Recognition of patients who would benefit from LAI antipsychotic treatment: how to assess adherence.

Many patients with schizophrenia have problems adhering to their medication regimen. Numerous factors affect patients' adherence, such as patient and illness characteristics; medication efficacy, tolerability and formulations; provider and system characteristics; and patients' support networks. To compound this problem, accurately measuring adherence is challenging. Data suggest that clinicians should use multiple methods to assess patients' adherence, including supplementing their own clinical judgment and patient reports with more objective measures. Patients with poor social support, substance abuse disorders, or a history of florid psychosis and those in the earlier phases of their illness may be at risk for nonadherence. Assessing patients for nonadherence is a key step in determining their optimal form of treatment and avoiding frequent switching or deterioration. Doing so, clinicians can identify patients who would potentially benefit from a long-acting injectable (LAI) antipsychotic, which can be a valuable treatment option. Because lack of adherence increases the risk of hospitalization and does not help prevent suicide attempts, clinicians should address barriers to adherence, provide psychoeducation about medication-taking behaviors, and offer a wide range of antipsychotic treatment options, including LAIs, to improve patient outcomes.