Non-adherence to treatments is a widespread issue that hampers clinical management of many mental disorders. It reduces the success of the treatment regimen and the ability to achieve remission from illness, but it also increases the burden for relapse treatments, emergency admissions and hospitalisation. Greater adherence to treatment can contribute not only to more successful disorder management and better quality of life, but also to improved attitudes towards treatment and medication, as well as increasing insight and confidence.

What is the evidence for treatment non-adherence?

Moderate to high quality evidence found around 44% of people with bipolar disorder were non-adherent to medications. Moderate to low quality evidence found factors associated with antipsychotic non-adherence included poor insight, substance use, negative attitudes toward medication, medication side effects, and to a lesser extent, cognitive impairments.

In children and adolescents, moderate to high quality evidence found factors associated with medication non-adherence included greater illness severity, medication side effects, and having a comorbid substance use disorder or ADHD. Moderate quality evidence found factors associated with medication adherence in children and adolescents included having positive patient and family attitudes toward care, a positive clinician-patient relationship, adherence to psychotherapy, good insight, and a comorbid medical illness.

November 2021

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Satisfaction with medication is positively related to better treatment adherence, which in turn is associated with symptom reduction. Patient attitudes towards medications are influenced by the duration of bipolar disorder, insight into the disorder, and past treatment experiences. Identifying factors that encourage or discourage the use of medications may help inform personalised therapy.

What is the evidence for attitudes to medication?

Moderate quality evidence suggests patient attitudes towards antipsychotic medications are generally positive, with longer duration of stable illness, and psychoeducation and adherence treatments being associated with more positive attitudes. Clinician perceptions of efficacy and tolerability impact on prescribing.

November 2021

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Non-adherence to medication is a widespread issue that can make the clinical management of bipolar disorders problematic. Non-adherence to treatment reduces the likelihood of symptom improvement and increases the likelihood of relapse and hospitalisation. Greater treatment adherence generally improves quality of life, fosters positive attitudes towards treatment, and results in greater insight into the disorder. Also see this related topic on treatment non-adherence under the course and outcomes category.

What is the evidence for therapies for treatment non-adherence?

Moderate to low quality evidence suggests a medium-sized effect of improved medication adherence with any psychosocial intervention.

November 2021

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