THE CONTENT AND CONTEXT OF COMPLIANCE

Compliance is adherence to a prescribed and appropriate treatment, not necessarily pharmacological. Non-compliance may occur in up to 50% of patients with schizophrenia who are prescribed neuroleptics. It may b e commoner in young people, particularly if male or from certain ethni c minority groups, but demographic factors are relatively unimportant, Clinical features such as positive symptoms are associated with non-c ompliance but the strongest clinical relationship is with a ''dual dia gnosis'', usually with an associated alcohol abuse, Patients' and rela tives' beliefs about schizophrenia and about medication are of conside rable importance in determining compliance, and can be understood in t erms of the ''health belief model'', However, a full understanding of non-compliance must take into account the relationship between patient s and doctors in the context of the sick role. Several techniques for increasing compliance have been described, but they contain common ele ments-the provision of information within the context of a warm and eq uitable therapeutic relationship, preferably maintained over some time , and the use of the relationship to encourage and prompt compliance a nd to establish more productive views of the illness and medication. T he costs of poor compliance to sufferers and to society alike are cons iderable, and effective ways of improving it are a crucial part of goo d management.