Skip to main content

Advertisement

SpringerLink
Log in

Teaching Medication Compliance to Psychiatric Residents: Placing an Orphan Topic Into a Training Curriculum

  • Perspective
  • Published:
Academic Psychiatry Aims and scope Submit manuscript

Abstract

Objective

Medication compliance is an orphan topic. Training in the understanding and management of noncompliance does not neatly fall within the domain of psychopharmacology, nor does it clearly fit into other core curricula areas, such as clinical interviewing or psychotherapy training. The objective of this article is to increase awareness about this vagueness among academic psychiatrists and to offer a suggested curriculum to facilitate implementation.

Methods

The authors present a curriculum covering major aspects of the theory and practice of compliance. The proposed curriculum is divided into five core components that can be used together or separately. These components are: 1) definition of compliance and noncompliance; 2) understanding how compliance depends on efficacy; 3) assessment of compliance and noncompliance; 4) the importance of the therapeutic alliance; and 5) pharmacological and psychosocial strategies to improve compliance. These five sections can be modified into specific lectures that are added to ongoing psychopharmacology, psychiatric interviewing or psychotherapy courses.

Results

A careful review of the American Board of Psychiatry and Neurology (ABPN) core curriculum found no mention of medication compliance/adherence as a specific training goal, and our residency program like many others did not have a specific course that focused on this issue. To address this omission, the authors designed and taught a five-session course for PGY-III and PGY-IV psychiatry residents that specifically addressed assessment and management of noncompliance. It was piloted in the 2003–2004 academic year. The course was very well received and formed the basis of this material presented in this review and discussion.

Conclusion

The principles of understanding, assessing, and managing medication compliance should be a part of the core curriculum for every psychiatric residency training program.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Horwitz RI, Horwitz SM: Adherence to treatment and health outcomes. Archives of Internal Med 1993; 153: 1863–1868

    Article  CAS  Google Scholar 

  2. Lerner BH, Gulick RM, Dubler NN: Rethinking nonadherence: historical perspectives on triple-drug therapy for HIV disease. Annals of Internal Med 1998; 129: 573–578

    Article  CAS  Google Scholar 

  3. Johnson DAW: Further observations on the duration of depot neuroleptic maintenance therapy in schizophrenia. Br J Psychiatry 1979; 135: 524–530

    Article  CAS  PubMed  Google Scholar 

  4. Pampallona S, Bollini P, Tibaldi G, et al: Patient adherence in the treatment of depression. Br J Psychiatry 2002; 180: 104–109

    Article  CAS  PubMed  Google Scholar 

  5. Sajatovic M, Davies M, Hrouda DR: Enhancement of treatment adherence among patients with bipolar disorder. Psychiatr Serv 2004; 55: 264–269

    Article  PubMed  Google Scholar 

  6. Weiden P, Olfson M. Cost of relapse in schizophrenia. Schizophrenia Bulletin 1995;21: 419–428

    Article  CAS  PubMed  Google Scholar 

  7. Weiden P: Psychopharmacologic management of noncompliance in schizophrenia. J Practical Psychiatry and Behavioral Health 1997; 3: 239–245

    Google Scholar 

  8. Zygmunt A, Olfson M, Boyer CA, et al: Interventions to improve medication adherence in schizophrenia. Am J Psychiatry 2002; 159: 1653–1664

    Article  PubMed  Google Scholar 

  9. Velligan DI, Prihoda TJ, Ritch JL, et al: A randomized singleblind pilot study of compensatory strategies in schizophrenia outpatients. Schizophrenia Bulletin 2002;28: 283–292

    Article  PubMed  Google Scholar 

  10. Neurology ABoP. Psychiatry and Neurology Core Competencies Version 4.1; 2004

  11. Haynes RB, Taylor DW, Sackett DL: Compliance in health care. Baltimore: Johns Hopkins University Press; 1979

    Google Scholar 

  12. Weiden PJ, Kozma C, Grogg A, et al: The relationship between medication compliance and hospitalization in patients with schizophrenia: a retrospective review of the california medicaid database. Psychiatr Services 2004; 55: 886–891

    Article  Google Scholar 

  13. Cramer J, Mattson R, Prevey M, et al: How often is medication taken as prescribed? A novel assessment technique. JAMA 1989; 261: 3273–3277

    Article  CAS  PubMed  Google Scholar 

  14. Schooler NR, Levine J, Severe JB, et al: Prevention of relapse in schizophrenia: An evaluation of fluphenazine decanoate. Archives of General Psychiatry 1980; 37: 16–24

    Article  CAS  PubMed  Google Scholar 

  15. Norell SE: Accuracy of patient interviews and estimates of clinical staff in determining medication compliance. Soc Science and Med 1981; 15: 57

    Article  CAS  Google Scholar 

  16. Barofsky I: Compliance, adherence, and the therapeutic alliance: steps in the development of self-care. Soc Science and Med 1978; 12: 369–376

    CAS  Google Scholar 

  17. Grunebaum MF, Weiden PJ, Olfson M: Medication supervision and adherence of persons with psychotic disorders in residential treatment settings: A pilot study. J Clin Psychiatry 2001; 62: 394–399

    Article  CAS  PubMed  Google Scholar 

  18. Blackwell Scientific B: Treatment adherence. Am J Psychiatry 1976; 129: 513–531

    Article  Google Scholar 

  19. Perkins DO: Predictors of noncompliance in patients with schizophrenia. J Clin Psychiatry 2002; 63: 1121–118

    Article  PubMed  Google Scholar 

  20. Fenton W, Blyler C, Heinssen R. Determinants of medication compliance in schizophrenia: Empirical and clinical findings. Schizophrenia Bulletin 1997;23: 637–651

