Medication adherence failure in schizophrenia: A forensic review of rates,reasons, treatments, and prospects

Forensic patients with schizophrenia who fail to adhere to prescribed antip sychotic medication risk recidivism, which continues to be a serious concer n. it affects ail stages of trial proceedings and impacts on the treaters' liability. Although much remains unchanged since the authors reviewed the s ubject in 1986, significant advances have occurred. A patient's insight can be assessed with greater precision. Risks posed by past noncompliance, sub stance abuse, and a dysphoric response to medication are more clearly docum ented. Clinical and laboratory methods for assessing compliance have improv ed. Major advances in the effective amelioration of adverse effects can be applied to promote adherence. New augmentation strategies enable adequate t reatment at lower doses. The development of atypical antipsychotic agents m akes compliance easier to achieve and maintain. Other advances apply to the containment of relapse when it does occur. This review organizes the liter ature documenting these trends for use in both treatment and consultation.