When patients with psychiatric disorders have difficulty taking meds

By Samar Mahmoud, PhD | Medically reviewed by Kevin Kennedy, MD
Published July 27, 2022

Key Takeaways

  • A major barrier in the treatment of psychiatric disorders is patient non-adherence to medications.

  • Patients may not comply with their medications due to adverse side effects, perceived ineffectiveness, complexity of medication regimen, and medication cost.

  • To increase patient adherence, healthcare providers should maintain open lines of communication with patients.

There have been significant developments in the medications used to treat psychiatric disorders over the past 60 years, leading to improvements in symptoms and social functioning, as well as prevention of relapse.[]

But despite these positive changes, the treatment of psychiatric disorders remains challenging, with a major obstacle being patient non-adherence to treatments—in particular, refusing to take their medications.

Defining nonadherence

The degree to which an individual’s behavior aligns with medical or health advice is defined as adherence. This term’s opposite, nonadherence, can be divided into primary and secondary nonadherence.

Primary nonadherence is defined as the act of not purchasing or receiving the medicine, while secondary nonadherence occurs when patients do not comply with drug instructions related to dosage, frequency and duration of use.

While nonadherence and nonadherence are used interchangeably, the terms adherence and nonadherence are thought to place the emphasis onto patients instead of clinicians.

Reasons for nonadherence

While studies report highly variable rates of nonadherence, these rates can reach 70% to 80% for the treatment of psychotic disorders. For the treatment of depression, nonadherence rates can reach 60%. While nonadherence is less prevalent in the inpatient setting, it still occurs 5% to 37% of the time, compared with 20% to 65% in an outpatient setting.[]

The adverse effects associated with medications are the most common reason underlying patient nonadherence.

Commonly prescribed psychiatric medications usually have one or more significant adverse effects, and patients may decide to not take their prescribed medication due to a negative impact on their quality of life.

For instance, antipsychotics can lead to Parkinsonian symptoms such as tremors, drooling, and muscle rigidity. In some cases, patients taking antipsychotics experience sedation, leading to challenges at home, at work, and with routine activities such as driving.

While antipsychotic medications have evolved since their introduction, no treatments are more than 80% effective and many are much less effective. Perceived ineffectiveness is another common underlying reason for medication nonadherence.

In some cases, there can be an additive effect, where patients who have concerns about a medication’s cost as well as its adverse effects discontinue taking a medication because they also see it as ineffective.

The complexity of medication regimens is another potential barrier to patient adherence.

Strategies for healthcare providers

To facilitate the discussion on why a patient is not taking their medication, healthcare provider awareness of such situations is a necessary first step.

Clinicians can also increase adherence by primarily prescribing medications they have the most confidence in, and conveying these feelings to patients and caregivers.

Similarly, adherence can increase when healthcare providers enable patients to play an active role in their treatment decisions, including medications.

Maintaining open lines of communication with patients is also vitally important. To increase patient adherence, focus on the following:

  • Understanding patient concerns

  • Delivering medical information with empathy

  • Providing patients with the education they need to make informed treatment decisions

  • Ensuring that patients have reasonable expectations of the treatment

  • Giving patients the opportunity to ask questions

Other ways to address nonadherence

Multiple support services are available to help you address patient nonadherence.[]

Cognitive-behavioral therapy (CBT) can be used to help patients overcome their negative feelings about taking psychiatric medications. CBT is often utilized in combination with motivational interviewing to instill in patients the importance of taking medications and give them the confidence needed to adhere to a medication regimen.

Cognitive adaptation training can also be used to increase patient adherence by helping them work through certain cognitive impairments.

These impairments can often lead to memory problems which can be managed through the use of pillboxes, alarms, and activity checklists.

Support services can also be instrumental to addressing other barriers to adherence, such as providing transportation to medical services and facilitating insurance benefits.

What this means for you

Nonadherence to medications represents a major hurdle in the treatment of psychiatric conditions. To increase adherence, encourage patients to take an active role in their medication decisions. Be understanding of patient concerns and provide a positive environment where they feel free to ask questions. It’s also critical that patients have realistic expectations about the effectiveness of their treatment and are made aware of any potential side effects.

Read Next: Medication adherence and the psychology behind it
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