Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, 75-59 263rd Street, Glen Oaks, New York, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA; Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA.
World Psychiatry. 2013 Oct;12(3):216-26. doi: 10.1002/wps.20060.
Although non-adherence is common across all branches of medicine, psychotic disorders pose additional challenges that increase its risk. Despite the importance of non-adherence, clinicians generally spend too little time on assessing and addressing adherence attitudes and behaviors. Importantly, how adherence is measured significantly impacts the findings, and the most frequently employed methods of asking patients or judging adherence indirectly based on efficacy or tolerability information have poor validity. Novel technologies are being developed that directly assess adherence and that can also be used to both provide real-time feedback to clinicians and serve as an intervention with patients. Several treatments are available that can positively impact adherence. Among psychosocial interventions, those combining multiple approaches and involving multiple domains seem to be most effective. Although long-acting injectable antipsychotics are theoretically a very powerful tool to assure adherence and signal non-adherence, recent results from randomized controlled trials failed to show superiority compared to oral antipsychotics. These data are in contrast to nationwide cohort studies and mirror-image studies, which arguably include more representative patients receiving long-acting antipsychotics in clinical practice. This disconnect suggests that traditional randomized controlled trials are not necessarily the best way to study interventions that are thought to work via reducing non-adherence. Clearly, non-adherence is likely to remain a major public health problem despite treatment advances. However, increasing knowledge about factors affecting adherence and leveraging novel technologies can enhance its early assessment and adequate management, particularly in patients with psychotic disorders.
尽管所有医学领域都普遍存在不依从性，但精神障碍症增加了其风险，带来了额外的挑战。尽管不依从性很重要，但临床医生通常在评估和解决依从性态度和行为方面花费的时间太少。重要的是，依从性的衡量方法对结果有重大影响，而最常采用的询问患者或根据疗效或耐受性信息间接判断依从性的方法有效性较差。正在开发直接评估依从性的新技术，这些技术也可用于向临床医生提供实时反馈，并作为与患者的干预措施。有几种治疗方法可以积极影响依从性。在心理社会干预措施中，那些结合多种方法并涉及多个领域的方法似乎最有效。尽管长效注射抗精神病药从理论上说是确保依从性和提示不依从性的非常有力的工具，但最近随机对照试验的结果并未显示其优于口服抗精神病药。这些数据与全国性队列研究和镜像研究形成对比，这些研究可能包括更具代表性的在临床实践中接受长效抗精神病药的患者。这种脱节表明，传统的随机对照试验不一定是研究被认为通过减少不依从性起作用的干预措施的最佳方法。显然，尽管治疗取得了进展，但不依从性仍可能是一个主要的公共卫生问题。然而，增加对影响依从性因素的了解并利用新技术可以增强其早期评估和适当管理，特别是在精神障碍症患者中。
