Harvard Mental Health Letter

The treatment of schizophrenia: Making it work

We know a great deal about how to care for people with schizophrenia, but often that knowledge is difficult to act on. Insufficient resources and an inefficient public health system are partly responsible, but an equally serious problem is that patients with schizophrenia don't consistently take an interest in their treatment. They stop taking their medications, miss their appointments, and lose touch with mental health professionals and others who might help them.

This lack of compliance with (or adherence to) treatment greatly increases the cost of care and the risk of homelessness and suicide. It is probably the most important cause of relapse leading to hospitalization. In one study, patients with schizophrenia who quit taking their medication were almost five times more likely to relapse over a five-year period. Even gaps of a few days increased the risk of hospitalization.

Most people with schizophrenia neglect or avoid treatment at some time and to some extent. A study of nearly 8,000 Medicaid patients with schizophrenia and bipolar disorder found that about a third of them took their antipsychotic medications less than 80% of the time. In another study, patients went without their medication on average once in every three days.

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