Opinion

Latimer: Medications compliance critical with schizophrenia

Schizophrenia is a very serious and disabling mental illness. Troubling symptoms including hallmark psychotic hallucinations and delusions tend to develop in the prime of life and can lead to detachment from reality and a near total loss of ability to function in society.

With appropriate treatment, symptoms can be managed and some degree of function restored for many patients with this condition.

Unfortunately, if prescribed treatment plans are not carefully followed or are discontinued, problems can arise. This is not an uncommon issue.

For many reasons, close to 50 per cent of people discontinue or fail to regularly take a prescribed antipsychotic medication within the first year of treatment. Sometimes, as symptoms subside with a new treatment, the patient no longer feels as though medication is needed and so discontinues or becomes irregular with it. Others may discontinue because of unpleasant side effects or if the treatment is not working as well as hoped. Unstable life situations can also play a role in irregular medication usage.

While psychiatrists have long advocated the importance of sticking to a treatment plan when it comes to serious conditions such as schizophrenia, a new study published in the American Journal of Psychiatry has shown just how important it is. Researchers from UCLA followed outpatients taking oral antipsychotic medications and examined their adherence to prescribed treatments as well as effects for those who chose not to reliably follow their treatment plan. After 18 months, results showed even short periods of irregular medication use can lead to relapse of psychotic symptoms and a need for hospitalization.

Although not totally unexpected, the researchers were surprised to learn that irregular medication use even for brief periods is associated with a significant risk of relapse.

Within the study: 32 per cent took their medication as prescribed; 33 per cent had mild non-adherence (meaning they took only 50 to 75 per cent of meds over a two week period); 16 per cent had moderate non-adherence (taking less than 50 per cent of meds during a two to four week period); and 19 per cent had severe non-adherence (taking less than 50 per cent of meds for more than four consecutive weeks or dropping out of treatment).

Any irregular treatment compliance—even mild—was associated with a risk of relapse. Typically, symptoms would begin to show up within a couple of months of irregularity in medication usage. Although it’s not clear why even mild issues with medication compliance are dangerous, researchers suggest it may be due in part to the current practice of prescribing the lowest amount of medication that will improve symptoms while minimizing side effects—leaving very little room for missed doses.

Whatever the reason, this study highlights the importance of sticking to a course of treatment and working closely with a professional when managing a serious mental illness such as schizophrenia.

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