Poor adherence to antipsychotics is a critical prognostic factor for patients with schizophrenia. Good illness insight, while helpful, is neither necessary nor sufficient for good antipsychotic adherence. Psychiatrists need to competently estimate the degree of adherence in order to devise appropriate interventions. A good adherence assessment inquires about attitude (towards drugs), barriers, and (actual) compliance behavior. “Drug attitude” can be viewed as a final common pathway that sums up a patient’s subjective risk-benefit assessment of a medication; it includes medication efficacy, particularly its ability to reduce perceived suffering. Adherence is unlikely if drug attitude is not good. Clinical adherence-enhancing interventions can be grouped into universal (for all patients), selected (for patients at high risk for non-adherence) or indicated interventions (for currently non-adherent patients). Among the various interventions, long-acting injectable antipsychotics are an underused first-line treatment for schizophrenia patients who require maintenance treatment.

This presentation emphasizes how to comprehensively assess adherence using the ABCs of adherence (i.e., drug attitude, barriers, and compliance behavior) and how to optimize adherence based on the reasons for non-adherence. The appropriate use of long-acting injectable antipsychotics will be highlighted.

Learning Objectives

• List four important risk factors for non-adherence to antipsychotics
• Estimate adherence by inquiring about drug attitude, barriers, and compliance behavior
• Develop a patient-specific treatment plan to optimize adherence

Target Audience

Psychiatrist, Nurse/Nurse Practitioner

Instructional Level

Intermediate

Estimated Time to Complete

Estimated Duration: 1.0 hours 
Program Start Date: March 8, 2022
Program End Date: March 8, 2025

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit ™ or a certificate of participation may do so by completing all sections of the course, including the evaluation. A multiple choice quiz is provided based on the content. A passing score of 75% must be achieved. Retakes are available for the test. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The APA designates this enduring CME event for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and Planner Disclosures

Presenter/Planner

• Oliver Freudenrech, MD, FACLP, Co-Director, Massachusetts General Hospital Schizophrenia Clinical and Research Program. Reports no financial relationships with commercial interests. 

Planners

• John Torous, MD, Beth Israel Deaconess Medical Center. Dr. Torous has no relevant financial relationships to disclose. (Reviewed on 4/6/22) 
• Teri Brister, PhD, LPC, National Alliance on Mental Illness. Dr. Brister has no relevant financial relationships to disclose. (Reviewed on 4/6/22)

Accessibility for Participants with Disabilities

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Technical Requirements

This internet-based CME activity is best experienced using any of the following:

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari
• Internet Explorer 11+

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration:

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version)
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version)
• Internet Connection: 1 Mbps or higher

Minimum Requirements:

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content

For assistance: Contact educme@psych.org for questions about this activity | Contact SMIAdviserHelp@psych.org for technical assistance