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The science of compliance
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Brendan T. Carroll, M.D.
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Mean Compliance Rates
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58% Antipsychotics
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65% Antidepressants
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76% Non Psych Meds.
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30% of Patients take less than prescribed.
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Compliance is overestimated by physicians.
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Compliance is highest after resolution of acute episodes. It declines thereafter.
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In the maintenance treatment of schizophrenia the risk of relapse is ~ 55% with placebo compared with 21% with medication.
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Compliance declines with any of the following:
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Few or no sypmtoms.
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Uncomfortable side effects. Specifically, dysphoria and/or akisthesia.
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Pleasant hallucinations or delusions.
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Alcohol or substance abuse.
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Lack of medication /education.
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High negative expressed emotions (EE).
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Living alone.
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Complex regimens.
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Ways to increase compliance with antipsychotics.
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Therapeutic alliance leads to compliance.
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Find a common ground and express empathy.
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Enlist the patients help in finding an antipsychotic with beneficial effects and few, if any, tolerable side effects.
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Medication, Education and dialog.
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Provide a rationale that can weather the storm of psychosis.
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Illness perception by patients with schizophrenia.
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Schizophrenia is not experienced nor perceived as severe as illnesses like diabetes, epilepsy or cancer.
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Negative attitudes towards medications are related to the presence of positive symptoms and side effects.
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Illness perception may change based on experience.
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Positive reinforcement of beneficial medications can improve illness perception.
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Consolidation of attitudes among physicians and non physicians is essential for compliance.
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Physicians hold the greatest sway among team members.
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Medication selection.
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In general, the novel antipsychotics are superior to standard antipsychotics when controlled for compliance.
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They have fewer side effects and more favorable patient acceptance.
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Depot antipsychotics are an important option in the treatment strategies for psychosis.
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Patient attitudes are more important than physician rationale when it comes to compliance.
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