Adherence to treatment of mental disorders and other chronic dis eases

Czech version

Authors: Artim Štefan ¹; Pečeňák Ján ²
Authors‘ workplace: Psychiatrická nemocnice Brno, Česko ¹; Psychiatrická klinika, Univerzita Komenského, Lekárska fakulta a UNB, Bratislava, Slovensko ²
Published in: Čes. a slov. Psychiat., 121, 2025, No. 2, pp. 61-68.
Category: Review
doi: https://doi.org/10.48095/cccsp202507

Overview

Most mental disorders belong to chronic non-communicable diseases that require long-term treatment. The goal of such treatment is to minimize or eliminate the symptoms of the mental disorder, prevent relapses, potential readmission, and improve the quality of life of patients. Adherence to recommended treatment is one of the essential factors in achieving these goals. The shift from an authoritative approach by the physician to a greater emphasis on patient autonomy is also reflected in the terminology. This paper describes the changes in concepts from compliance through adherence to concordance. Monitoring adherence should be part of routine clinical practice, and simple procedures such as: discussion with a patient, keeping records of medication intake, and pill counting can be applied, as well as technologically advanced methods such as medications containing electronic chips that signal medication intake. The proportion of medication actually dispensed from the prescribed amount derived from medical and insurance databases, known as the medication possession ratio (MPR), is often used in adherence analyses. In the pharmacological treatment of mental disorders, specific factors such as stigmatization and lack of insight also play a role in poor adherence. In the treatment of schizophrenia, adherence can be expected in about 50% of patients over 12 months, with similar findings for bipolar affective disorder and unipolar depression. However, published data vary widely depending on the methodology used and the patient population, with persistence in treatment reaching up to 90% in observational studies. Nonadherence in the treatment of mental disorders is not an exception and is also observed in physical illnesses such as hypertension (27–40%), diabetes (approximately 40%), and osteoporosis (up to 60% after the first prescription). Improving adherence requires focusing on the reasons that lead to intentional or unintentional nonadherence in patients and targeted solutions to these causes can often be relatively easily implemented. These include simplifying the daily medication regimen or prescribing medications with lower co-payments. Recently, the potential of mobile applications and tools utilizing artificial intelligence methods has been evaluated.

Keywords:

treatment adherence – persistence – nonadherence – chronic non-communicable diseases

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