help him gain better
compliance to medication.
1. Simplifying regimen characteristics.
Although patients usually misinterpret medication instructions, nurses should use simple
language and have the patient repeat the instructions for proper understanding (Gearing et al.,
2011). For the case of George, the nurse can use compliance aids to assist him organize his
medication such as medication boxes and alarms to recall dosage times. The Nurse can also use
microelectronic kit to know whether George has been taking the drugs as per the prescription.
Patients like can also use instruments made to boost physical dexterity especially when
administering injections.
2. Imparting crucial knowledge
According to research, many patients do not understand prescription instructions and usually
forgets lots of what their nurses tell them. To solve this problem, the nurse should provide
George with education by limiting instructions to key points in every discussion, and use simple
language particularly when giving instructions or explaining diagnosis. Another key thing here
would be to involve George’s Family and friends as well as emphasize on the key points
discussed.
3. Modify Patients Beliefs/human behavior
For complex interventions that require lifestyle changes, it is vital to address the patient’s
intentions, beliefs, and the ability to perform an action. This is due to the fact that knowledge is
not enough to boost compliance in recommendations pertaining complex behavior change
(Bosworth et al., 2011). The nurse would optimize George’s behavior change by ensuring that

FACTORS THAT COMPLICATE ADHERENCE TO MEDICATION 6
he perceives his medical condition to be serious, have channels to address his fears/concerns and
see him as having requisite skills needed to perform health behavior.
4. Evaluating adherence
Ideally, physicians underestimate the issue of lack of compliance in patients. When a nurse
cannot detect non compliance, it becomes difficult for her to correct the problem. Therefore, it
becomes hard to measure as well as evaluate patient’ compliance reliably. The nurse can achieve
this through self –reports, drug counting as well as urine and serum drug levels. Moreover, the
physician should ensure regular examination of the patient to increase his adherence to
medication.
5. Counseling
A comprehensive dialogue of the merits and demerits of a prescribed medication during patient’s
consultation is regarded as the foundation for the growth of medication compliance (Di Matteo et
al., 2012). In this case motivational interviewing can be very helpful to frame a discussion of the
patient’s fears, treatment rationale and social pressure. Hardeman et al., (2010) holds that the
value of the patient’s choice need to be strengthened and rules for the pills consumption be in
written formats. Moreover, the aspect of reminders also comprises of the patient’s family, the
nurse and the pharmacologist. A patient needs not to be given the information alone about the
effects of a certain medication, the dosage and time of intake, but also be provided with
information regarding the meaning as well as chances of side effects and interactions (Gearing et
al., 2011). Compliance to medication needs to be discussed every time the patient goes back to
the therapist as much as possible. For example, this can be done by requesting the patients to
submit the medical joint boxes for discussion and joint inspection. Studies have shown that
forgetfulness is an integral element leading to lack of compliance. This is an explanation for the

FACTORS THAT COMPLICATE ADHERENCE TO MEDICATION 7
study that many effects of counseling are transient and the challenge is to implement continuous
counseling technique. According to Di Matteo et al., (2012) telephone counseling as a measure
to boost medication compliance has been shown very useful in a two-year randomized controlled
trial in more than 400 non-adherent patients receiving four or more drugs prescribed for the
treatment of a chronic disease
6. Therapeutic approaches
Successful treatment is all about engaging the patients in a healthcare process according to their
psychiatric diagnosis as well as cognitive level. The five A’s of a basic outpatient care are
approachability, availability, appropriateness, affordability, acceptability. According to Bubalo et
al., (2010) caring for a person with a chronic condition cannot happen unless a health care officer
is readily accessible. Afternoon hours may work well for patients who do not prefer morning
visits especially when circadian rhythms are not properly aligned. In case the nurse is not
approachable, he cannot be successful in handling patients intimate plus complicated mental
disorders over a long time (Bosworth et al., 2011). Besides, it is hard to establish a beneficial
alliance when the patient finds it hard to see the physicist.
Conclusion
The chronic aspect of mental illnesses like schizophrenia calls for a regular engagement
between the person with schizophrenia and the treatment staff. Transparency when sharing
information, communicating or involvement in decision making is critical to the establishment of
treatment decisions that can help a patient in his/her personal goals. Since nurses are some of the
most trusted healthcare professionals, skills and expertise at soliciting client’s beliefs and
perceptions for a plan of care are vital, and psychiatric healthcare staff are in the utmost position

FACTORS THAT COMPLICATE ADHERENCE TO MEDICATION 8
to educate the patients about the need for shared decision making in conjunction to the
prescribing pharmacologist. Most importantly, helping a schizophrenia person identify his/her
medicine, choose targeted psychological interventions as well as select a medication that best
suits his lifestyle and objective are some of the strategies that can boost adherence to medication.
In the case study presented, George admitted to not taking the prescribed antipsychotic
Risperidone. In an attempt to treat his conditions he (George) chose to use cannabis which he
was positive it could cure his condition. All in all, psychiatric health officers and
pharmacologists need to educate people with schizophrenia about the need for adherence to
medication.

FACTORS THAT COMPLICATE ADHERENCE TO MEDICATION 9
REFERENCES
Australian, R. (2017). Royal Australian and New Zealand College of Psychiatrists clinical
practice guidelines for the treatment of schizophrenia and related disorders. Australian &
New Zealand Journal of Psychiatry.
Bosworth, H. B., Granger, B. B., Mendys, P., Brindis, R., Burkholder, R., Czajkowski, S. M., ...
& Kimmel, S. E. (2011). Medication adherence: a call for action. American heart journal,
162(3), 412-424.
Bubalo, J., Clark, R. K., Jiing, S. S., Johnson, N. B., Miller, K. A., Clemens-Shipman, C. J., &
Sweet, A. L. (2010). Medication adherence: pharmacist perspective. Journal of the
American Pharmacists Association, 50(3), 394-406.
Gearing, R. E., Townsend, L., MacKenzie, M., & Charach, A. (2011). Reconceptualizing
medication adherence: six phases of dynamic adherence. Harvard review of psychiatry,
19(4), 177-189.
Hardeman, S. M., Harding, R. K., & Narasimhan, M. (2010). Simplifying adherence in
schizophrenia. Psychiatric Services, 61(4), 405-408.
DiMatteo, M. R., Haskard-Zolnierek, K. B., & Martin, L. R. (2012). Improving patient
adherence: a three-factor model to guide practice. Health Psychology Review, 6(1), 74-
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Dunbar-Jacob, J., Schlenk, E., & McCall, M. (2012). 12 Patient Adherence to Treatment
Regimen. Handbook of health psychology, 271.
Minzenberg, M. J., & Carter, C. S. (2012). Developing treatments for impaired cognition in
schizophrenia. Trends in cognitive sciences, 16(1), 35-42.

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Subotnik, K. L., Nuechterlein, K. H., Ventura, J., Gitlin, M. J., Marder, S., Mintz, J., ... & Singh,
I. R. (2011). Risperidone nonadherence and return of positive symptoms in the early
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Teter, C. J., Falone, A. E., Bakaian, A. M., Tu, C., Öngür, D., & Weiss, R. D. (2011). Medication
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