Review of clinical medication adherence in patients with schizophrenia

Abstract

Medication adherence in patients with schizophrenia is essential for managing symptoms, improving prognosis, and enhancing the quality of life. Despite the importance of adherence, it remains a global challenge. It is influenced by various factors, including symptom severity (e.g., excitement and impulse control disorders), attitudes towards medication (e.g., pharmacophobia), lack of social support, and the communication efficacy of healthcare teams. Regarding assessment tools, self-report questionnaires, such as the Morisky Scale, are common but subject to recall bias. Electronic monitoring devices (e.g., Medication Event Monitoring System) and pharmacy refill data offer more objective measures of adherence, whereas biomarkers, such as blood drug concentration monitoring, show promise under specific conditions but require further validation. Long-acting injectable antipsychotic medications have shown greater adherence benefits than oral medications. Psychological interventions such as motivational interviewing and mindfulness training, along with multidisciplinary team efforts, including psychiatrists, pharmacists, and psychotherapists, can significantly improve patient outcomes. Future research should integrate innovative drug formulations (e.g., long-acting, low-side-effect medications), digital health technologies (e.g., medication reminder apps and wearable devices), and supportive policies (e.g., community-based free medication services) as well as patient education to enhance disease awareness. However, the ethical and legal dilemmas (e.g., balancing patient autonomy with involuntary medication) and privacy concerns in technological applications require further exploration. In conclusion, enhancing medication adherence in patients with schizophrenia requires a personalized, multifaceted approach, and collaborative efforts across various sectors to achieve optimal clinical results and social functioning.

Keywords: Medication adherence; Schizophrenia; Long-acting injectable antipsychotics; Psychological interventions; Digital health technologies; Ethical-legal challenges

Core Tip: Medication adherence is critical for managing symptoms, improving prognosis, and enhancing quality of life in patients with schizophrenia. This article examines the multifaceted factors influencing adherence, including symptom severity, attitudes toward medication, social support, and healthcare team communication. It evaluates assessment tools such as the Morisky Scale, electronic monitoring devices, and biomarkers, while highlighting effective strategies like long-acting injectable antipsychotics, psychological interventions, and multidisciplinary team efforts. Future directions emphasize innovative drug formulations, digital health technologies, and supportive policies. However, ethical, legal, and privacy challenges require further exploration.