    Article  CAS  PubMed  Google Scholar 

  21. Frank AF, Gunderson JG: The role of the therapeutic alliance in the treatment of schizophrenia. Archives of General Psychiatry 1990; 47: 228–235

    Article  CAS  PubMed  Google Scholar 

  22. Jamison KR, Akiskal HS: Medication compliance in patients with bipolar disorder. pcna 1983; 6: 175–192

    CAS  Google Scholar 

  23. Jamison K. Lithium compliance in manic-depressive illness. In: Blackwell Scientific B, Ed. Treatment compliance and the therapeutic alliance. 5 vol. Amsterdam: Harwood Academic Press Publishers; 1996: 251–275

    Google Scholar 

  24. Tuma A, May P, Yale C, et al: Therapist characteristics and outcome of treatment of schizophrenia. Archives of General Psychiatry 1978; 35: 81–85

    Article  CAS  PubMed  Google Scholar 

  25. Corrigan PW, Liberman RP, Engel JD: From noncompliance to collaboration in the treatment of schizophrenia. Hosp and Community Psychiatry 1990; 41: 1203–1211

    CAS  Google Scholar 

  26. Blaska B: The myriad medication mistakes in psychiatry: A consumer’s view. Hosp and Community Psychiatry 1990; 41: 993–998

    CAS  Google Scholar 

  27. Blackwell Scientific B, Griffin B, Magill M: Teaching medical students about treatment compliance. J Med Education 1978; 53: 672

    Google Scholar 

  28. Rao NR, Meinzer AE, Berman SS: Countertransference: Its continued importance in psychiatric education. J Psychotherapy Practice and Res 1997; 6: 1–11

    CAS  Google Scholar 

  29. Soumerai S, McLaughlin TJ, Ross-Degnan D, et al: Effects of limiting medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. New England J Med 1994; 331: 650–655

    Article  CAS  Google Scholar 

  30. Goldfinger SM, Hopkin JT, Surber RW: Treatment resisters or system resisters?: toward a better service system for acute care recidivists. New Directions in Ment Health Services 1984; 21: 17–27

    Article  Google Scholar 

  31. Eisenthal S, Emery R, Lazare A, et al: Adherance and the negotiated approach to patienthood. Archives of General Psychiatry 1979; 36: 393–398

    Article  CAS  PubMed  Google Scholar 

  32. Hall JA, Dornan MC: What patients like about their medical care and how often they are asked: A meta-analysis of the satisfaction literature. Soc Science and Med 1988; 27: 935–939

    Article  CAS  Google Scholar 

  33. Moran AE, Freedman RI, Sharfstein SS: The journey of sylvia frumpkin: A case study for policy makers. Hosp and Community Psychiatry 1984; 35: 887–893

    CAS  Google Scholar 

  34. Palardy N, Greening L, Ott J, et al: Adolescents’ health attitudes and adherence to treatment for insulin-dependent diabetes mellitus. Developmental and Behavioral Pediatrics 1998; 19: 31–37

    Article  CAS  Google Scholar 

  35. Williams GC, Ryan RM, Rodin GC, et al: Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychol 1998; 17: 269–276

    Article  CAS  PubMed  Google Scholar 

  36. Fishbein M, Ajzen I. Belief, Attitude, Intention and Behavior. Reading,Mass; 1975

  37. Becker MH: Patient adherence to prescribed therapies. Med Care 1985; 23: 539–555

    Article  CAS  PubMed  Google Scholar 

  38. Becker MH, Maiman LA. Strategies for enhancing patient compliance. J Community Health 1980;6: 113–135

    Article  CAS  PubMed  Google Scholar 

  39. Haynes RB, Sackett DL, Taylor DW. How to detect and manage low patient compliance in chronic illness. Geriatrics 1980;35: 91–93, 96–97

    CAS  PubMed  Google Scholar 

  40. Haynes RB, Sackett DL, Gibson ES, et al: Improvement of medication compliance in uncontrolled hypertension. Lancet 1976; 1: 1265–1268

    Article  CAS  PubMed  Google Scholar 

  41. Haynes RB, Sackett DL, Taylor DW, et al: Manipulation of the therapeutic regimen to improve compliance: conceptions and misconceptions. Clin Pharmacol Ther 1977; 22: 125–130

    CAS  PubMed  Google Scholar 

  42. Weiden PJ, Rapkin B, Mott T, et al: Rating of medication influences (ROMI) scale in schizophrenia. Schizophrenia Bulletin 1994;20: 297–310

    Article  CAS  PubMed  Google Scholar 

  43. Weiden PJ: Understanding depot therapy in schizophrenia. J Practical Psychiatry and Behavioral Health 1995; 1: 182–184

    Google Scholar 

  44. Weiden P, Mackell J, MacDonell D. Obesity as a risk factor for antipsychotic noncompliance. Schizophrenia Research 2003:in press.

  45. Viguera AC, Baldessarini RJ, Hegarty JD, et al: Clinical risk following abrupt and gradual withdrawal of maintenance neuroleptic treatment. Archives of General Psychiatry 1997; 54

Download references

Author information

Authors and Affiliations

  1. Psychiatry, SUNY Downstate Medical Center, Box 1203, 450 Clarkson Ave., Brooklyn, New York, 11203, USA

    Peter J. Weiden M.D. (Director of Schizophrenia Research Service) &  Nyapati Rao M.D. (Director of Residency Training)

Authors
  1. Peter J. Weiden M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nyapati Rao M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter J. Weiden M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Weiden, P.J., Rao, N. Teaching Medication Compliance to Psychiatric Residents: Placing an Orphan Topic Into a Training Curriculum. Acad Psychiatry 29, 203–210 (2005). https://doi.org/10.1176/appi.ap.29.2.203

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1176/appi.ap.29.2.203

Keywords

Search

Navigation