Tackling nonadherence in psychiatric disorders: current opinion

Saeed Farooq,1,2 Farooq Naeem3 1Staffordshire University, Staffordshire, UK; 2Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan; 3Department of Psychiatry, Queen's University, Kingston, Ontario, Canada Abstract: Nonadherence to treatment is a major challenge in all...

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Autores principales:	Farooq S, Naeem F
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/59a497cf77ea46fc92086f97c2ce6253
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spelling	oai:doaj.org-article:59a497cf77ea46fc92086f97c2ce62532021-12-02T01:24:41ZTackling nonadherence in psychiatric disorders: current opinion1178-2021https://doaj.org/article/59a497cf77ea46fc92086f97c2ce62532014-06-01T00:00:00Zhttp://www.dovepress.com/tackling-nonadherence-in-psychiatric-disorders-current-opinion-a17186https://doaj.org/toc/1178-2021 Saeed Farooq,1,2 Farooq Naeem3 1Staffordshire University, Staffordshire, UK; 2Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan; 3Department of Psychiatry, Queen's University, Kingston, Ontario, Canada Abstract: Nonadherence to treatment is a major challenge in all fields of medicine, and it has been claimed that increasing the effectiveness of adherence interventions may have far greater impact on the health of the population than any improvement in specific medical treatments. However, despite widespread use of terms such as adherence and compliance, there is little agreement on definitions or measurements. Nonadherence can be intermittent or continuous, voluntary or involuntary, and may be specific to single or multiple interventions, which makes reliable measurement problematic. Both direct and indirect methods of assessment have their limitations. The current literature focuses mainly on psychotic disorders. A large number of trials of various psychological, social, and pharmacologic interventions has been reported. The results are mixed, but interventions specifically designed to improve adherence with a more intensive and focused approach and interventions combining elements from different approaches such as cognitive-behavioral therapy, family-based, and community-based approaches have shown better outcomes. Pharmacologic interventions include careful drug selection, switching when a treatment is not working, dose adjustment, simplifying the treatment regimen, and the use of long-acting injections. The results for the most studied pharmacologic intervention, ie, long-acting injections, are far from clear, and there are discrepancies between randomized controlled trials, nationwide cohort studies, and mirror-image studies. Nonadherence with treatment is often paid far less attention in routine clinical practice and psychiatric training. Strategies to measure and improve adherence in clinical practice are based more on personal experience than on research evidence. This overview focuses on strategies used for improving treatment adherence in psychiatric disorders in the light of current evidence, with emphasis on public health aspects of treatment adherence and the management of nonadherence in routine clinical practice. Keywords: depression, anxiety, psychosis, compliance, drug treatment, clinical practiceFarooq SNaeem FDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2014, Iss default, Pp 1069-1077 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Farooq S Naeem F Tackling nonadherence in psychiatric disorders: current opinion
description	Saeed Farooq,1,2 Farooq Naeem3 1Staffordshire University, Staffordshire, UK; 2Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan; 3Department of Psychiatry, Queen's University, Kingston, Ontario, Canada Abstract: Nonadherence to treatment is a major challenge in all fields of medicine, and it has been claimed that increasing the effectiveness of adherence interventions may have far greater impact on the health of the population than any improvement in specific medical treatments. However, despite widespread use of terms such as adherence and compliance, there is little agreement on definitions or measurements. Nonadherence can be intermittent or continuous, voluntary or involuntary, and may be specific to single or multiple interventions, which makes reliable measurement problematic. Both direct and indirect methods of assessment have their limitations. The current literature focuses mainly on psychotic disorders. A large number of trials of various psychological, social, and pharmacologic interventions has been reported. The results are mixed, but interventions specifically designed to improve adherence with a more intensive and focused approach and interventions combining elements from different approaches such as cognitive-behavioral therapy, family-based, and community-based approaches have shown better outcomes. Pharmacologic interventions include careful drug selection, switching when a treatment is not working, dose adjustment, simplifying the treatment regimen, and the use of long-acting injections. The results for the most studied pharmacologic intervention, ie, long-acting injections, are far from clear, and there are discrepancies between randomized controlled trials, nationwide cohort studies, and mirror-image studies. Nonadherence with treatment is often paid far less attention in routine clinical practice and psychiatric training. Strategies to measure and improve adherence in clinical practice are based more on personal experience than on research evidence. This overview focuses on strategies used for improving treatment adherence in psychiatric disorders in the light of current evidence, with emphasis on public health aspects of treatment adherence and the management of nonadherence in routine clinical practice. Keywords: depression, anxiety, psychosis, compliance, drug treatment, clinical practice
format	article
author	Farooq S Naeem F
author_facet	Farooq S Naeem F
author_sort	Farooq S
title	Tackling nonadherence in psychiatric disorders: current opinion
title_short	Tackling nonadherence in psychiatric disorders: current opinion
title_full	Tackling nonadherence in psychiatric disorders: current opinion
title_fullStr	Tackling nonadherence in psychiatric disorders: current opinion
title_full_unstemmed	Tackling nonadherence in psychiatric disorders: current opinion
title_sort	tackling nonadherence in psychiatric disorders: current opinion
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/59a497cf77ea46fc92086f97c2ce6253
work_keys_str_mv	AT farooqs tacklingnonadherenceinpsychiatricdisorderscurrentopinion AT naeemf tacklingnonadherenceinpsychiatricdisorderscurrentopinion
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Tackling nonadherence in psychiatric disorders: current opinion

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