Compliance in psychiatry

Authors: E. Češková
Authors‘ workplace: Psychiatrická klinika LF MU a FN Brno
Published in: Čas. Lék. čes. 2009; 148: 489-492
Category: Review Article


In the first place for economic reasons the compliance is a great problem in all branches of clinical medicine. In psychiatric patients the compliance is lower than in somatically ill patients. It plays an important role especially in severe psychotic disorders, e.g. in affective and schizophrenic disorders. The low compliance in schizophrenia is associated with a higher risk of relapses, which have an unfavourable influence on the course of illness. Compliance can be improved mainly by influencing the factors associated with the treatment. The doctors can choose the optimal drug on the base of their knowledge about psychopharmacotherapeutic possibilities and information about patient. Nowadays we have at our disposal atypical antipsychotics, which are subjectively better tolerated and are available in different formulations. In comparison with typical antipsychotics there are advantages especially with long-term treatment.

Key words:
compliance, schizophrenic disorder, atypical antipsychotics, individualized treatment, drug formulations.


1. Cooper D, et al. Adherence to atypical antipsychotic treatment among newly treated patients: a population–based study in schizophrenia. J Clin Psychiatry 2007; 68: 818–825.

2. Wahl C, et al. Concordance, compliance and adherence in healthcare: closing gaps and improving outcomes. Health Q 2005; 8: 65–70.

3. Cramer JA, Rosenheck R. Compliance with medication regimens for mental and physical disorders. Psychiatr Serv 1998; 49: 196–201.

4. Lin EH, et al. The role of the primary care physician in patients adherence to antidepressant therapy. Med Care 1995; 33: 67–74.

5. Češková E, et al. Současné možnosti farmakoterapie deprese. Čes a slov Psychiatrie 2004; 100: 148–152.

6. Scott J, Pope M. Self-reported adherence to treatment with mood stabilizers, plasma levels and psychiatric hospitalization. Am J Psychiatry 2002; 159: 1927–1929.

7. Grant BF, et al. Prevalence, correlates and comorbidity of bipolar I disorder and axis I and II disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2005; 66: 1205–1215.

8. Sajatovic M, et al. Predictors of nonadherence among individuals with bipolar disorder receiving treatment in a community mental health clinic. Compr Psychiatry 2009; 50: 100–107.

9. Češková E. Schizofrenie a její léčba. 2. vydání. Praha: Jessenius Maxdorf 2007.

10. Češková E, et al. Schizofrenie. In: Raboch J, et al. Psychiatrie. Doporučené postupy léčby psychiatrické péče II. Praha: Infopharm 2006; 54–63.

11. Mullins DC, et al. Risk of discontinuation of atypical antipsychotic agents in the treatment for schizophrenia. Schizophr Res 2008; 98: 8–15.

12. Mőller HJ. State of the art of drug treatment of schizophrenia and the future position of the novel/atypical antipsychotics. World J Biol Psychiatry 2000; 1: 204–214.

13. Lieberman JA, et al. Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first–episode psychosis: a randomized, double–blind trial of olanzapine versus haloperidol. Am J Psychiatry 2003; 160: 1396–1404.

14. Perkins DO, et al. Predictors of treatment discontinuation and medication nonadherence in patients recovering from a first episode of schizophrenia, schizophreniform disorder, or schizoaffective disorder. A randomized, double-bliind, flexible-dose, multicenter study. J Clin Psychiatry 2008; 69: 106–113.

15. Leucht S, et al. Relapse prevention in schizophrenia with new-generation antipsychotics. A systematic review and exploratory meta-analysis of randomized, controlled trials. Am J Psychiatry 2003; 160: 1209–1222.

16. Lieberman JA, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005; 353: 1209–1223.

17. Kahn RS, et al. Effectiveness of antipsychotic druha in first-episode schizophrenia and schizophreniphorm disorder: an open randomised clinical trial. Lancet 2008; 371: 1085–1097.

18. Haro JM, et al. Antipsychotic treatment discontinuation in previously untreated patients with schizophrenia: 36-month results from the SOHO study. J Psychiatr Res 2009; 43: 265–273.

19. Jones PB, et al. Randomized controlled trial of the effect on quality of life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CutLASS 1). Arch Gen Psychiatry 2006; 63: 1079–1087.

20. Fleischhacker WW, et al. Factors influencing compliance in schizophrenia patients. J Clin Psychiatry 2003; 64 (Suppl. 16): 10–13.

21. Byerly MJ, et al. The brief adherence rating scale (BARS) validated agents electronic monitoring in assessing the antipsychotic medication adherence of outpatients with schizophrenia and schizoaffective disorder. Schizophr Res 2008; 100: 60–69.

22. Remington G, et al. The use of electronic monitoring (MEMS) to evaluate antipsychotic compliance in outpatients with schizophrenia. Schizophr Res 2007; 90: 229–237.

23. Haen E, et al. Wirkstoffkonzentrationsbestimmungen zur Therapieleitung. (Erganzung therapeutischer Referenzbereiche durch dosisbezogene Referenzbereiche) Nervenarzt 2008; 79: 558–566.

24. Češková E, et al. Bipolární afektivní porucha In: Raboch J., et al. Psychiatrie, doporučené postupy psychiatrické péče II. 1. vydání. Praha: NOCTIS STUDIO 2006; 88–96.

25. Češková E, et al. Insight in first-episode schizophrenia Int J Psychiatry in Clin Practice 2008; 12: 36–40.

26. Weiden PJ, Buckley PF. Reducing the burden of side effects during long-term antipsychotic therapy: the role of switching medications. J Clin Psychiatry 2007; 68 (Suppl. 6): 14–23.

27. Diaz E, et al. Adherence to conventional and atypical antipsychotics after hospital discharge. J Clin Psychiatry 2004; 65: 354–360.

28. Kamer M, et al. Paliperidone extended-release tablets for prevention of symptom recurrence in patients with schizophrenia. A randomized, double-blind, placebo-controlled study. J Clin Psychopharmacology 2007; 27: 6–14.

29. Peuskens J, et al. Prevention of schizophrenia relapse with extended release quetiapin fumarate dosed once daily. A randomized, placebo-controlled trial in clinically stable patients. Psychiatry 2007; 34–50.

Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account