Atypical neuroleptics: autonomy and compliance?

Non-compliance is a major stumbling block to the effectiveness of drug therapy. The nurse, both in hospital and community, has a crucial role to play in overcoming this problem to the benefit of the patient. Recent treatment advances, 'new-generation' anti-depressants and atypical neuroleptics, make this issue highly topical in mental health nursing. The atypical neuroleptics are a pharmacological breakthrough in the treatment of schizophrenia, which could herald a new era in psychiatry. These medicines give the benefits of the older (typical) neuroleptics but with fewer side-effects. Neuroleptics are sometimes called antipsychotics, antischizophrenics or major tranquillisers. Currently the atypical neuroleptics are not available in depot form. This critical review considers literature on interventions to promote compliance with neuroleptics generally and reflects on nursing implications relevant to the atypical neuroleptics. Three main forms of interventions emerge from the review; these are labelled as: imposed compliance, chosen compliance and active compliance. Historically the literature shows a gradual trend towards a realization by professionals that increased patient autonomy and involvement relates to improved compliance. This change in thinking is reflected in the new name 'adherence', which has begun to replace the term 'compliance'. It is concluded that mental health nurses have a key role to play in enabling this reconceptualization to change practice.