Drug compliance and the psychiatric patient.

Non-compliance is one of the commonest causes of therapeutic failure in both medicine and psychiatry. With psychiatric patients the factors contributing to non-compliance are related to: illness variables (schizophrenia, mania, paranoia, chronicity), patient variables (inappropriate health beliefs, need to rebel against authority, a wish to remain sick, defective memory), medication variables (inefficient and ineffective regimens, side effects) and patient-therapist variables (degree of supervision, trust and information).Treatment must consist of constant vigilance, health teaching-both verbal and written-enlisting the help of family and community to provide supervision, simplification of drug regimens, frequent examination and vigorous treatment of side effects, and improving the patient-therapist interaction.