CLINICAL PRACTICE GUIDELINES Treatment of Schizophrenia IV. Psychosocial Interventions

Medication Adherence and Psychoeducation Despite the effectiveness of psychopharmocological interventions in producing improved outcomes in schizophrenia, medication nonadherence occurs frequently (in up to 50% or more of cases) and for various reasons (123). A recent comprehensive review identified that the lack of awareness of illness was a key factor in medication nonadherence (124). Such lack of insight has been hypothesized by some to be a cognit ive impairment associated with schizophrenia itself (125,126). Other issues contributing to nonadherence include concurrent alcohol or drug abuse, problems with the therapeutic alliance (127), medication side effects (128) and complicated dosage schedules, problems with access to treatment, and financial obstacles to obtaining medication (129). The impact of nonadherence is costly, not only for the person and his or her family but also more generally for the health care system (130).