The importance of treatment acceptability to patients

Antipsychotic drug treatment plays a central role in the care of patients w ith schizophrenia. The chronic nature of the illness means that most patien ts are likely to require long-term antipsychotic medication to alleviate sy mptoms and to prevent recurrence of an acute psychotic episode. Unfortunate ly, a high proportion of patients with schizophrenia do not comply with med ication and this has profound consequences in terms of the number and sever ity of relapse episodes, rehospitalization rates, worsening of residual sym ptoms and social costs, including substance misuse, homelessness and the bu rden on carers. Ensuring that antipsychotic treatment is acceptable to the patient is fundamental to managing adherence. Side-effects, particularly me ntal and extrapyramidal symptoms (EPS), are the cause of much distress to p atients and dissatisfaction with treatment, so a treatment regimen with a l ow side effect profile will help to improve adherence to the treatment. Suc h regimens have unmasked many of the other side-effects of treatment that w ere previously viewed as subsidiary to EPS; but the physical and psychologi cal consequences of side-effects suck as antipsychotic-induced sexual dysfu nction or weight gain are highly distressing to the patient, and as likely as EPS to trigger non-adherence to medication Consequently, careful selecti on of antipsychotic agent and nose regimens is essential to maximize the ef ficacy of the antipsychotic and to minimize the overall burden of side-effe cts. Satisfaction also depends very much on the extent to which the patient understands the treatment and its side-effects. Therefore, a close therape utic alliance between the patient and the psychiatrist must underpin all at tempts to increase the acceptability of treatment. This will allow the clin ician to determine how the illness and its treatment are affecting all aspe cts of the life of the patient, and then to tailor the treatment continuous ly to obtain the best possible outcome for the patient.