Psychiatrists’ awareness of adherence to antipsychotic medication in patients with schizophrenia: results from a survey conducted across Europe, the Middle East, and Africa

José Manuel Olivares,¹ Köksal Alptekin,² Jean-Michel Azorin,³ Fernando Cañas,⁴ Vincent Dubois,⁵ Robin Emsley,⁶ Philip Gorwood,⁷ Peter M Haddad,⁸ Dieter Naber,⁹ George Papageorgiou,¹⁰ Miquel Roca,¹¹ Pierre Thomas,¹² Guadalupe Martinez,¹³ Andreas Schreiner<sup>14

1</sup>Department of Psychiatry, Hospital Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; ²Department of Psychiatry, Dokuz Eylül University School of Medicine, Izmir, Turkey; ³Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France; ⁴Department of Psychiatry, Hospital Dr R Lafora, Madrid, Spain; ⁵Cliniques Universitaires St-Luc, Bruxelles, Belgium; ⁶Department of Psychiatry, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa; ⁷Sainte-Anne Hospital, Paris Descartes University and INSERM U894, Paris, France; ⁸Greater Manchester West Mental Health National Health Service Foundation Trust and Department of Psychiatry, University of Manchester, Manchester, UK; ⁹Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie, Hamburg, Germany; ¹⁰Department of Psychiatry, Evangelismos General Hospital, Athens, Greece; ¹¹Unidad de Psiquiatría, Hospital Juan March, Institut Universitari d’Investigació en Ciències de la Salut, Universitat de les Illes Balears, Palma de Mallorca, Spain; ¹²Department of Psychiatry, Fontan Hospital CHRU Lille, UDSL, University North of France, Lille, France; ¹³Medical Affairs, Janssen, Madrid, Spain; ¹⁴Medical Affairs, Janssen, Neuss, Germany

Background: Nonadherence is common among patients with schizophrenia, although the rates vary according to means of assessment and patient population. Failure to adhere to medication can have a major impact on the course of illness and treatment outcomes, including increasing the risk of relapse and rehospitalization. Understanding psychiatrists’ perception of the causes and consequences of nonadherence is crucial to addressing adherence problems effectively.
Methods: The Europe, the Middle East, and Africa (EMEA) Spanish Adherencia Terapéutica en la Esquizofrenia (ADHES) survey was conducted by questionnaire during January–March 2010 among psychiatrists treating patients with schizophrenia in 36 countries. The survey comprised 20 questions. In addition to recording the demographic details of the 4722 respondents (~12% response rate), it canvassed their preferred methods of assessing adherence, their perceptions of adherence rates, reasons for nonadherence, and strategies to improve adherence.
Results: Psychiatrists estimated that 53% of their patients with schizophrenia were partially/nonadherent during the previous month. They estimated only one-third of patients who deteriorated after stopping medication were able to attribute this to nonadherence. Psychiatrists assessed adherence most often by patient interview. Lack of insight was viewed as the most important cause of medication discontinuation, followed by patients feeling better and thinking their medication unnecessary, and experiencing undesirable side effects. Considerably fewer psychiatrists viewed insufficient efficacy, cognitive impairment, or drug/alcohol abuse as the most important reasons for their patients stopping medication.
Conclusion: Psychiatrists throughout EMEA recognize the impact of partial/nonadherence to medication, with patient enquiry being the most commonly used means of assessment. There remains a need for more proactive management of patients with schizophrenia, particularly in increasing patient insight of their illness in order to improve adherence and minimize the consequences of relapse. Strategies focused on raising awareness of the importance of adherence are also warranted, with the aim of improving patient outcomes in schizophrenia.

Keywords: adherence, schizophrenia, psychiatrist, survey, ADHES