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.
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Funding for this initiative was made possible (in part) by Grant No. 1H79SM080818-01 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
- 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
Psychiatrist, Nurse/Nurse Practitioner
Estimated Time to Complete
Estimated Duration: 1.0 hours
Program Start Date: March 8, 2019
Program End Date: March 8, 2022
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.
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
- Oliver Freudenrech, MD, FACLP, Co-Director, Massachusetts General Hospital Schizophrenia Clinical and Research Program. Reports no financial relationships with commercial interests.
- Tristan Gorrindo, MD, Director of Education, American Psychiatric Association. Reports no financial relationships with commercial interests.
- Donna Rolin, PhD, APRN. Clinical Associate Professor and Director of the Psychiatric Nurse Practitioner program, School of Nursing, University of Texas, Austin. Reports no financial relationships with commercial interests.
- Alexander S. Young, MD, MSHS, Professor, Department of Psychiatry, UCLA; Director of Health Services, VA Mental Illness Research, Education and Clinical Center; Senior Scientist, RAND. Reports no financial relationships with commercial interests.
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