GRAY R., WYKES T. & GOURNAY K. (2002) Journal of Psychiatric and Mental Health Nursing 9, 277–284 From compliance to concordance: a review of the literature on interventions to enhance compliance with antipsychotic medication Journal of Psychiatric and Mental Health Nursing, 2002, 9, 277–284 © 2002 Blackwell Science Ltd 277 Blackwell Science, LtdOxford, UK JPMJournal of Psychiatric and Mental Health Nursing1351-0126Blackwell Science Ltd, 2002 93June 2002 474 Antipsychotic medication compliance R. Gray et al. 10.1046/j.1351-0126.2002.00474.x Original Article277284BEES SGML From compliance to concordance: a review of the literature on interventions to enhance compliance with antipsychotic medication R. GRAY 1 rn p h d , T. WYKES 2 cp sychol p h d & K. GOURNAY 3 cbe mp hil p h d cp sychol afbpss frcn rn 1 MRC Fellow in Health Services Research, 2 Professor of Rehabilitation and Clinical Psychology and 3 Professor of Psychiatric Nursing, Health Services Research Department, Institute of Psychiatry, De Crespigny Park, London, UK Correspondence: R. Gray Health Services Research Department Institute of Psychiatry De Crespigny Park London SE5 8AF UK Non-compliance with antipsychotic medication is observed in around 50% of people with schizophrenia and is a major preventable cause of psychiatric morbidity. A number of factors influence patient’s decisions about taking medication and include awareness of illness, beliefs about treatment and side-effects of medication. A variety of interventions targeted at improving compliance have been tested. Education increases patients’ under- standing of their illness and treatment but does not improve compliance. However, inter- ventions, such as compliance therapy, based on cognitive–behavioural techniques appear to be effective in enhancing compliance and preventing relapse. Keywords: antipsychotic medication, compliance, concordance, review Introduction The use of antipsychotic medication in the treatment of schizophrenia is well established and there is overwhelming evidence from clinical trials to demonstrate the benefits of these drugs for patients (Kennedy et al. 2000, Quraishi & David 2000, Thornley et al. 2000, Wahlbeck et al. 2000). There is also good evidence that the prophylactic use of antipsychotic medication prevents relapse (Kane 1989, Marder et al. 1999). However, a number of studies have demonstrated that compliance with antipsychotic medica- tion is generally poor and not taking medication is associ- ated with a substantial increase in rehospitalizations and a generally poorer outcome in people with psychotic disor- ders (Gabel & Piezcker 1985, Helgason 1990). Kemp et al. (1997) have proposed that the so called ‘revolving door phenomena’ can be almost exclusively attributed to repeated non-compliance. Kisling (1994) has argued that if patients were completely compliant with their medication, relapse rates would fall to about 15% (currently 50% of patients relapse within a year of achieving remission). However, the assumption that poor compliance can be attributed solely to the patient’s failure to do what clini- cians have told them to must be juxtaposed with evidence that professionals often do not carry out their own respon- sibilities regarding medication. For example, Taylor et al. (2000) showed that prescriptions for antipsychotics are often inappropriate, resulting in unwanted and unneces- sary side-effects. Non-compliance suggests that a patient has not done what they were told by a mental health professional (i.e. stopped taking medication). Repper & Perkins (1998) have highlighted the importance of language in mental health and suggest that the use of words like compliance infer that Accepted for publication: 29 October 2001