Medication adherence in schizophrenia

Table 1 Adherence evaluation methods

Direct	Indirect
Detection of the drug or drug metabolites	Objective
Direct observation	Tablet count
	Electronic monitoring
	Pharmacy records
	Subjective
	Psychometric scales
	Questioning the patient
	Questioning the relatives
	Clinical judgment

Table 2 Identified risk factors for non-adherence by patients with schizophrenia

Patient-related risk factors

Sociodemographic factors

Younger and older patients

Male

General clinical factors

Drugs or alcohol consumption

Previous non-adherence

Psychopathological symptoms

Impaired insight

Cognitive deficiency

Delusion of persecution, poisoning or grandeur

Psychotic symptoms

Negative symptoms

Psychological factors: attitudes, beliefs and other subjective aspects

Negative attitude toward the treatment

Negative subjective response to treatment

Regarding the disease as mild and/or perceived minor benefit from treatment

Shame or stigmatization associated with the medication or the disease

Environment-related risk factors

Poor social and familial support

Negative social perception of the disease

Stigmatization

Difficulty accessing healthcare services

Physician-related risk factors

Poor relationship with the therapist

Poor psychoeducation and information to patients and relatives

Poor contact with the therapist

Inadequate planning of the post-discharge period

Treatment-related risk factors

Ineffectiveness against persistent symptoms (psychotic and negative symptoms)

Fear of adverse effects

Complex medication schedule

Poorer adherence to oral than to intramuscular treatments