Why Medication Monitoring?

Antipsychotic Medications and Nonadherence

  • “Reported rates of nonadherence to antipsychotic range from 11% to 80%, with an average rate of approximately 50%.”9
  • Nonadherence to antipsychotics may be the single most important modifiable factor contributing to psychotic relapse and hospitalization10
  • Clinically adherent schizophrenic patients incur about half as many inpatient admissions and fewer total days hospitalized10
  • Patients with schizophrenia and substance abuse issues are 13 times more likely to be nonadherent with their antipsychotic medication.13

Antipsychotic medication is a primary and critical treatment modality for patients with serious mental illnesses, such as schizophrenia or bipolar disorder. Adherence to these medications is essential for proper symptom management, improvement in functioning and clinical stability. Meanwhile, nonadherence to antipsychotic medication is associated with:

  • Higher likelihood of relapse2
  • Threefold higher rate of hospitalization1
  • Increase in the severity of community violence3
  • Increased risk of suicide attempts4
  • Higher rates of co-morbid substance abuse1
  • Higher costs for psychiatric hospitalization, emergency services, medications and outpatient services5

Approximately 50% of patients with serious mental illness are also impacted by substance abuse, increasing the risk of2, 12:

  • Poor medication adherence
  • Frequent and longer periods of hospitalization
  • Depressive symptoms
  • Suicide
  • Violence

Why Are Patients Nonadherent?

The single most common reason for medication nonadherence, cited by 55 percent of individuals, was that they did not believe they were sick or that they had lack of insight.12 The second most important reason for medication nonadherence in individuals with severe psychiatric illness is concurrent substance abuse.

Nonadherence to antipsychotic medication appears to be a widespread problem. Among patients with schizophrenia, approximately 50 percent have been shown to be nonadherent to antipsychotic medications within 1 year of hospital discharge, increasing to 75 percent within two years of discharge.6

What Information Can Medication Monitoring Give Clinicians?

Patient reporting and clinical observation are commonly used to assess patients’ medication adherence. Even methods such as pill counts and electronic monitoring are likely to overstate adherence. 7,8

Urine drug monitoring with Ameritox can play a critical role in the treatment process, providing additional information to help practitioners:

  • Identify potential nonadherence to antipsychotics
  • Identify areas of potential substance abuse
  • Identify additional medications the patient may be taking

Learn more about working with Ameritox and the process of medication monitoring or contact Ameritox for more information.

1 Ascher-Svanum H, Zhu B, Faries DE, Furiak NM, Montgomery W. Medication adherence levels and differential use of mental-health services in the treatment of schizophrenia. BMC Research Notes. 2009;2:6.
2 American Psychiatric Association Steering Committee on Practice Guidelines. Practice Guideline for the Treatment of Patients With Schizophrenia. Second Edition. American Psychiatric Association. 2004.
3 Alia-Klein N, O-Rourke TM, Goldstein RZ, Malaspina D. Insight into illness and adherence to psychotropic medications are separately associated with violence severity in a forensic sample. Agg Behav. 2007;33:86-96.
4 Kane JM. Improving treatment adherence in patients with schizophrenia. J Clin Psychiatry. 2011;72(9):e28.
5 Ascher-Svanum H, Zhu B, Faries DE, et al. The cost of relapse and the predictors of relapse in the treatment of schizophrenia. BMC Psychiatry. 2010;10:2.
6 Velligan, DI, et al. The expert consensus guideline series: Adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry 2009;70[suppl 4]:1–48.
7 Velligan, DI, et al, Relationships Among Subjective and Objective Measures of Adherence to Oral Antipsychotic Medications. Psychiatr Serv 58:1187-1192, September 2007.
8 Diaz E, Levine HB, Sullivan MC, et al: Use of the Medication Event Monitoring System to estimate medication
compliance in patients with schizophrenia. Journal of Psychiatry and Neuroscience 26:325—329, 2001
9 Dolder, CR, et al. Interventions to improve antipsychotic medications adherence: Review of recent literature. Journal of Clinical Psychopharmacology; 2003;23(4)389-399.
10 Marder SR. Overview of partial compliance. J Clin Psychiatry. 2003;64(suppl 16):3–9.
11 Bond WS, Hussar DA. Detection methods and strategies for improving medication compliance. Am J Hosp Pharm. 1991;48:1978-1988.
12 Kessler et al. The prevalence and correlates of untreated serious mental illness, Health Services Research 2001;36:987–1007.
13 Kashner TM, Rader LE, Rodell DE, Beck CM, Rodell LR, Muller K. Family characteristics, substance abuse, and hospitalization patterns of patients with schizophrenia. Hosp Community Psychiatry. 1991;42(2):195-196.